Shorts about acute pancreatitis

1. PANCREATITIS
Dr. Nazmul Azam
Registrar
Department of Surgery
TMC & RCH.
Presented By
2022
1st August

2. Anatomy of
Pancreas
In Greek Pan - all; Kreas-flesh/ meat.
Name
Pancreas is an elongated retroperitoneal organ;
15-20 cm in length; lies against L1–L2 vertebra. It
lies posterior to stomach, separated by lesser sac.
Basic Anatomy

3. Anatomy of
Pancreas
It is divided into head, neck, body, tail.
Parts
1. Main duct of pancreas (Duct of Wirsung).
2. Accessory pancreatic duct (Duct of Santorini)
Ducts of Pancreas

4. Functions
of
Pancreas
Secretes pancreatic juice which helps
in digestion of proteins,
carbohydrates and fats.
Constitutes islets of pancreas which is
distributed more numerous in tail of
pancreas.
Alpha cells of islets secrete insulin.
Beta cells secrete glucagon.
Exocrine
Endocrine

5. Pancreatiti
s
Pancreatitis is inflammation of the
pancreatic parenchyma.

6. Calcificati
on
A. Marseilles’ classification:
1. Acute pancreatitis.
2. Acute relapsing pancreatitis.
3. Chronic relapsing pancreatitis.
4. Chronic pancreatitis.
B. Trapnell’s aetiological classification:

7. ACUTE
PANCREATITIS
Acute pancreatitis is defined as an acute
condition presenting with abdominal pain, a three
fold or greater rise in the serum levels of the
pancreatic enzymes amylase or lipase, and or
characteristic findings of pancreatic inflammation
on contrast-enhanced CT.

8. Pathogenesis

9. Classification of
Acute pancreatitis
Atlanta classification of acute pancreatitis recommends that patients with acute pancreatitis be
stratified into 3 groups
● no organ failure.
● no local or systemic complications.
● organ failure that resolves
within 48 hours (transient organ
failure); and/or
● local or systemic complications
without persistent organ failure.
● persistent organ failure (>48
hours);
● single organ failure;
● multiple organ failure.
Moderately severe
Mild Severe

10. Clinical
Features
Symptoms

11. Clinical
Features
Symptoms

12. Differential
Diagnosis

13. Investigation
s
?
?
?

14. Investigatio
ns
S. amylase
1 S. Calcium
6
S. Lipase
2 Amylase
creatinine ratio
7
Blood Urea
3 S.
lactescence
8
Plain X-ray
1
1
USG of W/A
1
2
Spiral CT
1
3
S. Creatinine
4 S. trypsin
9
Blood
Glucose
5 LFT
1
0
MRI, MRCP
1
4
ERCP, CXR
1
5

15. X-ray Findings

16. ERCP in Acute
Pancreatitis

17. 1
Acute abdominal pain and tenderness in the upper abdomen
Elevated levels of pancreatic enzymes in blood, urine, or
ascitic fluid
The presence of abnormal imaging findings in the
pancreas that are associated with acute pancreatitis
2
3
Diagnostic
Criteria

18. ASSESSMENT OF SEVERITY
M E D I C A L T R E A T M E N T
P R E S E N T A T I O N
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19. CT Severity
Score
The CT severity index is the sum
of the scores obtained with the
Balthazar score and those
obtained with the evaluation of
pancreatic necrosis:
0-3: mild acute pancreatitis
4-6: moderate acute pancreatitis
7-10: severe acute pancreatitis

20. Treatment of
Pancreatitis

21. P
1. Pain Relief
2. Plasma
3. Protease
Inhibitor
Mnemonic
‘PANCREAS’
Treatment
Conservative
S
E
R
C
N
A
A
1. Antibiotics
2. Anticholenergics
1. NG Suction
2. Nasal O2
3. Nutritional
Support
1. Ca-Gluconate
2. Clacitonin
3. CVP Line
1. Rehydration
2. Respiratory
Supp.
3. Resuscitation
1. ET intubation
2. Electrolytes
Managements
1. Antacids
1. Swan-Ganz Catheter
2. Somatostatin &
analogue

22. 1
If condition of patient deteriorates in spite of good
conservative treatment.
If there is formation of pancreatic abscess, or infected
necrosis.
In severe necrotizing pancreatitis as a trial to save the
life of the patient which has got very high mortality
2
3
Surgery
Indications

23. Open surgery is the gold standard for infected pancreatic necrosis.
Necrosectomy
- Closed continuous lavage.
- Closed drainage.
- Open packing.
- Closure and relaparotomy
Surgery

24. Complications

25. Pain
Fluid & Electrolytes imbalance
Metabolic disturbance
Multiorgan failure
Infection of:
- Pancreatic Necrosis
- Fluids collections
Pseudocyst Formation
Complications
0 Week 1 >6 Weeks
Week 2-6

26. THANKS.