Assess pancreatic exocrine and
endocrine functions. Evaluate the severity of diabetes mellitus and its
sequelae, particularly the presence of cardiovascular, renal, and autonomic
impairment. Optimize diabetic control. Patients with stable, well-controlled
diabetes undergoing relatively minor surgery may be admitted as “day
admit” cases, whereas patients with brittle diabetes may require
preoperative admission for stabilization and optimal preparation.
Derangement in intravascular volume status is not uncommon during an acute attack of
pancreatitis and should be corrected. Chronic exocrine pancreatic
insufficiency may result in malnutrition and fat-soluble vitamin
deficiencies. Electrolyte abnormalities are common, particularly calcium and
potassium homeostasis, and any abnormalities should be corrected
preoperatively. Many of these patients with chronic pancreatitis are opioid
dependent and alcoholics. Investigations include complete blood count, serum
electrolytes, urea and creatinine levels, serum albumin and proteins,
coagulation studies, urine ketones, and chest radiography (pleural effusion
or pulmonary edema). Anxiety and stress result in an increased sympathetic
discharge with its sequelae on substrate metabolism and cardiovascular
system; a sedative premedication is advocated. Consider insulin-dependent
diabetes mellitus precautions if diabetes mellitus is established. Consider
antithrombotic prophylaxis if history of venous thrombosis.