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Pancreatitis crónica

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Pancreatitis crónica

  1. 1. PancreatitisPancreatitis CrónicaCrónica
  2. 2. PANCREATITIS CRONICAPANCREATITIS CRONICA EpidemiologíaEpidemiología •La verdadera incidencia y prevalencia de la pancreatitis crónica no es bien conocida aunque su frecuencia ha aumentado en las últimas décadas. •Se estima que la incidencia de la pancreatitis crónica se sitúa en torno a 6,7 casos para hombres y 3,5 para mujeres cada 100.000 habitantes en el mundo, causado principalmente por el consumo continuado de alcohol.
  3. 3. Pancreatitis CrónicaPancreatitis Crónica Enfermedad Inflamatoria • Crónica • Irreversible
  4. 4. PANCREATITIS CRONICAPANCREATITIS CRONICA ETIOLOGIAETIOLOGIA • Alcohólica (70%)Alcohólica (70%) • No alcohólicaNo alcohólica - Tropical- Tropical (nutricional)(nutricional) - Hereditaria- Hereditaria - Metabólica- Metabólica (hipercalcemia)(hipercalcemia) - Autoinmune- Autoinmune - Idiopática- Idiopática
  5. 5. Chronic Pancreatitis and Pancreatic Exocrine Insufficiency: Tigar-O Classification System  Toxic-metabolic  Alcoholic  Tobacco smoking  Hypercalcemia  Hyperlipidemia  Chronic renal failure  Medications—phenacetin abuse  Toxins—organotin compounds (e.g., DBTC)  Idiopathic  Early onset  Late onset  Tropical  Genetic  Hereditary pancreatitis  Cationic trypsinogen  PRSS1  PRSS2  CFTR mutations  SPINK1 mutations  Autoimmune  Isolated autoimmune chronic pancreatitis  Autoimmune chronic pancreatitis associated with Sjögren's syndrome  Inflammatory bowel disease  Primary biliary cirrhosis  Recurrent and Severe Acute Pancreatitis  Postnecrotic (severe acute pancreatitis)  Recurrent acute pancreatitis  Vascular diseases/ischemia  Postirradiation  Obstructive  Pancreas divisum  Sphincter of Oddi disorders (controversial)  Duct obstruction (e.g., tumor)  Preampullary duodenal wall cysts  Posttraumatic pancreatic duct scars Abbreviations: DBTC, dibutylin dichloride; TIGAR-O, toxic-metabolic, idiopathic, genetic, autoimmune, recurrent and severe acute pancreatitis, obstructive.
  6. 6. Pancreatitis autoinmune Características clínicas
  7. 7. Pancreatitis CrónicaPancreatitis Crónica I- Daño anatómicoI- Daño anatómico II- Daño funcionalII- Daño funcional
  8. 8. Pancreatitis CrónicaPancreatitis Crónica - Células ascinares - Conductos pancreáticos I- Daño anatómicoI- Daño anatómico
  9. 9. • Conductos pancreáticos: • presencia de cálculos • tortuosidad • dilatación • Parénquima: • zonas de fibrosis DOLOR CRONICO
  10. 10. Pancreatitis CrónicaPancreatitis Crónica II.- Daño funcionalII.- Daño funcional • Insuficiencia pancreática exócrina •Insuficiencia pancreática endócrina
  11. 11. PANCREATITIS CRONICAPANCREATITIS CRONICA Cuadro ClínicoCuadro Clínico Dolor INSUFICIENCIA PANCREATICA EXOCRINA INSUFICIENCIA PANCREATICA ENDOCRINA
  12. 12. PANCREATITIS CRONICAPANCREATITIS CRONICA Cuadro ClínicoCuadro Clínico Dolor DIARREA CRONICA S A I D INSUFICIENCIA PANCREATICA EXOCRINA
  13. 13. PANCREATITIS CRONICAPANCREATITIS CRONICA Cuadro ClínicoCuadro Clínico Dolor INSUFICIENCIA PANCREATICA EXOCRINA INSUFICIENCIA PANCREATICA ENDOCRINA DIABETES
  14. 14. PANCREATITIS CRONICAPANCREATITIS CRONICA Cuadro ClínicoCuadro Clínico • Dolor • Pérdida de peso • DIARREA CRONICA • DIABETES MELLITUS
  15. 15. PANCREATITIS CRONICAPANCREATITIS CRONICA DiagnósticoDiagnóstico • T A C •US Endoscópico • CPRE - sensibilidad – 90% - especificidad – 100%
  16. 16. DiagnósticoDiagnóstico
  17. 17. DiagnósticoDiagnóstico
  18. 18.  A. Chronic pancreatitis and pancreatic calculi: CT scan. In this contrast-enhanced CT scan of the abdomen, there is evidence of an atrophic pancreas with multiple calcifications and stones in the parenchyma and dilated pancreatic duct (arrow).  B. In this contrast-enhanced CT scan of the abdomen, there is evidence of an atrophic pancreas with multiple calcifications (arrows). Note the markedly dilated pancreatic duct seen in this section through the body and tail (open arrows).
  19. 19.  C. Chronic pancreatitis on MRCP: dilated duct with filling defects. Gadolinium-enhanced MRI/MRCP reveals a dilated pancreatic duct (arrow) in chronic pancreatitis with multiple filling defects suggestive of pancreatic duct calculi.
  20. 20. Algoritmo diagnósticoAlgoritmo diagnóstico
  21. 21. PANCREATITIS CRONICAPANCREATITIS CRONICA TratamientoTratamiento • Abstinencia de alcohol •Al no conocer la etiología, el tratamiento es sintomático •La abstinencia total de alcohol no previene la progresión de la enfermedad, pero disminuye dramáticamente las complicaciones y mejora el pronóstico.
  22. 22. PANCREATITIS CRONICAPANCREATITIS CRONICA TratamientoTratamiento • MANEJAR DOLOR •Analgésicos y/o antiespasmódicos •El dolor incontrolable, es la indicación más frecuente de intervenciones invasivas •Descompresión o resección
  23. 23. PANCREATITIS CRONICAPANCREATITIS CRONICA TratamientoTratamiento • Dieta • Enzimas pancreáticas • Bloquear la acidez gástrica
  24. 24. PANCREATITIS CRONICAPANCREATITIS CRONICA PronósticoPronóstico • Ésta es una enfermedad grave que puede conducir a la incapacidad o a la muerte. El riesgo puede reducirse evitando el consumo de alcohol.
  25. 25. PANCREATITIS CRONICAPANCREATITIS CRONICA ReferenciasReferencias • Principios de Medicina Interna. Harrison. Mc Graw Hill. 2012

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