ACUTE PANCREATITIS Symptoms Diagnosis and Treatment

ACUTE PANCREATITIS Symptoms Diagnosis and Treatment

ACUTE PANCREATITIS

  • acuteHeart Failure Causes Symptoms NYHA classification with Heart Failure Treatment. Read more ... » inflammatory process of the pancreas. It is usually associated with severe acuteHeart Failure Causes Symptoms NYHA classification with Heart Failure Treatment. Read more ... » upper abdominal pain and elevated blood levels of pancreatic enzymes
  • The pancreas secretes 1500 to 3000 ml of pancreatic fluid with about 20 enzymes.
  • The disease may be relatively mild, resolving in 3 or 4 days, or severe enough to cause multiple organ system failure, shock, and death (in about 5% of patients).
  • pH is more than 8.
  • Pancreatic enzymes are involved in major digestion process.
  • Regulation of pancreatic secretion – Secretin is re­leased by stimulus of gastric acid, which stimulates secretion of pancreatic juice. Release of CCK (chole­cystokinin) from the duodenum and jejunum occurs.’
  • The parasympathetic nervous system i.e. vagus nerve stimulates release of pancreatic juice.
  • Nitric oxide is also a neuro-transmitter for pancreatic exocrine secretion.


Water and electrolyte secretion

  • Bicarbonate is the chief ion in pancreatic secretion and helps to neutralize gastric acid.

Enzyme secretion

  • The pancreas secretes amylolytic, lipolytic and pro­teolytic enzymes which are amylase, lipase, phospho­lipase A, cholesterol esterase; Endopeptidase-trypsin and chymotrypsin; Exopeptidases – Carboxypepti­dases, Aminopeptidases, Ribonucleases, Enteroki­nase.
  • Acetylcholine and peptides are neurotransmitters. Vasoactive intestinal peptide (VIP) causesHeart Failure Causes Symptoms NYHA classification with Heart Failure Treatment. Read more ... » the release of acetyl choline. •
  • Autodigestion of Pancreas is prevented by pres­ence of proteases in precursor form only (inactive form).
  • Exocrine – Endocrine function
    • Insulin stimulates secretion of CCK and secretin re­sulting in exocrine secretion.

ACUTE PANCREATITIS

ACUTEHeart Failure Causes Symptoms NYHA classification with Heart Failure Treatment. Read more ... » PANCREATITIS Etiology

  • · Gall stones
  • · Alcohol
  • · Hypertriglyceridemia
  • · Trauma
  • · Post operative
  • · Drugs – Azathioprine, sulphonamides, estrogens, tetracyclines, valproic acid, anti HIV, 6 mercap­topurine
  • · Sphincter of Oddi dysfunction
  • · Vasculitis
  • · Connective tissue disorder
  • · Thrombotic thrombocytopenic purpura
  • · Cancer
  • · Hypercalcemia
  • · Hereditary pancreatitis
  • · Cystic fibrosis
  • · Renal failure
  • · Infection – Mumps, parasites
  • · Autoimmune – Sjogren’s syndrome
  • · Biliary tract disease.

ACUTEHeart Failure Causes Symptoms NYHA classification with Heart Failure Treatment. Read more ... » PANCREATITIS Clinical Features Symptoms –

  • · Abdominal pain – may be mild to severe, con­stant and agonizing.
  • · Pain is located in epigastrium, periumbilical re­gion, radiating to back, chest, flanks, lower ab­domen.
  • · Pain is more in supine position; patients feel re­lieved with trunk flexed, knees drawn up.
  • · Nausea, vomiting, abdominal distension- due to gastric and intestinal hypomotility.

ACUTEHeart Failure Causes Symptoms NYHA classification with Heart Failure Treatment. Read more ... » PANCREATITIS Physical examination

  • · Patient is anxious
  • · There is low grade fever
  • · Tachycardia and Hypotension are usually present.
  • · There is shock due to :
  • – Hypovofemia due to exudation of blood and proteins into retroperitoneum (retroperitoneal burn)
  • – Vasodilatation and increased vascular permeability
  • – Systemic response
  • · Jaundice
  • · Erythema
  • · Pulmonary crepts, collapse, pleural effusion (left
  • sided)
  • · Abdominal tenderness
  • · Muscle rigidity
  • · Decreased bowel sounds
  • · Pancreatic pseudo-cyst palpable
  • · Cullen’s sign – blue discoloration around umbili­cus
  • · Turner’s sign – blue or brown discoloration of flanks.

ACUTEHeart Failure Causes Symptoms NYHA classification with Heart Failure Treatment. Read more ... » PANCREATITIS Lab Diagnosis

Diagnosis

ACUTEHeart Failure Causes Symptoms NYHA classification with Heart Failure Treatment. Read more ... » PANCREATITIS Differential diagnosis

ACUTEHeart Failure Causes Symptoms NYHA classification with Heart Failure Treatment. Read more ... » PANCREATITIS Complications

ACUTEHeart Failure Causes Symptoms NYHA classification with Heart Failure Treatment. Read more ... » PANCREATITIS Treatment

  • Usually self-limiting in 7 days AnalgesicsKetorolac. Read more ... » for pain
  • IV fluids and colloids
  • Nil orally
  • Nasogastric suction to prevent gastric contents entering duodenum
  • Antibiotics – Imipenem – cilastatin 500 mg T03 for 2 weeks
  • Glucocorticoids, calcitonin, NSAIDs, somatosta­tin, octreotide
  • Fungicides for Candida infection
  • CT scans help to decide severity and prognosis IV fluids – liquid diets
  • Supportive care
  • Surgical pancreatic debridement- necrosectomy Laparotomy with drainage and removal of ne­crotic tissue.
  • For hypertriglyceridemia – weight loss, fat free diet, exercise, avoid alcohol and drugs like estrogen, vita­min A, thiazides and beta blockers, control of diabe­tes.

Infected Pancreatic Necrosis, Abscess and Pseudocyst

  • It may occur from 2 – 4 wks after pancreatitis
  • There is secondary infection
  • Diagnosed by CT – guided needle aspiration Pseudocyt should be aspirated
  • For nectrotic pancreas management as above

Pseudocyst of pancreas