Pancreatitis is an inflammation of the pancreas that can be acute or chronic. Acute pancreatitis involves reversible injury to the pancreas and can range from mild to severe, with severe cases involving organ failure. Chronic pancreatitis is characterized by irreversible damage to the pancreas that typically causes pain and loss of pancreatic function over time. Treatment for acute pancreatitis depends on severity and may involve hospitalization, IV fluids, monitoring for organ failure, and antibiotics for severe cases. Treatment for chronic pancreatitis focuses on pain management, treating complications, and sometimes surgical interventions.
Pancreatitis - being one of the differentials for acute abdomen which includes Acute & Chronic pancreatitis, their aetiology, pathogenesis, clinical features & possible complications.
This document provides an overview of pancreatitis, including its epidemiology, pathophysiology, etiology, clinical presentation, workup, severity scoring systems, treatment, prognosis, and complications. It defines acute and chronic pancreatitis and describes the reversible inflammation of the pancreas that occurs in acute pancreatitis. Key points include that the annual incidence is 13-45 per 100,000 people, the pathophysiology involves premature activation of digestive enzymes within the pancreas rather than the intestines, and treatment depends on the severity but generally involves IV rehydration and pain management for mild cases and more aggressive monitoring and support in an ICU for severe cases.
Chronic pancreatitis is a progressive inflammatory disease of the pancreas characterized by irreversible destruction of pancreatic tissue. It commonly causes severe abdominal pain and can lead to exocrine and endocrine insufficiency over time. The most common causes are alcohol consumption and smoking. Diagnosis involves pancreatic function tests, imaging like CT or MRCP to identify changes in the pancreas and pancreatic duct. Treatment focuses on managing pain, treating underlying causes, nutrition support, and in some cases endoscopic or surgical interventions. The prognosis is often poor with declining health and function over time and an increased risk of pancreatic cancer with longstanding disease.
The document provides information on the normal anatomy and histology of the pancreas. It notes that the pancreas has both exocrine and endocrine functions, is retroperitoneal in location, and drains into the duodenum via the pancreatic duct system. The endocrine portion is composed of islets of Langerhans that secrete insulin, glucagon, and somatostatin. Common congenital anomalies and acquired conditions of the pancreas are also described.
Acute pancreatitis is characterized by reversible pancreatic inflammation resulting from inappropriate release and activation of pancreatic enzymes, which destroy pancreatic tissue and elicit an acute inflammatory reaction. The most common causes are biliary tract disease and alcoholism. Treatment involves IV fluid replacement to correct electrolyte imbalances and shock, which is a common cause of death in early stages. Surgical drainage may be needed for pancreatic complications like abscesses or pseudocysts.
This document discusses acute pancreatitis, including its anatomy, etiology, diagnosis, assessment of severity, treatment, complications, and management guidelines. It covers the key roles of the pancreas in enzyme and electrolyte secretion. Common causes of pancreatitis like gallstones and alcohol are described. Diagnosis involves serum markers, imaging, and severity scores. Treatment focuses on hydration, nutrition, and managing complications. Local complications like pseudocysts and necrosis are defined and approaches to their management are provided. Surgical debridement indications and timing are outlined.
This document discusses acute pancreatitis, including its causes, pathogenesis, symptoms, signs, investigations, classifications, differential diagnosis, severity, management, and complications. It notes that acute pancreatitis is an inflammation of the pancreas that can be caused by factors like alcohol, gallstones, hypertriglyceridemia, drugs, trauma or idiopathic origins. The condition involves three pathological phases and symptoms may include abdominal pain, nausea, vomiting and distension. Management involves IV fluid resuscitation, pain control, and targeted interventions depending on severity and complications which can be local like pseudocysts or systemic like respiratory, cardiac or renal issues.
Pancreatitis is an inflammation of the pancreas that can be acute or chronic. Acute pancreatitis involves reversible injury to the pancreas and can range from mild to severe, with severe cases involving organ failure. Chronic pancreatitis is characterized by irreversible damage to the pancreas that typically causes pain and loss of pancreatic function over time. Treatment for acute pancreatitis depends on severity and may involve hospitalization, IV fluids, monitoring for organ failure, and antibiotics for severe cases. Treatment for chronic pancreatitis focuses on pain management, treating complications, and sometimes surgical interventions.
Pancreatitis - being one of the differentials for acute abdomen which includes Acute & Chronic pancreatitis, their aetiology, pathogenesis, clinical features & possible complications.
This document provides an overview of pancreatitis, including its epidemiology, pathophysiology, etiology, clinical presentation, workup, severity scoring systems, treatment, prognosis, and complications. It defines acute and chronic pancreatitis and describes the reversible inflammation of the pancreas that occurs in acute pancreatitis. Key points include that the annual incidence is 13-45 per 100,000 people, the pathophysiology involves premature activation of digestive enzymes within the pancreas rather than the intestines, and treatment depends on the severity but generally involves IV rehydration and pain management for mild cases and more aggressive monitoring and support in an ICU for severe cases.
Chronic pancreatitis is a progressive inflammatory disease of the pancreas characterized by irreversible destruction of pancreatic tissue. It commonly causes severe abdominal pain and can lead to exocrine and endocrine insufficiency over time. The most common causes are alcohol consumption and smoking. Diagnosis involves pancreatic function tests, imaging like CT or MRCP to identify changes in the pancreas and pancreatic duct. Treatment focuses on managing pain, treating underlying causes, nutrition support, and in some cases endoscopic or surgical interventions. The prognosis is often poor with declining health and function over time and an increased risk of pancreatic cancer with longstanding disease.
The document provides information on the normal anatomy and histology of the pancreas. It notes that the pancreas has both exocrine and endocrine functions, is retroperitoneal in location, and drains into the duodenum via the pancreatic duct system. The endocrine portion is composed of islets of Langerhans that secrete insulin, glucagon, and somatostatin. Common congenital anomalies and acquired conditions of the pancreas are also described.
Acute pancreatitis is characterized by reversible pancreatic inflammation resulting from inappropriate release and activation of pancreatic enzymes, which destroy pancreatic tissue and elicit an acute inflammatory reaction. The most common causes are biliary tract disease and alcoholism. Treatment involves IV fluid replacement to correct electrolyte imbalances and shock, which is a common cause of death in early stages. Surgical drainage may be needed for pancreatic complications like abscesses or pseudocysts.
This document discusses acute pancreatitis, including its anatomy, etiology, diagnosis, assessment of severity, treatment, complications, and management guidelines. It covers the key roles of the pancreas in enzyme and electrolyte secretion. Common causes of pancreatitis like gallstones and alcohol are described. Diagnosis involves serum markers, imaging, and severity scores. Treatment focuses on hydration, nutrition, and managing complications. Local complications like pseudocysts and necrosis are defined and approaches to their management are provided. Surgical debridement indications and timing are outlined.
This document discusses acute pancreatitis, including its causes, pathogenesis, symptoms, signs, investigations, classifications, differential diagnosis, severity, management, and complications. It notes that acute pancreatitis is an inflammation of the pancreas that can be caused by factors like alcohol, gallstones, hypertriglyceridemia, drugs, trauma or idiopathic origins. The condition involves three pathological phases and symptoms may include abdominal pain, nausea, vomiting and distension. Management involves IV fluid resuscitation, pain control, and targeted interventions depending on severity and complications which can be local like pseudocysts or systemic like respiratory, cardiac or renal issues.
This document summarizes key information about pancreatitis. It discusses the definition, incidence, etiology, pathogenesis, symptoms, investigations and management of both acute and chronic pancreatitis. For acute pancreatitis, it covers risk stratification, treatment including fluid resuscitation and antibiotics, and complications. For chronic pancreatitis, it discusses etiology, consequences, diagnosis using imaging and functional tests, and the spectrum of disease damage.
This document discusses perforated peptic ulcers. It first covers the surgical anatomy and blood supply of the stomach and duodenum. It then discusses the epidemiology, pathophysiology, risk factors, presentation, diagnosis, and treatment of perforated peptic ulcers. Key points include that perforations are more common in duodenal versus gastric ulcers and have a higher mortality rate for gastric ulcers. Risk factors include H. pylori infection, NSAID use, smoking, and Zollinger-Ellison syndrome. Patients typically present with sudden severe abdominal pain. Diagnosis involves upright chest x-rays showing free air. Treatment is surgical repair of the perforation.
(1) Acute pancreatitis is an inflammatory condition of the pancreas most commonly caused by gallstones or alcohol abuse. (2) Damage to the pancreas leads to release of enzymes that autodigest pancreatic tissue. (3) Treatment involves fluid resuscitation, pain management, monitoring for complications like infection or pseudocyst formation, and identifying and addressing the underlying cause.
The document discusses acute pancreatitis, outlining its epidemiology, pathophysiology, etiology, clinical presentation, workup, severity scoring systems, treatment, prognosis, and complications. It defines acute pancreatitis as an acute condition presenting with abdominal pain associated with raised blood or urine pancreatic enzymes due to pancreatic inflammation. The document also classifies acute pancreatitis as mild or severe based on the presence of organ failure or local complications.
Seminar presentation by 5th-year medical students under the supervision of in house lecturer. He was previously working as a consultant surgeon in Syria. Reference as mentioned in the slides.
The document discusses acute cholangitis, including its pathogenesis, clinical manifestations, diagnostic criteria, severity assessment, imaging, and management. Regarding diagnostic criteria, it summarizes that Charcot's triad has low sensitivity for diagnosing acute cholangitis compared to the Tokyo Guidelines 2007 and 2013 criteria. It also notes that the Tokyo Guidelines 2007 criteria for severity assessment were insufficient and have been revised in subsequent guidelines to better distinguish mild from moderate cases in the initial diagnosis.
Acute pancreatitis is inflammation of the pancreas that ranges from mild to severe. Mild cases involve pancreatic edema while severe cases involve pancreatic necrosis and multi-organ failure. The main causes are gallstones and alcohol use. Diagnosis is based on abdominal pain and elevated pancreatic enzymes. Severity is assessed using criteria like Ranson score, CT severity index, and Atlanta criteria. Treatment of mild cases involves fluids and pain control while severe cases require intensive care monitoring, fluids, nutrition, and may involve ERCP or surgery for complications.
This document discusses pancreatitis, including its anatomy, physiology, etiology, clinical presentation, diagnosis, prognosis, management, and complications. Pancreatitis is defined as inflammation of the pancreas and can be acute or chronic. Acute pancreatitis is commonly caused by gallstones or alcohol and may range from mild to severe, with severe cases involving pancreatic necrosis and multi-organ failure. Diagnosis involves blood tests measuring amylase and lipase along with imaging like CT. Management depends on severity but generally involves hospitalization, IV fluids, pain control, and monitoring for complications.
1. Acute pancreatitis is inflammation of the pancreas that can range from mild to severe. It is most often caused by gallstones or excessive alcohol use.
2. Diagnosis is supported by laboratory tests showing elevated pancreatic enzymes in blood and urine, along with abdominal imaging showing swelling or inflammation of the pancreas.
3. The clinical course and severity can be predicted using scoring systems like Ranson's criteria that evaluate markers of organ failure over the first 48 hours. Early identification of severe cases allows for more aggressive management to reduce mortality risk.
This document discusses acute cholecystitis, which is inflammation of the gallbladder. It defines the condition and discusses its most common causes and risk factors. The main symptoms are abdominal pain in the right upper quadrant, nausea, vomiting, and fever. Diagnosis involves physical exam findings like Murphy's sign as well as imaging tests and bloodwork. Treatment involves intravenous fluids, antibiotics, and early cholecystectomy if symptoms worsen or complications arise. Both open and laparoscopic cholecystectomy are discussed as surgical treatment options.
Chronic pancreatitis is a progressive inflammatory condition of the pancreas characterized by irreversible morphological changes and loss of function. It is most commonly caused by long term heavy alcohol use. Symptoms include recurrent abdominal pain, steatorrhea due to exocrine insufficiency, and diabetes mellitus due to endocrine insufficiency. Diagnosis involves functional tests like fecal elastase and imaging modalities like CT, MRI, ERCP and EUS which demonstrate findings of pancreatic duct abnormalities, parenchymal changes and calcifications.
This document discusses obstructive jaundice, providing definitions, pathophysiology, effects on various body systems, etiology, history and examination findings, laboratory investigations, imaging modalities, and causes of biliary obstruction. It defines obstructive jaundice as a failure of bile to reach the intestine due to mechanical obstruction. Pathophysiological changes include bile duct dilation, hepatic fibrosis, and portal hypertension. Causes include gallstones, strictures, tumors, and congenital anomalies. A thorough history, physical exam, and lab tests can localize the level and cause of obstruction, while imaging modalities like ultrasound and MRCP can identify and characterize obstructive lesions.
The document discusses various disorders of the gallbladder and bile ducts. It describes that over 95% of biliary tract diseases are due to cholelithiasis (gallstones), which can be either cholesterol stones or pigment stones. Cholecystitis, an inflammation of the gallbladder, can be acute or chronic and is usually caused by gallstones blocking the cystic duct. Other complications of gallbladder disorders include cholangitis, an inflammation of the bile ducts, and secondary biliary cirrhosis from long-term bile duct obstruction.
The gallbladder is located near the liver and stores and concentrates bile produced by the liver. It has three parts - the neck, body, and fundus. The cystic duct connects the gallbladder to the common hepatic duct. Gallstones can form in the gallbladder and cause problems like biliary colic, cholecystitis, cholangitis, or pancreatitis. Risk factors for gallstones include obesity, female gender, rapid weight loss, and certain medical conditions. Complications may include perforation or gangrene of the gallbladder.
Acute pancreatitis means inflammation of the pancreas that develops quickly. The main symptom is tummy (abdominal) pain. It usually settles in a few days but sometimes it becomes severe and very serious. The most common causes of acute pancreatitis are gallstones and drinking a lot of alcohol.
This document provides an overview of acute pancreatitis including its anatomy, causes, clinical presentation, diagnosis, prognosis, management, and complications. Some key points:
- Acute pancreatitis is inflammation of the pancreas that can range from mild to severe. Gallstones and alcohol are common causes.
- Symptoms include severe abdominal pain, nausea, and vomiting. Physical exam may reveal abdominal tenderness while blood tests can show elevated pancreatic enzymes.
- CT scan is the best imaging method and can identify complications like pancreatic necrosis. Prognosis is predicted by Ranson's criteria or the Balthazar CT severity index.
- Mild cases are treated with fluids and pain management while severe cases require
This document provides an overview of acute pancreatitis, including:
- The definition, classification, and pathophysiology of the disease. It involves inflammation of the pancreas that can range from mild to severe.
- Common causes or etiologies like gallstones, alcohol use, hyperlipidemia.
- Typical clinical presentation including severe abdominal pain, nausea, vomiting. Findings on physical exam can include abdominal tenderness.
- Tests and severity scores used to evaluate patients and monitor for complications. Treatment involves pain control, fluid resuscitation, and treating any underlying causes or complications. Outcomes depend on the severity of the attack.
Chronic pancreatitis is a chronic inflammatory condition of the pancreas characterized by progressive fibrosis of the pancreatic parenchyma and loss of function. It has multiple etiologies but alcohol use is the most common cause. Patients experience abdominal pain, steatorrhea from maldigestion, and can develop diabetes. Treatment involves pain management, pancreatic enzyme replacement, and in severe cases, surgery such as drainage procedures or pancreatic resections.
Acute pancreatitis is an inflammatory condition of the pancreas caused by the early activation of digestive enzymes within the pancreas. It can range from mild to severe, and in severe cases, it can lead to organ failure. The most common causes are gallstones, alcohol use, and viral infections. Symptoms include severe abdominal pain, nausea, vomiting, and fever. Laboratory tests show elevated levels of pancreatic enzymes in the blood. Severity is assessed using the Ranson score or APACHE II score. Treatment involves intravenous fluids, bowel rest, pain medications, and treating the underlying cause. Complications can include pancreatic pseudocysts, abscesses, and necrosis.
This document summarizes key information about pancreatitis. It discusses the definition, incidence, etiology, pathogenesis, symptoms, investigations and management of both acute and chronic pancreatitis. For acute pancreatitis, it covers risk stratification, treatment including fluid resuscitation and antibiotics, and complications. For chronic pancreatitis, it discusses etiology, consequences, diagnosis using imaging and functional tests, and the spectrum of disease damage.
This document discusses perforated peptic ulcers. It first covers the surgical anatomy and blood supply of the stomach and duodenum. It then discusses the epidemiology, pathophysiology, risk factors, presentation, diagnosis, and treatment of perforated peptic ulcers. Key points include that perforations are more common in duodenal versus gastric ulcers and have a higher mortality rate for gastric ulcers. Risk factors include H. pylori infection, NSAID use, smoking, and Zollinger-Ellison syndrome. Patients typically present with sudden severe abdominal pain. Diagnosis involves upright chest x-rays showing free air. Treatment is surgical repair of the perforation.
(1) Acute pancreatitis is an inflammatory condition of the pancreas most commonly caused by gallstones or alcohol abuse. (2) Damage to the pancreas leads to release of enzymes that autodigest pancreatic tissue. (3) Treatment involves fluid resuscitation, pain management, monitoring for complications like infection or pseudocyst formation, and identifying and addressing the underlying cause.
The document discusses acute pancreatitis, outlining its epidemiology, pathophysiology, etiology, clinical presentation, workup, severity scoring systems, treatment, prognosis, and complications. It defines acute pancreatitis as an acute condition presenting with abdominal pain associated with raised blood or urine pancreatic enzymes due to pancreatic inflammation. The document also classifies acute pancreatitis as mild or severe based on the presence of organ failure or local complications.
Seminar presentation by 5th-year medical students under the supervision of in house lecturer. He was previously working as a consultant surgeon in Syria. Reference as mentioned in the slides.
The document discusses acute cholangitis, including its pathogenesis, clinical manifestations, diagnostic criteria, severity assessment, imaging, and management. Regarding diagnostic criteria, it summarizes that Charcot's triad has low sensitivity for diagnosing acute cholangitis compared to the Tokyo Guidelines 2007 and 2013 criteria. It also notes that the Tokyo Guidelines 2007 criteria for severity assessment were insufficient and have been revised in subsequent guidelines to better distinguish mild from moderate cases in the initial diagnosis.
Acute pancreatitis is inflammation of the pancreas that ranges from mild to severe. Mild cases involve pancreatic edema while severe cases involve pancreatic necrosis and multi-organ failure. The main causes are gallstones and alcohol use. Diagnosis is based on abdominal pain and elevated pancreatic enzymes. Severity is assessed using criteria like Ranson score, CT severity index, and Atlanta criteria. Treatment of mild cases involves fluids and pain control while severe cases require intensive care monitoring, fluids, nutrition, and may involve ERCP or surgery for complications.
This document discusses pancreatitis, including its anatomy, physiology, etiology, clinical presentation, diagnosis, prognosis, management, and complications. Pancreatitis is defined as inflammation of the pancreas and can be acute or chronic. Acute pancreatitis is commonly caused by gallstones or alcohol and may range from mild to severe, with severe cases involving pancreatic necrosis and multi-organ failure. Diagnosis involves blood tests measuring amylase and lipase along with imaging like CT. Management depends on severity but generally involves hospitalization, IV fluids, pain control, and monitoring for complications.
1. Acute pancreatitis is inflammation of the pancreas that can range from mild to severe. It is most often caused by gallstones or excessive alcohol use.
2. Diagnosis is supported by laboratory tests showing elevated pancreatic enzymes in blood and urine, along with abdominal imaging showing swelling or inflammation of the pancreas.
3. The clinical course and severity can be predicted using scoring systems like Ranson's criteria that evaluate markers of organ failure over the first 48 hours. Early identification of severe cases allows for more aggressive management to reduce mortality risk.
This document discusses acute cholecystitis, which is inflammation of the gallbladder. It defines the condition and discusses its most common causes and risk factors. The main symptoms are abdominal pain in the right upper quadrant, nausea, vomiting, and fever. Diagnosis involves physical exam findings like Murphy's sign as well as imaging tests and bloodwork. Treatment involves intravenous fluids, antibiotics, and early cholecystectomy if symptoms worsen or complications arise. Both open and laparoscopic cholecystectomy are discussed as surgical treatment options.
Chronic pancreatitis is a progressive inflammatory condition of the pancreas characterized by irreversible morphological changes and loss of function. It is most commonly caused by long term heavy alcohol use. Symptoms include recurrent abdominal pain, steatorrhea due to exocrine insufficiency, and diabetes mellitus due to endocrine insufficiency. Diagnosis involves functional tests like fecal elastase and imaging modalities like CT, MRI, ERCP and EUS which demonstrate findings of pancreatic duct abnormalities, parenchymal changes and calcifications.
This document discusses obstructive jaundice, providing definitions, pathophysiology, effects on various body systems, etiology, history and examination findings, laboratory investigations, imaging modalities, and causes of biliary obstruction. It defines obstructive jaundice as a failure of bile to reach the intestine due to mechanical obstruction. Pathophysiological changes include bile duct dilation, hepatic fibrosis, and portal hypertension. Causes include gallstones, strictures, tumors, and congenital anomalies. A thorough history, physical exam, and lab tests can localize the level and cause of obstruction, while imaging modalities like ultrasound and MRCP can identify and characterize obstructive lesions.
The document discusses various disorders of the gallbladder and bile ducts. It describes that over 95% of biliary tract diseases are due to cholelithiasis (gallstones), which can be either cholesterol stones or pigment stones. Cholecystitis, an inflammation of the gallbladder, can be acute or chronic and is usually caused by gallstones blocking the cystic duct. Other complications of gallbladder disorders include cholangitis, an inflammation of the bile ducts, and secondary biliary cirrhosis from long-term bile duct obstruction.
The gallbladder is located near the liver and stores and concentrates bile produced by the liver. It has three parts - the neck, body, and fundus. The cystic duct connects the gallbladder to the common hepatic duct. Gallstones can form in the gallbladder and cause problems like biliary colic, cholecystitis, cholangitis, or pancreatitis. Risk factors for gallstones include obesity, female gender, rapid weight loss, and certain medical conditions. Complications may include perforation or gangrene of the gallbladder.
Acute pancreatitis means inflammation of the pancreas that develops quickly. The main symptom is tummy (abdominal) pain. It usually settles in a few days but sometimes it becomes severe and very serious. The most common causes of acute pancreatitis are gallstones and drinking a lot of alcohol.
This document provides an overview of acute pancreatitis including its anatomy, causes, clinical presentation, diagnosis, prognosis, management, and complications. Some key points:
- Acute pancreatitis is inflammation of the pancreas that can range from mild to severe. Gallstones and alcohol are common causes.
- Symptoms include severe abdominal pain, nausea, and vomiting. Physical exam may reveal abdominal tenderness while blood tests can show elevated pancreatic enzymes.
- CT scan is the best imaging method and can identify complications like pancreatic necrosis. Prognosis is predicted by Ranson's criteria or the Balthazar CT severity index.
- Mild cases are treated with fluids and pain management while severe cases require
This document provides an overview of acute pancreatitis, including:
- The definition, classification, and pathophysiology of the disease. It involves inflammation of the pancreas that can range from mild to severe.
- Common causes or etiologies like gallstones, alcohol use, hyperlipidemia.
- Typical clinical presentation including severe abdominal pain, nausea, vomiting. Findings on physical exam can include abdominal tenderness.
- Tests and severity scores used to evaluate patients and monitor for complications. Treatment involves pain control, fluid resuscitation, and treating any underlying causes or complications. Outcomes depend on the severity of the attack.
Chronic pancreatitis is a chronic inflammatory condition of the pancreas characterized by progressive fibrosis of the pancreatic parenchyma and loss of function. It has multiple etiologies but alcohol use is the most common cause. Patients experience abdominal pain, steatorrhea from maldigestion, and can develop diabetes. Treatment involves pain management, pancreatic enzyme replacement, and in severe cases, surgery such as drainage procedures or pancreatic resections.
Acute pancreatitis is an inflammatory condition of the pancreas caused by the early activation of digestive enzymes within the pancreas. It can range from mild to severe, and in severe cases, it can lead to organ failure. The most common causes are gallstones, alcohol use, and viral infections. Symptoms include severe abdominal pain, nausea, vomiting, and fever. Laboratory tests show elevated levels of pancreatic enzymes in the blood. Severity is assessed using the Ranson score or APACHE II score. Treatment involves intravenous fluids, bowel rest, pain medications, and treating the underlying cause. Complications can include pancreatic pseudocysts, abscesses, and necrosis.
This document discusses acute pancreatitis, defining it as a reversible inflammation of the pancreas that ranges from mild to severe. It can be caused by gallstones, alcohol use, metabolic issues, infections, drugs, trauma, and other factors. Symptoms include severe abdominal pain that may radiate to the back. Investigations include blood tests of amylase, lipase, and other enzymes. Treatment focuses on supportive care, pain management, and identifying/treating any complications like infections. The mortality rate ranges from 1% for mild cases to 15-20% overall.
1) Acute pancreatitis is defined as an acute inflammatory process of the pancreas with variable involvement of other tissues. It is diagnosed when a patient presents with abdominal pain consistent with the disease as well as serum amylase or lipase levels over three times the upper limit of normal.
2) Common causes of acute pancreatitis include gallstones, alcohol use, hypertriglyceridemia, endoscopic retrograde cholangiopancreatography (ERCP), trauma, postoperative complications, and certain drugs.
3) Management involves adequate hydration, analgesia, monitoring for organ failure, cautious administration of fluids and insulin, and consideration of endoscopic procedures or surgery in severe cases with complications like necrosis
This document summarizes key points about the management of acute pancreatitis. It discusses the epidemiology, etiology, clinical presentation, diagnostic evaluation, determination of severity, treatment approaches, and complications of acute pancreatitis. Management depends on determining if the pancreatitis is mild, moderate, or severe based on the presence of organ failure or local complications on imaging. Nutritional support, antibiotics, and drainage of fluid collections are addressed.
Acute Pancreatitis (According to American College of Gastroenterology 2013 gu...Jibran Mohsin
This Presentation focuses on definition, new classification, different scoring systems for severity, rationale for radiological signs and new management recommendations as per 2013 American College of Gastroenterology guidelines
This document summarizes acute pancreatitis, including its definition, causes, symptoms, pathogenesis, complications, diagnostic tests, severity scoring systems, and management. Acute pancreatitis is characterized by inflammation of the pancreas and is most commonly caused by gallstones or alcoholism. It presents with severe epigastric pain and other gastrointestinal symptoms. The pathogenesis involves premature activation of digestive enzymes within the pancreas that can lead to autodigestion. Complications include pseudocysts, abscesses, necrosis, and systemic complications like shock. Diagnosis involves blood tests showing elevated pancreatic enzymes and imaging tests. Severity is assessed using scoring systems like Ranson criteria, APACHE II, and CT severity index. Treatment focuses on fluid
This document discusses the gallbladder, cholecystitis, acute pancreatitis, and a case study involving a 77-year-old female admitted with abdominal pain. It provides details on gallstones, the gallbladder, bile, pancreatitis, and treatments including cholecystectomy and enteral nutrition. Complications of pancreatitis like ARF, ARDS, and mortality risks are also reviewed. Popular stimulant drugs methamphetamines and bath salts are compared in terms of their effects, dangers, and side effects.
This document provides information about acute pancreatitis, including:
- It defines acute pancreatitis as inflammation of the pancreas that presents with abdominal pain and raised pancreatic enzymes.
- Common causes are gallstones, alcohol, and procedures like ERCP. Complications can affect the pancreas itself or other organ systems.
- Diagnosis involves blood tests of amylase, lipase, and other enzymes as well as imaging like ultrasound or CT scan. Severity is assessed using tools like Ranson's criteria or APACHE II score.
- Treatment depends on severity but generally involves intravenous fluids, analgesics, monitoring, and treating any complications surgically if needed. More severe cases require intensive care monitoring and
Acute biliary pancreatitis is caused by gallstones obstructing the common bile duct, which causes bile to reflux into the pancreas and induce inflammation. ERCP with sphincterotomy can effectively treat the obstruction but may benefit only patients with severe disease. While same-admission cholecystectomy is recommended after ERCP/sphincterotomy, further studies are needed to determine the optimal timing of cholecystectomy for mild versus severe cases of acute biliary pancreatitis.
Acute pancreatitis has an incidence of 17 per 100,000 people and a mortality of 2-3%. The most common causes are gallstones (50% of cases) and alcohol abuse (20-25% of cases). Necrotizing pancreatitis can lead to pancreatic infections which are most often polymicrobial. Treatment involves fluid resuscitation, pain control, nutritional support via enteral feeding when possible, and antibiotics only for infected necrosis or cholangitis. Complications include pancreatic pseudocysts and abscesses which may require percutaneous or surgical drainage.
Irreversible cellular injury can occur through two main types of cell death: necrosis and apoptosis. Necrosis is premature, unprogrammed cell death that is always pathological, occurring due to external factors like ischemia, toxins, or infections. It is characterized by loss of membrane integrity and inflammatory changes. Apoptosis is a normal, programmed form of cell death important for development, hormone regulation, and removing damaged cells. It occurs through an active enzymatic process and does not cause inflammation. Both pathways ultimately lead to cellular demise but differ significantly in their mechanisms and morphological appearance.
1. The document discusses various types of pancreatic and biliary cancers including carcinoma of the head of pancreas, periampullary carcinoma, cholangiocarcinoma, and carcinoma of the gallbladder.
2. Treatment options are discussed including surgical resection procedures like the Whipple procedure or palliative options for unresectable tumors focusing on relieving jaundice, pain, or duodenal obstruction.
3. Complications of resection and palliative procedures are also summarized along with prognosis for different tumor types and stages.
This document discusses pain management strategies for chronic pancreatitis. It begins with an overview of chronic pancreatitis and the mechanisms of pain, including ductal and parenchymal hypertension, pancreatic neuropathy, and neuroplasticity.
Conservative management approaches are outlined first, including lifestyle changes, pancreatic enzyme supplementation, and analgesics like amitriptyline. Endoscopic options for managing pancreatic duct obstructions and stones are then covered, such as sphincterotomy, stenting, and extracorporeal shockwave lithotripsy. Surgical interventions like lateral pancreaticojejunostomy are discussed as later options for intractable pain or complications.
This document discusses three case studies of patients presenting with acute pancreatitis and its complications:
Case 1 involves a 56-year-old man with severe acute pancreatitis, respiratory failure, and multiple organ dysfunction. CT reveals pancreatic necrosis. Intensive care support is needed.
Case 2 involves a 61-year-old man whose acute pancreatitis is complicated by infection of pancreatic necrosis from bile duct stones. Surgery is eventually needed to debride necrotic tissue.
Case 3 involves a 45-year-old man whose acute pancreatitis is complicated by a pancreatic rupture and collection. Percutaneous drainage is initially done but surgery is later needed to drain solid necrotic debris from the collection. He develops a
The document discusses acute pancreatitis, including causes, clinical features, diagnosis, severity grading, management, and prognosis. Gallstones and alcohol are the most common causes. Scoring systems like Ranson criteria and APACHE II can help indicate severity and prognosis. Management involves treatment of the underlying cause, supportive care, and monitoring for complications like pancreatic necrosis which may require intervention.
Pancreatic cancer is the 10th most common cancer and the 4th leading cause of cancer death. 80% are adenocarcinomas from the exocrine pancreas. Risk factors include smoking, low fruit/vegetable intake, obesity, and family history. Symptoms are nonspecific but include jaundice, weight loss, and pain. Imaging like CT scans and endoscopic ultrasound are used to determine if tumors are resectable in 15-20% of patients. The Whipple procedure removes the pancreas head while distal pancreatectomy removes the body/tail. Adjuvant chemo may be given but 70-80% of patients still recur due to the pancreas' rich blood supply
The document discusses the center of gravity (CoG) and stability of objects. It defines CoG as the point where the entire weight of an object can be considered to act. For regular shapes, the CoG is at the geometric center. For irregular objects, methods are described to find the CoG using a plumb line and balance point. An object is stable when its CoG is directly above or within its base, and unstable if the CoG falls outside the base, allowing it to more easily rotate. Features like a low CoG and wide base promote stability.
This document summarizes acute pancreatitis (AP), including its causes, presentation, diagnosis, severity assessment, treatment, and complications. AP ranges from mild to severe and is commonly caused by gallstones or alcohol abuse. Clinically it presents with abdominal pain and elevated pancreatic enzymes. Imaging like CT can help determine severity and guide management, which involves supportive care, pain control, and treating any underlying conditions or complications like pancreatic necrosis. More severe cases may require antibiotics, minimally invasive drainage procedures, or surgery.
The pancreas develops from ventral and dorsal buds that fuse during gestation. It has both exocrine and endocrine functions. Acute pancreatitis is commonly caused by gallstones or alcohol and results from premature activation of pancreatic enzymes within the pancreas, leading to autodigestion. It can range from mild to severe, with severe cases involving hemorrhage and necrosis. Treatment is usually initially conservative but surgery may be needed for complications or failure to improve.
The document discusses acute pancreatitis, including its causes, signs and symptoms, methods of diagnosis, severity scoring systems, and approaches to treatment. It notes that acute pancreatitis can range from mild to severe and sometimes leads to complications like pancreatic pseudocysts or abscesses if not properly treated. Treatment involves pain management, fluid resuscitation, nutritional support, antibiotics if infected, and sometimes surgery for gallstone removal or infected necrosis.
1. The pancreas is an elongated organ located in the abdominal cavity behind the stomach. It has three parts - head, body, and tail.
2. The pancreas has both exocrine and endocrine functions. Exocrine functions include producing pancreatic juice containing enzymes that digest carbohydrates, proteins, and fats. Endocrine functions include production of insulin, glucagon, and somatostatin by islets of Langerhans cells.
3. Pancreatitis is inflammation of the pancreas that can be acute or chronic. Acute pancreatitis symptoms include severe abdominal pain and its causes include gallstones and alcohol use. Chronic pancreatitis involves long-term inflammation that destroys the pancreas over
The pancreas is a retroperitoneal organ divided into a head, neck, body, and tail. It has both exocrine and endocrine functions. The exocrine part secretes pancreatic juice to aid digestion, while the endocrine part contains islets of Langerhans that secrete insulin and glucagon. Pancreatitis is inflammation of the pancreas that can be acute or chronic. Acute pancreatitis commonly results from gallstones or alcohol and causes abdominal pain. Chronic pancreatitis is characterized by irreversible pancreatic tissue damage that can lead to diabetes and malnutrition over time. Treatment involves pain management, nutritional support, and sometimes surgery.
This document provides an overview of acute pancreatitis, including:
1. It discusses the pathophysiology of acute pancreatitis, including local effects within the pancreas and general systemic effects involving multiple organ systems.
2. The most common causes of acute pancreatitis are gallstones and alcohol consumption. Radiology findings and severity scores can help assess prognosis.
3. Treatment involves pain relief, fluid resuscitation for shock, and monitoring for complications like necrosis which may require drainage or necrosectomy.
The document summarizes key aspects of the accessory organs of the digestive system including the liver, gallbladder and bile ducts, and pancreas. It describes the anatomy, functions, common diseases, and nursing care considerations for conditions that can affect each organ system.
The document discusses pancreatitis, including defining acute pancreatitis as an inflammation of the pancreas that can range from mild edema to severe hemorrhagic necrosis. It outlines causes such as gallstones and alcohol, pathophysiology, clinical manifestations like abdominal pain and vomiting, potential complications, diagnostic tests, treatment including pain management and nutritional support, and discusses chronic pancreatitis.
Based on current evidence and guidelines, enforced bed rest is no longer recommended for acute pancreatitis. The goals of treatment are to provide pain management and fluid resuscitation, prevent/treat complications, and maintain adequate nutrition while minimizing pancreatic stimulation. Resting the gut by withholding oral intake until symptoms resolve is still recommended, but complete bed rest does not provide additional benefits and may even be harmful by risking complications from immobility. Nurses should focus on supportive care, monitoring for complications, and early mobilization as tolerated.
This document summarizes a presentation on acute pancreatitis. It begins with an overview of the anatomy of the pancreas and then discusses the etiology, pathophysiology, clinical approach, differential diagnosis, investigations, assessment of severity, management, and complications of acute pancreatitis. The two most common causes are gallstones and alcohol abuse. Clinically, it presents with abdominal pain and elevated pancreatic enzymes. Investigations include blood tests and imaging like ultrasound, CT, and MRI. Management involves treating the underlying cause, pain control, and monitoring for local complications like pseudocysts or systemic complications like respiratory failure.
Acute pancreatitis is inflammation of the pancreas that commonly results from gallstones or alcohol abuse. It requires hospital admission for intravenous fluids and pain management. The condition ranges from mild edema to severe necrosis and affects over 200,000 patients annually in the US. Diagnosis is based on abdominal pain and elevated pancreatic enzymes. Treatment focuses on fluid resuscitation, nutritional support to rest the pancreas, and managing complications.
The document discusses acute pancreatitis, defining it as inflammation of the pancreas induced by activation of pancreatic enzymes. It describes the various causes including biliary tract diseases, alcohol use, viral infections, drugs, trauma, and idiopathic causes. Symptoms include severe epigastric pain, nausea, vomiting, and fever. Laboratory tests can show elevated amylase and lipase levels. Treatment focuses on pain relief, fluid resuscitation, suppressing pancreatic enzymes, and treating complications such as pseudocysts and abscesses. Prognosis depends on factors like the Ranson score and presence of organ failure.
The document discusses the anatomy, physiology, histology, and various pathologies of the pancreas including acute and chronic pancreatitis, pancreatic neoplasms, and congenital abnormalities. It provides details on the etiology, pathophysiology, diagnosis, imaging, severity assessment, and differential diagnosis of acute pancreatitis. Key factors in assessing severity include clinical risk factors, scoring systems, biological markers, computed tomography severity index, and presence of necrosis.
Acute pancreatitis is caused by the activation of pancreatic enzymes within the pancreas, leading to its auto-digestion. The most common causes are gallstones and alcohol. Clinically, it presents with severe mid-epigastric pain radiating to the back along with nausea and vomiting. Investigations show elevated serum amylase and lipase along with imaging findings of pancreatic swelling. Treatment is supportive with bowel rest, IV fluids, pain control and monitoring for complications like necrosis, abscess, pseudocyst and respiratory failure. Severe necrotizing pancreatitis may require endoscopic or surgical drainage and debridement.
Acute pancreatitis is inflammation of the pancreas that results from premature activation of pancreatic enzymes within the pancreas. Common causes include gallstones, alcohol use, and elevated triglycerides. Symptoms include severe abdominal pain that radiates to the back, nausea, and vomiting. Diagnosis is based on elevated serum amylase and lipase levels. Treatment focuses on supportive care including pain management, intravenous fluids, and nutritional support. Complications can include pancreatic necrosis, pseudocyst formation, and multi-organ failure. Management of severe cases may require endoscopic or surgical intervention.
Acute pancreatitis is a condition where pancreatic enzymes leak into the pancreas and cause its auto-digestion. Common causes include gallstones, alcohol use, and idiopathic factors. Patients present with epigastric pain radiating to the back that is exacerbated by eating or lying down. Lab tests show elevated pancreatic enzymes and imaging shows changes to the pancreas. Treatment is supportive with NPO, IV fluids, pain control and monitoring for complications like necrosis, pseudocysts, shock and respiratory failure. Severe cases may require ERCP, surgery or drainage procedures.
This document provides an overview of chronic liver disease (CLD) including:
- CLD results from long-term inflammation and damage to the liver that can progress to cirrhosis over 6 months. Common causes include alcohol, viral hepatitis, fatty liver disease, and genetic/autoimmune conditions.
- Clinical manifestations range from asymptomatic to jaundice, abdominal pain/swelling, bleeding, confusion and liver failure. Complications include portal hypertension, ascites, hepatic encephalopathy and liver cancer.
- Investigations include blood tests of liver function and damage, imaging like ultrasound/CT, and biopsy. Prognosis is assessed using Child-Pugh or MELD scores. Management focuses on treating the underlying
This document provides an overview of pancreatitis and pancreatic pseudocysts. It defines acute and chronic pancreatitis, describes the pathogenesis involving premature activation of pancreatic enzymes, and lists common causes like gallstones. Signs and symptoms include abdominal pain while complications involve local issues like pseudocysts or systemic problems. Diagnosis involves blood tests, imaging, and assessing severity with tools like BISAP score. Management focuses on supportive care, treating underlying causes, and draining complications surgically or minimally invasively. Pseudocysts are pancreatic fluid collections that often resolve on their own but sometimes require intervention.
This document provides information on acute pancreatitis, including:
- It is a common cause of hospitalization in the US, with gallstones and alcohol responsible for 80-90% of cases.
- It ranges from mild to severe, with severe cases involving persistent organ failure lasting over 48 hours.
- CT imaging can identify necrosis which is associated with increased morbidity and mortality.
- The document discusses the etiology, pathogenesis, clinical assessment, management, and classifications of acute pancreatitis.
EWOCS-I: The catalog of X-ray sources in Westerlund 1 from the Extended Weste...Sérgio Sacani
Context. With a mass exceeding several 104 M⊙ and a rich and dense population of massive stars, supermassive young star clusters
represent the most massive star-forming environment that is dominated by the feedback from massive stars and gravitational interactions
among stars.
Aims. In this paper we present the Extended Westerlund 1 and 2 Open Clusters Survey (EWOCS) project, which aims to investigate
the influence of the starburst environment on the formation of stars and planets, and on the evolution of both low and high mass stars.
The primary targets of this project are Westerlund 1 and 2, the closest supermassive star clusters to the Sun.
Methods. The project is based primarily on recent observations conducted with the Chandra and JWST observatories. Specifically,
the Chandra survey of Westerlund 1 consists of 36 new ACIS-I observations, nearly co-pointed, for a total exposure time of 1 Msec.
Additionally, we included 8 archival Chandra/ACIS-S observations. This paper presents the resulting catalog of X-ray sources within
and around Westerlund 1. Sources were detected by combining various existing methods, and photon extraction and source validation
were carried out using the ACIS-Extract software.
Results. The EWOCS X-ray catalog comprises 5963 validated sources out of the 9420 initially provided to ACIS-Extract, reaching a
photon flux threshold of approximately 2 × 10−8 photons cm−2
s
−1
. The X-ray sources exhibit a highly concentrated spatial distribution,
with 1075 sources located within the central 1 arcmin. We have successfully detected X-ray emissions from 126 out of the 166 known
massive stars of the cluster, and we have collected over 71 000 photons from the magnetar CXO J164710.20-455217.
When I was asked to give a companion lecture in support of ‘The Philosophy of Science’ (https://shorturl.at/4pUXz) I decided not to walk through the detail of the many methodologies in order of use. Instead, I chose to employ a long standing, and ongoing, scientific development as an exemplar. And so, I chose the ever evolving story of Thermodynamics as a scientific investigation at its best.
Conducted over a period of >200 years, Thermodynamics R&D, and application, benefitted from the highest levels of professionalism, collaboration, and technical thoroughness. New layers of application, methodology, and practice were made possible by the progressive advance of technology. In turn, this has seen measurement and modelling accuracy continually improved at a micro and macro level.
Perhaps most importantly, Thermodynamics rapidly became a primary tool in the advance of applied science/engineering/technology, spanning micro-tech, to aerospace and cosmology. I can think of no better a story to illustrate the breadth of scientific methodologies and applications at their best.
Immersive Learning That Works: Research Grounding and Paths ForwardLeonel Morgado
We will metaverse into the essence of immersive learning, into its three dimensions and conceptual models. This approach encompasses elements from teaching methodologies to social involvement, through organizational concerns and technologies. Challenging the perception of learning as knowledge transfer, we introduce a 'Uses, Practices & Strategies' model operationalized by the 'Immersive Learning Brain' and ‘Immersion Cube’ frameworks. This approach offers a comprehensive guide through the intricacies of immersive educational experiences and spotlighting research frontiers, along the immersion dimensions of system, narrative, and agency. Our discourse extends to stakeholders beyond the academic sphere, addressing the interests of technologists, instructional designers, and policymakers. We span various contexts, from formal education to organizational transformation to the new horizon of an AI-pervasive society. This keynote aims to unite the iLRN community in a collaborative journey towards a future where immersive learning research and practice coalesce, paving the way for innovative educational research and practice landscapes.
Authoring a personal GPT for your research and practice: How we created the Q...Leonel Morgado
Thematic analysis in qualitative research is a time-consuming and systematic task, typically done using teams. Team members must ground their activities on common understandings of the major concepts underlying the thematic analysis, and define criteria for its development. However, conceptual misunderstandings, equivocations, and lack of adherence to criteria are challenges to the quality and speed of this process. Given the distributed and uncertain nature of this process, we wondered if the tasks in thematic analysis could be supported by readily available artificial intelligence chatbots. Our early efforts point to potential benefits: not just saving time in the coding process but better adherence to criteria and grounding, by increasing triangulation between humans and artificial intelligence. This tutorial will provide a description and demonstration of the process we followed, as two academic researchers, to develop a custom ChatGPT to assist with qualitative coding in the thematic data analysis process of immersive learning accounts in a survey of the academic literature: QUAL-E Immersive Learning Thematic Analysis Helper. In the hands-on time, participants will try out QUAL-E and develop their ideas for their own qualitative coding ChatGPT. Participants that have the paid ChatGPT Plus subscription can create a draft of their assistants. The organizers will provide course materials and slide deck that participants will be able to utilize to continue development of their custom GPT. The paid subscription to ChatGPT Plus is not required to participate in this workshop, just for trying out personal GPTs during it.
The debris of the ‘last major merger’ is dynamically youngSérgio Sacani
The Milky Way’s (MW) inner stellar halo contains an [Fe/H]-rich component with highly eccentric orbits, often referred to as the
‘last major merger.’ Hypotheses for the origin of this component include Gaia-Sausage/Enceladus (GSE), where the progenitor
collided with the MW proto-disc 8–11 Gyr ago, and the Virgo Radial Merger (VRM), where the progenitor collided with the
MW disc within the last 3 Gyr. These two scenarios make different predictions about observable structure in local phase space,
because the morphology of debris depends on how long it has had to phase mix. The recently identified phase-space folds in Gaia
DR3 have positive caustic velocities, making them fundamentally different than the phase-mixed chevrons found in simulations
at late times. Roughly 20 per cent of the stars in the prograde local stellar halo are associated with the observed caustics. Based
on a simple phase-mixing model, the observed number of caustics are consistent with a merger that occurred 1–2 Gyr ago.
We also compare the observed phase-space distribution to FIRE-2 Latte simulations of GSE-like mergers, using a quantitative
measurement of phase mixing (2D causticality). The observed local phase-space distribution best matches the simulated data
1–2 Gyr after collision, and certainly not later than 3 Gyr. This is further evidence that the progenitor of the ‘last major merger’
did not collide with the MW proto-disc at early times, as is thought for the GSE, but instead collided with the MW disc within
the last few Gyr, consistent with the body of work surrounding the VRM.
ESR spectroscopy in liquid food and beverages.pptxPRIYANKA PATEL
With increasing population, people need to rely on packaged food stuffs. Packaging of food materials requires the preservation of food. There are various methods for the treatment of food to preserve them and irradiation treatment of food is one of them. It is the most common and the most harmless method for the food preservation as it does not alter the necessary micronutrients of food materials. Although irradiated food doesn’t cause any harm to the human health but still the quality assessment of food is required to provide consumers with necessary information about the food. ESR spectroscopy is the most sophisticated way to investigate the quality of the food and the free radicals induced during the processing of the food. ESR spin trapping technique is useful for the detection of highly unstable radicals in the food. The antioxidant capability of liquid food and beverages in mainly performed by spin trapping technique.
Mending Clothing to Support Sustainable Fashion_CIMaR 2024.pdfSelcen Ozturkcan
Ozturkcan, S., Berndt, A., & Angelakis, A. (2024). Mending clothing to support sustainable fashion. Presented at the 31st Annual Conference by the Consortium for International Marketing Research (CIMaR), 10-13 Jun 2024, University of Gävle, Sweden.
Describing and Interpreting an Immersive Learning Case with the Immersion Cub...Leonel Morgado
Current descriptions of immersive learning cases are often difficult or impossible to compare. This is due to a myriad of different options on what details to include, which aspects are relevant, and on the descriptive approaches employed. Also, these aspects often combine very specific details with more general guidelines or indicate intents and rationales without clarifying their implementation. In this paper we provide a method to describe immersive learning cases that is structured to enable comparisons, yet flexible enough to allow researchers and practitioners to decide which aspects to include. This method leverages a taxonomy that classifies educational aspects at three levels (uses, practices, and strategies) and then utilizes two frameworks, the Immersive Learning Brain and the Immersion Cube, to enable a structured description and interpretation of immersive learning cases. The method is then demonstrated on a published immersive learning case on training for wind turbine maintenance using virtual reality. Applying the method results in a structured artifact, the Immersive Learning Case Sheet, that tags the case with its proximal uses, practices, and strategies, and refines the free text case description to ensure that matching details are included. This contribution is thus a case description method in support of future comparative research of immersive learning cases. We then discuss how the resulting description and interpretation can be leveraged to change immersion learning cases, by enriching them (considering low-effort changes or additions) or innovating (exploring more challenging avenues of transformation). The method holds significant promise to support better-grounded research in immersive learning.
4. The pancreas is situated in the retroperitoneum.
It is divided into a head, body and tail.
The head lies within the curve of the duodenum, overlying
the body of the second lumbar vertebra and the vena cava.
The aorta and the superior mesenteric vessels lie behind the
neck of the gland.
Coming off the side of the pancreatic head and passing to
the left and behind the superior mesenteric vein is the
uncinate process of the pancreas.
Behind the neck of the pancreas, near its upper border, the
superior mesenteric vein joins the splenic vein to form the
portal vein.
The tip of the pancreatic tail extends up to the splenic hilum.
5. The pancreas is a dual-function gland, having
features of both endocrine and exocrine glands.
The part of the pancreas with endocrine function is
made up of cell clusters called islets of Langerhans.
Four main cell types exist in the islets.
α alpha cells secrete glucagon (increase glucose in
blood), β beta cells secrete insulin (decrease
glucose in blood), Δ delta cells secrete somatostatin
(regulates/stops α and β cells) and PP cells, or γ
(gamma) cells, secrete pancreatic polypeptide.
6. The pancreas also functions as an exocrine
gland that assists the digestive system.
Exocrine cells make and release pancreatic
juice. The juice travels through the pancreatic
duct into the duodenum. Enzymes in the
pancreatic juice help digest fat, carbohydrates
and protein in food.
Pancreatic juice discharges into the duodenum
through ducts. It is alkaline as it
contains bicarbonate and chloride ions.
7.
8.
9. The pancreas receives parasympathetic nerve fibers
from the posterior vagal trunk via its celiac branch.
Sympathetic supply comes from T6-T10 via the
thoracic splanchnic nerves and the celiac plexus
10. Pancreatitis is inflammation of the gland
parenchyma of the pancreas.
Acute pancreatitis is defined as an acute
condition presenting with abdominal pain
and is usually associated with raised
pancreatic enzyme levels in the blood or
urine as a result of pancreatic inflammation.
Acute pancreatitis may recur.
11. ETIOLOGY
The two major causes of acute pancreatitis are
biliary calculi, which occur in 50–70 per cent of
patients, and alcohol abuse, which accounts
for 25 per cent of cases.
12. POSSIBLE CAUSES OF ACUTE PANCREATITIS
Gallstones
Alcoholism
Post-ERCP
Abdominal trauma
Following biliary, upper gastrointestinal or cardiothoracic
surgery
Ampullary tumour
Drugs (corticosteroids, azathioprine, asparaginase, valproic
acid, thiazides, oestrogens)
Hyperparathyroidism
Hypercalcaemia
Pancreas divisum
Autoimmune pancreatitis
Hereditary pancreatitis
Viral infections (mumps, Coxsackie B)
14. CLASSIFICATION
V All-russian convention of surgeons, 1978
Clinico-anatomical forms:
• Arching form
• Fatty pancreatonecrosis
• Hemorrhagic pancreatonecrosis
Prevelence of necrosis:
• Local(focus) damage of gland
• Subtotal dmage of the gland
• Total damage of the gland
Accordng to progress:
• Abortive
• progressive
Periods of disease:
• Hemodynamic violations and pancreatogenic shock
• Functional insufficiency of parenchymatous organ
• Degenerative and suppuration complication
15. PATHOGENESIS OF ACUTE PANCREATITIS
Interstitial oedema
Impaired blood flow
Ischaemia
Acinar cell injury
Interstitial inflammation
oedema
Gallstone
Chronic alcoholism
Release of intracellular
proenzymes and
lysosomal hydrolases
Activation of enzymes
ACTIVATED ENZYMES
Delivery of proenzymes to
lysosomal compartment
Intracellular activation of
enzymes
Proteolysis
(proteases)
Fat necrosis
(lipase, phospholipase)
Haemorrhage
(elastase)
Alcohol, drugs
trauma, ischaemia,
viruses
Metabolic injury
(experimental)
Alcohol, duct obstruction
DUCT OBSTRUCTION ACINAR CELL INJURY DEFECTIVE INTRACELLULAR
TRANSPORT
16.
17.
18. • Autodigestion is a currently accepted pathogenic theory; according
to it, pancreatitis results when proteolytic enzymes (e.g.,
trypsinogen, chymotrypsinogen, proelastase, and lipolytic enzymes
such as phospholipase A 2 ) are activated in the pancreas rather than
in the intestinal lumen. A number of factors (e.g., endotoxins,
exotoxins, viral infections, ischemia, anoxia, lysosomal calcium,
and direct trauma) are believed to facilitate activation of trypsin.
Activated proteolytic enzymes, especially trypsin, not only digest
pancreatic and peripancreatic tissues but also can activate other
enzymes, such as elastase and phospholipase A 2 .
• Spontaneous activation of trypsin also can occur.
• Activation of pancreatic enzymes in the pathogenesis of acute pancreatitis.
• Theory of “general duct” with the reflux of bile into the ducts of pancreas.
• Theory of blockade of outflow of pancreatic juice with the development of
intraductal hypertension and penetration of secret into the interstial tissue.
• Violation of blood flow of pancreatic juice (vasculitis, thrombophelibitis, and
embolism).
• Toxic and allergic damage of gland.
19. PATHOMORPHOLOGY
•The process of acute inflamation of pancreas passes through the
stages of edema,pancreatonecrosis and suppuration
•Edema : Hyperemia, increased in volume, with shallow nodes of
necrosis .
•Pancreatonecrosis can be fatty or hemorrhagic character (shows
whitish yellow necrosis).
•Dystrophy : its exposed microscopically .
•Necrosis: hemorrhages, thrombosis of vessels and signs of
inflammatory.
23. SIGNS AND
SYMPTOMS
Main symptoms :
• Upper abdominal pain that radiates into the back. It may
be aggravated by eating, especially foods high in fat.
• Swollen and tender abdomen
• Nausea and vomiting (coffee ground appearence)
• Fever
• Increased heart rate
24. Additional symptoms:
• Weight loss caused by poor absorption (malabsorption) of
food.
• This malabsorption happens because the gland is not
releasing enough enzymes to break down food.
• Also, diabetes may develop if the insulin-producing cells
of the pancreas are damaged.
• Severe intoxication
25. CULLEN SIGN – DISCOLOURATION AROUND
UMBILICUS
Grey-Turner sign- discolouration in the flanks
26. • The abdominal is distended, peristaltic sounds inaudible.
• The signs of paresis of stomach and intestine appears
early.
• On palpation tenderness in the epigastria area and in
right and some times in the left hypochondria also
marked.
*
27. Complication:
Early
• Shock
• Acute cardiac, pulmonary, hepatic insufficiency
Late
• Abscess of pancreas
• Subdiaphargmatic, interintestinal abscesses
• Pyogenic abscesses of omentum
• Phelgmons of retro peritoneal space.
• Erosive bleeding.
29. predicting the severity of acute pancreatitis:
At admission
age in years > 55 years
white blood cell count > 16000 cells/mm3
blood glucose > 11 mmol/L (> 200 mg/dL)
serum AST > 250 IU/L
serum LDH > 350 IU/L
At 48 hours
Calcium (serum calcium < 2.0 mmol/L (< 8.0 mg/dL)
Hematocrit fall > 10%
Oxygen (hypoxemia PO2 < 60 mmHg)
BUN increased by 1.8 or more mmol/L (5 or more mg/dL) after IV fluid hydration
Base deficit (negative base excess) > 4 mEq/L
Sequestration of fluids > 6 L
30. Score 0 to 2 : 2% mortality Score 3 to 4 : 15% mortality
Score 5 to 6 : 40% mortality Score 7 to 8 : 100%
mortality
Hemorrhagic peritoneal fluid
Obesity
Indicators of organ failure
Hypotension (SBP <90 mmHG) or tachycardia > 130
beat/min
PO2 <60 mmHg
Oliguria (<50 mL/h) or increasing BUN and creatinine
Serum calcium < 1.90 mmol/L (<8.0 mg/dL)
serum albumin <33 g/L (<3.2.g/dL)>
31. Balthazar Grade
Balthazar Grade Appearance on CT CT Grade Points
Grade A Normal CT 0
points
Grade B Focal or diffuse enlargement of the pancreas 1
point
Grade C Pancreatic gland abnormalities and peripancreatic inflammation
2points
Grade D Fluid collection in a single location 3
points
Grade E Two or more fluid collections and / or gas bubbles in or adjacent to
pancreas4points
Necrosis Score
Necrosis Percentage Points
No necrosis 0 points
0 to 30% necrosis 2 points
30 to 50% necrosis 4 points
Over 50% necrosis 6 points
The numerical CTSI (Computed Tomography Severity Index) has a maximum of
ten points, it is the sum of the Balthazar grade points and pancreatic necrosis
grade points
32. Diagnostic criteria:
Blood test
Urine test
Biochemical test (amylase, bilirubin, sugar)
Ultrasound
CT scan
Cholecystocholangiography
Endoscopic retrograde cholangiopancreatgraphy
Laparoscopy
Laprocentesis
34. LIVER ENZYMES :
Determine alkaline phosphatase, total bilirubin, aspartate aminotransferase (AST), and
alanine aminotransferase (ALT) levels to search for evidence of gallstone pancreatitis. An
ALT level higher than 150 U/L suggests gallstone pancreatitis and a more fulminant disease
course.
Obtain measurements for blood urea nitrogen (BUN), creatinine, and electrolytes; a great
disturbance in the electrolyte balance is usually found, secondary to third spacing of fluids.
Measure blood glucose level because it may be elevated from B-cell injury in the pancreas.
Measure calcium, cholesterol, and triglyceride levels to search for an etiology of
pancreatitis (eg, hypercalcemia or hyperlipidemia) or complications of pancreatitis (eg,
hypocalcemia resulting from saponification of fats in the retroperitoneum). However, be
aware that baseline serum triglyceride levels can be falsely lowered during an episode of
acute pancreatitis.
Elevated serum amylase and lipase levels, in combination with severe abdominal pain,
often trigger the initial diagnosis of acute pancreatitis.
Serum lipase rises 4 to 8 hours from the onset of symptoms and normalizes within 7 to 14
days after treatment.
Serum amylase may be normal (in 10% of cases) for cases of acute or chronic pancreatitis
(depleted acinar cell mass) and hypertriglyceridemia.
Reasons for false positive elevated serum amylase include salivary gland disease (elevated
salivary amylase), bowel obstruction, infarction, cholecystitis, and a perforated ulcer.
If the lipase level is about 2.5 to 3 times that of amylase, it is an indication of pancreatitis
due to alcohol.[9]
Decreased serum calcium
35. Ultrasound exam:
Increase in size of pancreas, thickening
of walls and presence or absence of
calculus of gall bladder and common
bile duct.
42. CONSERVATIVE TREATMENT:
Fluid replacement:
Aggressive hydration at a rate of
5 to 10 mL/kg per hour of isotonic
crystalloid solution (e.g., normal
saline or lactated Ringer’s
solution) to all patients with acute
pancreatitis.
Pain control:
1. Opioids are safe and effective
at providing pain control in
patients with acute
pancreatitis.
2. Hydromorphone or fentanyl (I
ntravenous) may be used for
pain relief in acute pancreatitis
43. Etiological treatment:
1. Antibiotic, antiviral drugs in
case of etiology is bacteria or
virus.
2. Carbapenems 0.5 gram
intravenously every eight
hours for two weeks.
Anticholinergic
drug(atropine sulphate,
methacin)
H2-histamine
drug(cimetidine, ranisan,
ranitidine)
45. Sphincterotomy. Using a small wire on the endoscope, the doctor
finds the muscle that surrounds the pancreatic duct or bile ducts and
makes a tiny cut to enlarge the duct opening. When a pseudocyst is
present, the duct is drained.
Gallstone removal. The endoscope is used to remove pancreatic or
bile duct stones with a tiny basket. Gallstone removal is sometimes
performed along with a sphincterotomy.
Stent placement. Using the endoscope, the doctor places a tiny piece
of plastic or metal that looks like a straw in a narrowed pancreatic or
bile duct to keep it open.
Balloon dilatation. Some endoscopes have a small balloon that the
doctor uses to dilate, or stretch, a narrowed pancreatic or bile duct. A
temporary stent may be placed for a few months to keep the duct
open.
People who undergo therapeutic ERCP are at slight risk for
complications, including severe pancreatitis, infection, bowel
perforation, or bleeding. Complications of ERCP are more common in
people with acute or recurrent pancreatitis. A patient who experiences
fever, trouble swallowing, or increased throat, chest, or abdominal pain
after the procedure should notify a doctor immediately.