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Treatment of Pancreatitis. Select the most appropriate treatment for the following patients.

A 45 year old man admitted with severe gallstone pancreatitis. He is anuric and is tubed and filtered on the ITU. His CT on day 3 shows stranding around his pancreatic head and gallstones in his gallbladder. His CBD measures 8mm. He has a rim of free fluid around his pancreatic body. His CRP is 450, WCC 20, BR 184 and he is pyrexial.

A 57 year old lady is in ITU with gallstone pancreatitis. Her CRP on day 6 was 450 and now on day 8 is down to 240. Her WCC remains elevated but has also reduced (from 39 to 17). She is off inotropes. Her LFTs are normal. Repeat CT on day 8 shows a 6X6 fluid collection adjacent to her pancreatic head.

A 57 year old man with a recent history of alcohol pancreatitis presents with a left sided effusion. The effusion is drained radiologically and the fluid sent for MC&S and amylase. The amylase level in the fluid is confirmed to be 940.

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