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Acute Pancreatitis
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Acute Pancreatitis

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  • 1. Acute pancreatitis
  • 2.
    • Exocrine
    • -P roduces enzymes t hat break down breakdown of the carbohydrates , protein and fat
    • Endocrine
    • Producing several important hormones, including insullin , glucagon
    Function
  • 3.
    • Acute inflammation of the pancreas
    • Varying degree of regional tissue involvement and remote organ systems
    • Classified as acute unless there is evidence of chronic pancreatitis, otherwise considered as exacerbation of inflammation superimposed on chronic pancreatitis
    What is pancreatitis ?
  • 4.
    • Other ( 10 % ) => include
      • Trauma
      • Postendoscopic retrograde cholangiopancreatography
      • Pancreatic malignancy , PUD ,IBD
    • Medications
      • Thizide Tetracycline Sulphonamid Croticosteroide
      • Metabolic
      • - Hypertriglyceridemia ,Hypercalcemia
    • Infectious
      • -Viral , Bacterial , Parasitic
    Causes of Acute Pancreatitis
    • Gall stone (45 % )
    • Ethanol abuse (Alcohol )
    • (35 %)
    • Idiopathic ( 10 % )
  • 5. Clinical Presentation
    • Epigastric pain or Upper abdominal / Diffuse abdominal pain with radiation to back
    • Nausea & Vomiting
    • Fever
    • Nausea and V omiting
    • Tachycardia
  • 6.
    • Decreased or absent bowel sounds
    • Abdominal tenderness , Guarding
    • Jaundice if there’s obstruction of the bile duct
    • Cullen’s sign
    • Grey Turner’s Sign
    Abdominal Examination
  • 7.
    • Grey-Turner’s sign
    • ( H emorrhagic d iscoloration of the flanks)
  • 8.
    • Cullen’s sign
    • ( Hemorrhagic discoloration of the umbilicus )
  • 9.
    • Physical examination
    • Investigation
    Pancreatitis Diagnosis
  • 10.
      • Marker of pancreatitis injury
      • Serum amylase
      • Most accurate when at least twice the upper limit of normal; amylase levels and sensitivity decrease with time from onset of symptoms
      • Serum Lipase
      • Increased sensitivity in alcohol-induced pancreatitis; more specific and sensitive than amylase for detecting acute pancreatitis
    Laboratory Investigation
  • 11.
    • Marker of biliary tract involvement
    • Alanine aminotransferase ( ALT )
    • Elevate in gallstone pancreatitis
    • Other
    • - C - reactive protein (CRP )
    • ( Predictive of severity Late marker )
    • H igh levels associated with pancreatic necrosis
  • 12.
    • Plain Films Abdomen & CXR
      • Localized segment of small intestine (“sentinel loop”)
      • Generalize ileus
      • Calcifications (stones, or pancreas with chronic calcific pancreatitis)
      • Pneumobilia following stone passage and/or bilioenteric fistula formation
      • Severe ascites
      • Retroperitoneal gas (pancreatic abscess)
      • 30% with CXR abnormalities (elevated hemidiaphragm, pleural effusion, basal atelectasis, pulmonary infiltrates)
    Radiological Findings
    • Abdominal ultrasound
      • Cholelithiasis, biliary sludge, bile duct dilation, and pseudocysts
    • CT of abdomen
    • MRCP
    • (Magnetic resonance cholangiopancreatography)
  • 13. Other testing will reveal……
    • Urine amylase increased for 1-2 weeks
    • Elevated WBC
    • Decreased serum calcium
    • Elevated serum bilirubin, AST, ALT, LD, and alkaline phosphatase
    • Serum triglycerides >150mg/dl
  • 14.
    • Pulmonary
      • Atelactasis
      • Pleural effusions
      • ARDS
    • Cardiovascular
      • Cardiogenic shock
    • Neurologic
      • Pancreatic encephalopathy
    • Metabolic
      • Metabolic acidosis
      • Hypocalcemia
      • Altered glucose metabolism
    • Hematologic
      • GI bleeding
    • Renal
      • Prerenal failure
    Common Complications of Acute Pancreatitis
  • 15.
    • If not improve
    • If infected pancreatic necrosis
    Anti - inflammatory & Antisecretory agents drug Treatment . Mild Acute Pancreatitis Severe Pancreatitis (pancreatic necrosis or infected) Supportive Care Antibiotic iv
      • - I.V. fluid resuscitation
      • -Nutritional support
      • -Analgesia
    Fine needle aspiration (FNA ) Percutaneous Drainage
  • 16. Antibiotic in Acute Pancreatitis
    • I mipenem-cilastin 500 mg iv 8 hr x 2 wks
    • Q uinolone group ( C iprofloxacin or O floxacin ) ร่วมกับ M etronidazole
    • T hird generation cephalosporin
    • ( C efotaxime ) ร่วมกับ M etronidazole
  • 17.
    • M ild acute pancreatitis ไม่ได้เป็นข้อบ่งชี้ในการทำ surgery
    • ควรทำ FNA เพื่อใช้ในการแยกระหว่าง sterile และ infected pancreatic necrosis ในผู้ป่วยที่มีอาการ sepsis
    • การใช้ P rophylactic antibiotic สามารถลดอัตราการติดเชื้อแต่ไม่ลด survival
    Guideline for management of acute pancreatitis
  • 18.
    • Infected pancreatic necrosis ที่มีอาการของ sepsis เป็นข้อบ่งชี้ในการทำ surgery และ Radiological drainage
    • ผู้ป่วยที่เป็น sterile necrosis ( FNA negative) ควรได้รับการรักษาแบบ conservative
    • ไม่แนะนำให้ทำการผ่าตัดในช่วง 14 วันแรกหลังจากมีอาการในผู้ป่วย necrotizing pancreatitis