Acute pancreatitis

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.