Scribd Logo
Upload

Welcome to Scribd!

  • 8 views

    Acute Pancreati-Wps Office 100

    Uploaded by

    Mariam Antony
    The document provides information about acute pancreatitis including: - A case scenario describing a 56-year-old alcoholic man presenting with epigastric pain and vomiting, consistent with acute pancreatitis. - Definitions, causes, clinical features, investigations, assessments of severity, management, and complications of acute pancreatitis. - Key points covered are the definition requiring abdominal pain, elevated pancreatic enzymes, or CT findings; gallstones and alcohol being leading causes; symptoms of epigastric pain radiating to the back along with nausea and vomiting; and treatments involving fluid resuscitation, antibiotics, and supportive care along with managing complications such as fluid collections, necrosis, and organ failure.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd

    Acute Pancreati-Wps Office 100

    Uploaded by

    Mariam Antony
    8 views45 pages
    The document provides information about acute pancreatitis including: - A case scenario describing a 56-year-old alcoholic man presenting with epigastric pain and vomiting, consistent with acute pancreatitis. - Definitions, causes, clinical features, investigations, assessments of severity, management, and complications of acute pancreatitis. - Key points covered are the definition requiring abdominal pain, elevated pancreatic enzymes, or CT findings; gallstones and alcohol being leading causes; symptoms of epigastric pain radiating to the back along with nausea and vomiting; and treatments involving fluid resuscitation, antibiotics, and supportive care along with managing complications such as fluid collections, necrosis, and organ failure.

    Original Title

    Acute Pancreati-wps Office 100

    Copyright

    © © All Rights Reserved

    Available Formats

    PPTX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    The document provides information about acute pancreatitis including: - A case scenario describing a 56-year-old alcoholic man presenting with epigastric pain and vomiting, consistent with acute pancreatitis. - Definitions, causes, clinical features, investigations, assessments of severity, management, and complications of acute pancreatitis. - Key points covered are the definition requiring abdominal pain, elevated pancreatic enzymes, or CT findings; gallstones and alcohol being leading causes; symptoms of epigastric pain radiating to the back along with nausea and vomiting; and treatments involving fluid resuscitation, antibiotics, and supportive care along with managing complications such as fluid collections, necrosis, and organ failure.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    8 views45 pages

    Acute Pancreati-Wps Office 100

    Uploaded by

    Mariam Antony
    The document provides information about acute pancreatitis including: - A case scenario describing a 56-year-old alcoholic man presenting with epigastric pain and vomiting, consistent with acute pancreatitis. - Definitions, causes, clinical features, investigations, assessments of severity, management, and complications of acute pancreatitis. - Key points covered are the definition requiring abdominal pain, elevated pancreatic enzymes, or CT findings; gallstones and alcohol being leading causes; symptoms of epigastric pain radiating to the back along with nausea and vomiting; and treatments involving fluid resuscitation, antibiotics, and supportive care along with managing complications such as fluid collections, necrosis, and organ failure.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 45

    ACUTE

    PANCREATITIS
    JULIA ABRAHAM
    114 Batch
    PANCREAS
    ◦ Situated in the retroperitoneum
    ◦ Head(30%),Body and Tail(70%), Neck and
    Uncinate process
    ◦ Weighs approximately 80 g
    ◦ 80-90 percentage is composed of exocrine
    acinar tissue which is organised into lobules
    ◦ Rest of the gland is composed of endocrine
    cells known as islets of Langerhans.
    VENOUS
    DRAINAGE
    CASE SCENARIO
    ◦ A 56 year old man, alcoholic, presented with
    sudden severe epigastric pain and recurrent
    episodes of vomiting. The pain was sharp,
    constant, agonising in nature, radiated to the
    back ,aggravated on lying down and mildly
    improved on leaning forward. On examination,
    the patient was in agony with pain , had
    tachypnoea, tachycardia and hypotension.
    Abdomen was mildly distended and tender .His
    pancreatic enzymes were elevated. X ray shows
    'sentinel loop'.
    ACUTE PANCREATITIS
    Definition:-
    Acute pancreatitis is defined as an acute condition
    presenting with abdominal pain, 3 fold or greater
    rise in the serum levels of pancreatic enzymes
    amylase or lipase, and /or characteristic findings of
    pancreatic inflammation on contrast-enhanced CT.

    Two types - mild or severe


    MECHANISM OF INJURY
    ◦ Premature activation of pancreatic enzymes -
    Autodigestion
    ◦ Anything that injures the acinar cell and
    impairs the secretion zymogen granules,or
    damages the duct epithelium and thus delays
    enzymatic secretion,can trigger acute
    pancreatitis.
    Aetiology:-

    • Gall stones most common(50-70%)


    • Alcoholism(25%)
    • Post ERCP(3%)
    • Abdominal trauma
    • Autoimmune pancreatitis
    • Hereditary pancreatitis
    • Ampullary tumor
    • Drugs (Corticosteroids, azathioprine,
    asparaginase, valproic acid, thiazides,
    Oestrogen)
    • Mumps
    • Hyperparathyroidism
    • Hypercalcaemia
    • Malnutrition
    • Scorpion bite
    • Idiopathic
    CLINICAL FEATURES
    SYMPTOMS
    Severe upper abdominal epigastric pain radiating
    to the back. Relieved on sitting & bending
    forward. Aggravated on lying down .pain is
    constant.
    • Nausea, repeated vomiting that is
    profuse,projectile follows pain with retching
    • Hiccups due to gastric distension or irritation of
    the diaphragm.
    SIGNS
    • Febrile
    • Tachypnoea
    • Faint jaundice
    • Features of shock—feeble pulse, tachycardia,
    hypotension, cold extremities.
    • Abdominal findings—tenderness in epigastrium,
    upper abdominal guarding and distension of
    abdomen, mass in epigastrium .
    SIRS (Systemic Inflammatory
    Response Syndrome)
    • Heart rate >90/min
    • Core temperature < 36°c or >38°c
    • RR >20/min or pCO2 <32mmHg
    • WBC count <4000 or >12000/ mm3
    Cullen’s sign

    Bluish ecchymotic
    discolouration seen
    around umbilicus
    Grey Turner’s
    sign

    Bluish discolouration in
    the flanks.
    Both the signs are due to
    seepage of blood along
    the fascial plane
    Fox sign

    Discolouration
    below the inguinal
    ligament
    INVESTIGATIONS
    • Serum amylase raised 3 to 4 times.
    • But a normal serum amylase do not rule out
    the disease.
    • Serum lipase test is more sensitive and specific
    • Blood glucose - hyperglycemia
    • Serum calcium - hypocalcemia
    IMAGING
    Plain x-ray shows

    Sentinel loop sign


    Colon cut off
    sign:
    distension of
    transverse colon with
    collapse of
    descending colon
    RENAL HALO SIGN
    • Ultrasound abdomen
    • Contrast enhanced CT - gold standard
     If there is diagnostic uncertainty
     Severe acute pancreatitis, to distinguish
    interstitial from necrotising pancreatitis
     with organ failure, signs of sepsis
     localised complication is suspected,- fluid
    collection, psuedocyst or psuedoanuerysms
    • Cross sectional MRI
    ASSESSMENT OF SEVERITY
    • APACHE II (Acute Physiology And Chronic
    Health evaluation) Scoring system –
    above 8 in severe pancreatitis
    • C reactive protein >150mg/L at 48hrs.
    Limitation– sensitivity of the assay decreases if
    CRP levels are measured within 48hrs after
    onset of symptoms.
    ATLANTA CLASSIFICATION
    • Mild acute pancreatitis-no organ failure, no
    local or systemic complications
    • Moderately severe acute pancreatitis-organ
    failure that resolves within 48 hours, local or
    systemic complications without persistent
    organ failure
    • Severe acute pancreatitis- persistent organ
    failure >48 hrs, single organ failure, multiple
    organ failure.
    MANAGEMENT
    • Admission(HDU/ICU)
    • Analgesia
    • Aggressive fluid rehydration
    • Oxygenation
    • Invasive monitoring of vital signs, central
    venous pressure, urine output, blood gases
    • Frequent monitoring of LFT, RFT, clotting
    time , serum Ca, blood glucose
    • Nasogastric drainage
    • Antibiotic prophylaxis (Imipenem
    /Cefuroxime / ciprofloxacin
    +Metronidazole)
    • Blood transfusion if Hb low/protein low.
    • Nasogastric feeding
    • CVP line – to monitor, fluid therapy, total
    parenteral nutrition
    • IV ranitidine 50 mg 6th hourly - to prevent
    stress ulcers
    • Supportive therapy for organ
    failure—Inotropes, ventilatory
    support, haemofiltration.
    • ERCP within 72 hours for severe
    gall stone pancreatitis or signs of
    cholangitis
    • Somatostatin/ octreotide – reduce
    pancreatic secretion
    LAPROSCOPIC
    CHOLECYSTECTOMY
    • Indicated for all patients with mild acute biliary
    pancreatits
    • Safe procedure that decreases recurrence
    • Severe pancreatitis – conservative treatment for
    atleast 6 weeks before surgery.
    COMPLICATIONS
    Systemic :
    • Shock & arrhythmia
    • Respiratory insufficiency-
    • ARDS
    • Pleural effusion
    • Hypocalcemia
    • Hyperglycemia & hyperlipidemia
    • DIC
    • Renal failure
    Local complications:
    •Acute fluid collection
    •Sterile pancreatic necrosis
    •Infected pancreatic necrosis
    •Pancreatic abscess
    •Psuedocyst
    •Pancreatic ascites
    •Pleural effusion
    •Portal/ splenic vein thrombosis
    •Pancreatic fistula
    Local :
    • Acute fluid collection(APFC)
    1. sterile fluid collection, lacks fibrin wall or
    granulation tissue
    2. Treated by percutaneous aspiration under
    ultrasound or CT guidance.

    • Sterile and infected pancreatic necrosis


    1. Diffuse or focal area of non viable
    parenchyma – absence of parenchymal
    enhancement on CT
    with contrast.
    2. Pancreatic necrosis is associated with lysis of
    peripancreatic fat. This leads to ANC ( acute necrotic
    collection)
    3. ANC ( has no definable wall) WON (walled-off
    necrosis)
    4. Signs of sepsis- needle passed under CT guidance,
    percutaneous drainage of fluid.
    5. Pancreatic necrosectomy- infected pancreatic necrosis
    Midline laprotomy– head involved, Retroperitoneal
    approach – left flank incision with feeding jejunostomy
    (body and tail involved), Gallstones-
    cholecystectomy ,Closed continuous lavage(beger’s lavage),
    Closed drainage, Open packing, Closure and relaparotomy
    (Bradley)
    PANCREATIC ABSCESS
    • Circumscribed intra-abdominal collection of
    pus usually in proximity to the pancreas.
    • ANC or WON infected
    • Percutaneous drainage with the widest possible
    drains placed under standard imaging guidance
    is the treatment.
    • Antibiotics and supportive care
    PANCREATIC ASCITES
    • Chronic, generalized, peritoneal, enzyme rich
    effusion usually associated with pancreatic duct
    disruption.
    • Paracentesis reveals turbid fluid with a high
    amylase level.
    • Adequate drainage with wide bore drains under
    image guidance.
    PLEURAL EFFUSION
    Encapsulated collection of fluid in the plural cavity,
    arising as a consequence of acute pancreatitis.
    HAEMORRHAGE
    Bleeding may occur into the gut, Into the
    retroperitoneum or into the peritoneal cavity
    Possible causes include bleeding into a pseudocyst
    cavity, diffuse bleeding from a large raw surface or
    a pseudoaneurysm.
    PORTAL OR SPLENIC VEIN
    THROMBOSIS
    • Identified on CT scan
    • Marked rise in platelet count
    • Screened for pro coagulant tendencies
    • Varices or portal hypertension manage
    accordingly
    PSEUDOCYST
    • Collection of
    amylase-rich
    fluid enclosed in
    a wall of fibrous
    or granulation
    tissue
    • 4 weeks or more
    from the onset of
    acute pancreatitis
    • single/ multiple
    • identification- ultrasound or CT
    • low CEA ,high amylase level
    • cytology- inflammatory cells
    • Resolve spontaneously- most cases
    • if not resolved- percutaneous, surgical and
    endoscopic draining approaches
    • Percutaneous transgastric cystogastrostomy can
    be done under image guidance ,double pigtail
    drain placed with one end in cyst and other in
    gastric lumen.
    • Endoscopic drainage involves puncture of the
    cyst through the stomach or duodenal wall
    under EUS guidance and placement of tube
    drain .
    • Surgical drainage involves internally draining
    the cyst into the gastric or Jejunal lumen.
    PANCREATIC FISTULA
    • Determine site
    • Measure amylase level
    • Management - correct fluid level
    • Drain
    • Parenteral or nasojejunal feed
    • Octreotide
    • Relieve pancreatic duct obstruction( ERCP
    and Stent )
    THANK YOU

    You might also like