Acute pancreatitis, a quick glance at the definition, imaging, differential diagnosis and treatment. Also includes imaging and Ronson's criteria explained.

1. Acute
Pancreatitis
Aparajeya Shanker
Faculty of Medicine,
Medical University Pleven
aparajeya.com

2. Definition
Acute
Pancreatitis
Topics to be discussed:
Symptoms and Signs
Differential Diagnosis
Causes
Laboratory Analysis
Imaging
Treatment
Prognostic Criteria

3. Acute Pancreatitis is the
inflammation of the pancreas,
characterized by epigastric pain
and elevated pancreatic
enzyme levels
Definition

4. Idiopathic
Gallstones
Ethanol
Trauma
Scorpions
Mumps
Autoimmune
Steroids
Hypercalcemia
ERCP
Drugs
Causes
Hyperlipidemia
Mnemonic: I GET SMASHHED

5. Azathioprine
Sulfonamides
Sulindac
Tetracycline
Valproic Acid
Didanosine
Methyldopa
Estrogens
6-Mercaptopurine
5-aminosalicylic acid
drugs
Octreotide
Drugs that cause pancreatitis
Furosemide
Note: These drugs are the ones confirmed with data to definitely
cause Acute pancreatitis. Other drugs are either suspected or are only
case reports
Corticosteroids

6. Pathogenesis
AUTODIGESTION OF PANCREATIC CELLS BY PANCREATIC ZYMOGENS
Gallstone
obstruction
Blocks the ampulla of
Vater
Accumulation of
pancreatic
zymogens
They cannot be
drained into the
duodenum
Activation of
pancreatic
trypsin
Causes autodigestion
of pancreatic cell
membranes
Stasis and Reflux
of Bile into Bile
duct

7. Signs and Symptoms
Epigastric pain that
might radiate to the back
Nausea and Vomiting
Epigastric tenderness
Diffuse abdominal
tenderness
Decreased abdominal
sounds (adynamic ileus)
Fever
Dehydration/Shock
Symptoms Signs

8. Differential
Diagnosis
01 GASTRITIS
02
03
04
05
PERFORATED VISCUS
ACUTE CHOLECYSTITIS
SHORT BOWEL OBSTRUCTION
MESENTERIC ISCHEMIA/INFARCTION
06
RUPTURED AORTIC ARTERY
ANEURYSM
07
08
09
10
BILIARY COLIC
INFERIOIR MI
PNEUMONIA
PEPTIC ULCER DISEASE

9. Laboratory
Analyses
COMPLETE BLOOD COUNT
WHITE BLOOD CELLS ELEVATED
LIVER FUNCTION TESTS
AST>250
SERUM AMYLASE AND LIPASE
HIGH
ARTERIAL BLOOD GASES COAGULATION
SERUM LIPIDS
LACTATE DEHYDROGENASE
BILE UREA NITROGEN (BUN)
>5MG/DL IN THE 1ST 48H
GLUCOSE
>200
CALCIUM
<8
C-REACTIVE PROTEIN

10. AXR WILL SHOW THE
PRESENCE OF SENTINEL
LOOPS
A C
Imaging
ABDOMINAL X-RAYS
A SENTINEL LOOP IS A
SHORT SEGMENT OF
ADYNAMIC ILEUS
CLOSE TO AN INTRA-
ABDOMINAL
INFLAMMATORY
PROCESS.
COLON CUT OFF PRESENT

11. PHLEGMON
PHLEGMON IS AN AREA
OF SOFT TISSUE
INFLAMMATION
A
Imaging
ULTRASOUND

12. NPO
TREATMENT
IV FLUIDS (RINGER'S LACTATE UNLESS HYPERCALCEMIA,
OTHERWISE NORMAL SALINE IS ALSO SUFFICIENT)
NGT
TOTAL PARENTERAL NUTRITION WITH POSTPYLORIC
TUBE FEEDS
H2 BLOCKERS/PPI
CORRECTION OF ELECTROLYTES AND COAGULATION
FACTORS
DEMEROL FOR ANALGESIA (AVOID MORPHINE, DUE TO
SPHINCTER OF ODDI CONSTRICTION)

13. RANSON'S CRITERIA
PROGNOSTIC CRITERIA
AT PRESENTATION
AGE > 55
WBC> 16,000
GLUCOSE>200
AST>250
LDH>350
INITIAL 48 HOURS
BASE DEFICIT>4
WBC> 16,000
BUN INCREASE>5MG/DL
FLUID SEQUESTRATION>6L
SERUM CALCIUM <8
HCT DECREASE >10%
PO2 <60 MM HG
EACH CRITERIA IS
WORTH 1 POINT
MORTALITY
0 TO 2: <5%
3 TO 4: 15%
5 TO 6: 40%
7 TO 8: 100%

14. THANK YOU
Email Address
APARAJEYA247SHANKER@GMAIL.COM
Website
APARAJEYA.COM