Pancreatitis and its Complications, and Acute Cholangitis

2. Pancreatitis
Adeel Abbas Dhahri
Nourelhuda Darwish

4. Anatomy

7. Physiology
• Exocrine gland
• Digestive enzymes
• Amylase
• Lipase
• Trypsin
• Peptidase
• Endocrine gland
• Glucagon
• Insulin

8. Pancreatitis
• Causes?
• I GET SMASHED

9. Pancreatitis
• Symptoms & Signs?
• Epigastric pain – frequently radiates to back (patient can’t lie at back)
• Nausea & Vomiting
• Epigastric tenderness/ Diffuse abdominal tenderness
• Ileus
• Fever
• Dehydration/ Shock

10. Pancreatitis
• Differential Diagnosis
• PUD
• Perforation
• Acute cholecystitis
• Mesenteric ischemia
• Ruptured AAA
• Small bowel obstruction
• Biliary Colic
• MI
• Pneumonia

11. Pancreatitis
• Investigations?

12. Pancreatitis
• Investigations?
• FBC
• LFT
• Amylase/ Lipase
• ABG
• Serum Calcium
• Coagulation
• G&S

13. Pancreatitis
• Investigations?

14. Pancreatitis
• Investigations?

15. Pancreatitis
• Investigations?

16. Pancreatitis
• Glasgow Score
• Ranson’s Criteria

17. Pancreatitis
• Management
• PANCREAS
• P
• A
• N
• C
• R
• E
• A
• S

18. Pancreatitis
• Complications?
• Pseudocyst
• Abscess
• Necrosis
• ARDS
• Sepsis/ MODS/ DIC
• Diabetes
• Chronic pancreatitis

19. Gallstone Pancreatitis
• Diagnosis?
• Definitive Treatment?
• ERCP
• Cholecystectomy
• ‘Index surgery’

20. Haemorrhagic Pancreatitis
• Special Clinical Feature?

21. Pancreatic Abscess
• Clinical Features?
• Treatment?

22. Pseudocyst Pancreas
• Pseudo Wall…
• Treatment?
• Observation
• Resolves in about 50%
• Drainage
• Wait for 6 weeks
• Size
• Surgery

23. Cholangitis
• Most common cause is ….
• Charcot’s Triad?
• Treatment?

24. Recap

25. • What is/ are most common cause of Acute Pancreatitis?
• What are the special signs of haemorrhagic pancreatitis?
• Which score to assess severity of gall-stone pancreatitis?

26. • When you do CT in acute pancreatitis?
• Will you advise patient to be Nil By Mouth when managing
pancreatitis?

27. • What is the definitive treatment of gall-stone pancreatitis?
• What is the treatment of acute cholangitis?
• When you advise drainage in pancreatic pseudocyst?