Acute pancratitis

Acute pancratitis

Acute pancratitis

Etiology
 Alcohol ingestion
 Biliary calculus
 Post operative
 Post ERCP
 Trauma to abdomen
 Metabolic  renal failure, hyprcal
 Penetrating peptic ulcr
 Connective tissue disease SLE
 polyarteritis nodasa
 Infections mumps,roundwrm ,vir
  hepatitis
 Drugs sulphonamds
,oestrogen,thiazide ,frusemide,steroids.



 Hereditery pancratitis
 OP posng
PATHOLOGY
 Oedematous pancratitis
 necrotic    "
 haemorrhgic   "
CLINICAL FEATURES
SYMPTMS
 Cardinal s PAIN mild to severe
 intensity. Dull, boring ,sudden in onset gradually increases in severity usually located in epigastric radiates to back.
 Nausea n vomiting
 Anorexia.
SIGNS
 FEVER ,TACHYCARDIA,TACHYPNEA
 HYPOTEN, JAUNDICE,
 Abd tendrns ,guardng disten.
 LUNGS cynosis,pleural effusion
 SKIN erythematous modules
 Cullens sign (bluish dis arnd umbilics.)
 Turners sign (bluish dis in flnk)
OTHE$ Hemetmesis ,malaena,ischemic injry to retina.
INVESTIGATIONS
1)Serum amylase  Increase for 72 hours them decline to normal in 1to2 weeks.
2)Hypertriglyceridemia in 15to20%
3)serum Lipase  Preferable n more specific.
Marked increase in pleural n peritoneal fluid..
4)Blood picture
5)plain x ray and chest .to exclud othere cause of acute abdominal pain.
6)ultrasound abdomen to evaluate gallblader and billary tree. It can detect acute pancreatitis
7)CT abdomen show mass swollen pancreas.
PROGNOSTIC FEATURES
 RANSON CRITERIA
According to this if
0-2=mortality 2%
3-4=mortality 15%
5-6=mortality 40%
>6  mortality 100%
DD
Intestinal perforatin
Acute MI
Acute cholecystitis
Pneumonia
Acute appendicitis
COMPLICATIONS
LOCAL
 Necrosis
 Pseudocyst
 pancreatic abscess
 Pancreatic ascites
 Intraperitoneal hemorrhage
 obstructive laundice
 intestinal obstruction
SYSTEMIC
Hypovoldmic shock
Acute respiratory distess syn.
Multiple organ failure
Renal failure
DIC
Gstroint hemrge
Fat necrosis
Pleural effusion
TREATMENT
1) NBM
2)IV Fluids
3)analgesics
4)Nasogastric tube if pain ,vmtng
obstrn
5)Moniter TPR BP Urine bld
6)Antibiotics carbapenems or ceftazidime.
7)protön pmp inhb,glucagon ,octreotide,aprotonin.
8)Surgery if
 infected necrosis
 complicn
9)ERCP Wthn 36-48hr wtih gallstn pancreatitis.