pancreatitis - the university of tennessee graduate school of
TRANSCRIPT
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Pancreatitis
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Objectives
Define acute and chronic pancreatitisEtiologySigns and symptomsDiagnosisTreatmentsComplications
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Acute Pancreatitis
Diffuse inflammationEnzymatic destructionInterstitial edema and inflammationHemorrhage and necrosis
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Etiology Acute Pancreatitis
AlcoholBiliary tract diseaseHyperlipidemiaHereditaryHypercalcemiaTraumaIschemia, infections, venom
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Etiology
Azathioprine, estrogens, isoniazid, metronidazole, tetracycline, valproicacid, trimethoprim-sulfamethoxazole
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Clinical Presentation
Noncrampy, epigastric abdominal pain“knifing” or “boring through” to the backNausea and vomitingTachycardia, tachypnea, hypotension, hyperthermia Voluntary and involuntary guarding
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What is this? Why?
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Cullen’s Sign
Hemorrhagic pancreatitisBlood dissects up the falciformligament
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What is this? Why?
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Grey Turner’s Sign
Hemorrhagic pancreatitisBlood dissect into the posterior retroperitoneal soft tissue in the flank
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Fox’s Sign
Rare findingBluish discoloration below the inguinal ligament or at the base of the penis.
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Tests
labs- amylase and lipaseCT scan CXR-elevation of left diaphragmAXR- sentinal loop sign
-colon cutoff sign
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Early Prognostic Signs
Ranson’s prognostic signs of pancreatitisCriteria for acute gallstone pancreatitis
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Ranson’s
At admission: Age >55yWBC >16,000/mm3Blood glucose >200 mg/dlLDH >350 IU/LAST >250 U/dl
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Ranson’s
Initial 48 hoursHct fall >10%BUN elevation> 5 mg/dlSerum Calcium<8 mg/dlPao2< 60 mmHgBase deficit >4 mEq/lFluid sequestration > 6 L
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Acute Gallstone Pancreatitis
At admission:Age > 70yWBC >18,000Blood glucose > 220LDH > 400AST >250
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Acute Gallstone Pancreatitis
Initial 48 hHCT fall > 10%BUN elevation > 2Calcium < 8Base deficit > 5Fluid sequestration > 4 L
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Prognosis
Mortality zero; less than 2 criteriaMortality 10% to 20%; 3 to 5 criteriaMortality > 50%; more than 7
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Treatment Mild Pancreatitis
Supportive Restriction of oral intakeNGTH2 blockersPain control
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When Resume Diet?
After ABD pain has decreasedAmylase returns to normalDiet: low-fat and low-protein
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Severe Pancreatits
NPOSupportive care in the ICUAggressive fluid resus.TPN
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Complications
Paralytic ileusHyperglycemiaHypocalcemiaRenal failureHemorrhage-erosion into a major vessel
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Complications
NecrosisInfected necrosisAbscessPseudocystThrombosis of splenic vein- sinistralportal hypertension and gastric varices
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Chronic Pancreatitis
Chronic inflammatory conditionFibrosis, duct ectasis and acinaratrophy Irreversible destruction of tissue
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Etiology of Chronic Pancreatitis
Alcohol 70%IdiopathicHerditary hyperparathyroidismHypertriglyceridemiaAutoimmune Obstruction , traumaPancreas divisum
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Presentation
Chronic pain- epigastric radiates to backAnorexiaWeight lossIDDMSteatorrhea
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Diagnosis
Pancreatic calcificationsChain of lakes
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Treatment
Control painSmall-volume, frequent, low-fat, high-protein, high-carbohydrate meals.OctreotideLipase and trypsinERCP with stents, sphincterotomy, stone extraction
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Treatment Operative
SphincteroplastyPeustow- side-to-side longitudinal pancreasticojejunostomyCeliac plexus neurolysis with alcolholinjectionThoracoscopic splanchnicectomy
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