1. IF there is RUQ pain, or Jaundice((add LFT, PT, PTT,Bleeding time, INR, Amylase&lipase, CXR, KUB, U/S of the Abd.))
   1. Lipase is most specific & Sensitive
      1. Pancreatic
         1. Inv.CT to show extent of Disease
            1. Dx. ACUTE PANCREATITIS
            2. MILD edema =80% of pt. Rx is = GI rest(=NPO+NGT suction+Fluids(IV)) + morphine
            3. NECROTIC
            4. minimal or fever
            5. Rx. imipenem (IV)
            6. Large necrosis or abscess
            7. Rx. Surgery & imipenem(IV)
            8. Gall Stone or Cholangitis
            9. ERCP with sphincterotomy followed by cholecystectomy
            10. PSEUDOCYST
            11. most=self limiting w/in 6 weeks=Rx. is not needed
            12. not healed in 6 weeks or complicated=Rx. Surgery
   2. + LFT
      1. Liver disease
   3. + Alk.Phos.
      1. Bile stone
2. ACUTE Abd.(( add ABC, NPO,IV access w/NS, CXR, KUB, Blood cross matching.
   1. LLQ pain & tenderness
   2. Subtopic 2
   3. Subtopic 3
   4. Subtopic 4
3. Intermittent Abdominal Pain
   1. w/ DM
      1. w/ steatorrhea
         1. Dx. CRONIC PANCREATITIS(MCC alcohol)
            1. Inv. ERCP( show: irregular main duct, ductal dilation, and duct strictures) is better then CT
            2. mild
            3. Rx. NSAID, Insulin, & Replace pancreatic enzymes
            4. Strictures
            5. ERCP Sphincterotomy & stenting
            6. sever=OBstruction of GI or Bile, sever pain, r/o CA
            7. Surgery
      2. w/ liver disease, infertility and arthritis
         1. Dx. Hematochromatosis
            1. Rx. Phlebotomy
      3. w/ Risk of Coronary heart disease
         1. Dx. mesenteric ischemia
      4. Subtopic 4
   2. Subtopic 2
   3. Subtopic 3
4. Main Topic 2
5. Main Topic 3
   1. Subtopic 1
   2. Subtopic 2
6. Main Topic 6
7. Main Topic 7