This document provides information about pancreatitis, including: - It defines pancreatitis as inflammation of the pancreatic parenchyma and can be acute or chronic. Acute pancreatitis has various causes and presents with severe abdominal pain. - Chronic pancreatitis is an irreversible inflammatory disease that destroys the pancreas over many years, mainly caused by alcohol abuse. It presents with long-term abdominal pain. - Both forms are investigated and managed differently depending on severity and complications. Treatment aims to relieve pain and treat underlying causes. Prognosis depends on severity of attack in acute pancreatitis and extent of pancreatic damage in chronic pancreatitis.

1. PANCREATITIS
By Dr, AlokVerma

2. ANATOMY OF PANCREAS

3. Cont..

4. FUNCTION OF PANCREAS
 ENDOCINE
 EXOCRINE

6. PANCREATITIS
 Inflammation of pancreatic parenchyma.
On the basis of presentation this may be
 ACUTE
 CHRONIC

7. ACUTE PANCREATITIS
 INCIDENCE
3% of all cases of abdominal pain among patient
admitted in hospital in UK.
The hospital admission rate for acute
pancreatitis is 9.8 per year per 1000,000
population in UK.
Worldwide incidence ranges from 5 -50 per
100,000 population.
Peak in young men and older women.

8. Aetiology
 Abuse of ethanol
 Biliary tract stones
 Drugs
 Endoscopic retrograde cholangiopancreatography
 Hypercalcemia
 Hyperlipidemia
 Idiopathic
 Infections
 Ischemia
 Parasites
 Postoperative
 Scorpion sting
 Trauma

9. Gallstone pancreatitis

10. CLINCAL PRESENTATION
 PAIN
* Develops quickly , reaching maximum limit
within minuts rather than hrs.
* Appear first in epigastrium , later may be
localized to epigastrium or may be diffuse
throughout abdomen.
*Radiation to back in 50%
* Relief by sitting or leaning forwards.

11. Pain relived by leaning
forward

12.  Nausea
 RepeatedVomitting
 Retching
 Hiccough

13. On Examination
 Pt. gravely ill with profound shock, toxicity ,
confusion.
 Tachypnea
 Tachychardia
 Tem. May be normal or subnormal
 May be hypotention
 Mild icterus in case of gallstone pancreatitis
 Cullen sign positive
 Grey turner’s sign positive

14. Grey turner sign

15. Cullen sign

16. Abdominal ex. May reveal
 Distention
 A mass in epigastrium
 Rarely ascitis with sifting dullness.

17. INVESTIGATION
Are done to
 To Confirm diagnosis.
 To Asses severity of attack.
 To know correct etiology.

18. Cont….
 Routine blood examination
 Amylase measurement
 Other blood examination( lipase,interleukin
[IL]-1, IL-6, tumour necrosis factor-a, and C-
reactive protein

19. Cont….
Imaging
 Plane chest, abdominal X-Ray
 Ultrasound does not establish diagnosis but
shoud be done within 24 hr. to make proper D/D
 CT
 MRI
 MRCP
 ERCP

26. सङ्गृह्य पार्श्वोदरपृष्ठनाभीययद्वर्यते
कृ ष्णससरावनद्र्म् ||8
सशूलमानाहवदुग्रशब्दं सतोदभेदं
पवनात्मकं तत्|९|
यच्चोषतृष्णाज्वरदाहयुक्तं
पीतं ससरा भान्तत च यत्र पीतााः||९||
पीताक्षिववण्मूत्रनखाननस्य
वपत्तोदरं तत्त्वचचरासभवृद्चर्|१०|

27. Pathophysiology of pancreatitis
Obstruction of the pancreatic duct
Injury begins within pancreatic acinar cells
Intra-acinar cell activation of digestive enzyme
zymogens, including trypsinogen.
Pancreatic necrosis evolving into pancreatic
fibrosis.

28. ASSESMENT OF SEVERITY
 1. APACHE II SCORING SYSTEM
 2. RANSONS SCORE
 3. GLASGOW SCORE

29. APACHE II SCORING SYSTEM
 Used in ICU
score >8 indicate vey ill patient

30. RANSONS SCORE
ON ADMISSION
 Age >55 yr.
 WBC count >16x109
 B. glucose > 10 mmol / L
 LDH >700
 AST>250 sigma frankel unit %
WITHIN 48 HRS.
B. Urea nitrogen >5 mg %
PaO2 < 8 kPa
S.Calcium <2.0 mmol/L
Base deficit >4 mmol/L
Fliud sequestration >6 litr.
Patient is severely ill if score is 3 or more than 3

31. GLASSGOW SCALE
ON ADMISSION
 Age >55 yr.
 WBC count >15x109
 B. glucose > 10 mmol / L ( no H/O DM)
 S. urea > 16 mmol/L ( no reponse to IV fluid)
 PaO2 < 8 kPa
WITHIN 48 HRS.
S. Calcium <2.0 mmol/L
S. Albumin < 32 g/L
LDH >6 00 unit
AST/ALT >600 unit
Patient is severely ill if score is 3 or more than 3

32. MANAGMENT
 NILL BY MOUTH
 ADMISSION IN ICU
 IV FLIUD ADMINISTRATION
 CLOSE MONITORING
 POTENTANALGESIA WITH ANTIEMETICS
 CONFIRM DIAGNOSIS
 TREAT MENT OF UNDERLYING CAUSE

33. उदरचचककन्त्सतम्
 तत्र वातोदररणं ववदाररगतर्ाददससद्र्ेन
सवपयषास्नेहययत्वा,
यतल्वकववपक्वेनानुलोम्य,चचत्राफलतैलप्रगाढेन
 ववदाररगतर्ाददकषायेणास्थापयेदनुवासयेच्च,
साल्वणेन चोपनाहयेददरं,भोजयेच्चैनं
 ववदाररगतर्ाददससद्र्ेन िीरेण जाङ्गलरसेन च,
स्वेदयेच्चाभीक्ष्णम् su.chi. 5

34. उदरचचककन्त्सतम्
 वपत्तोदररणंतुमर्ुरगणववपक्वेनसवपयषास्नेहययत्वा,
र्श्यामात्रत्रफलात्रत्रवृद्ववपक्वेनानुलोम्य,शकय रामर्ुघृ
तप्रगाढेन
 तयग्रोर्ाददकषायेणास्थापयेदनुवासयेच्च,पायसेनो
पनाहयेदुदरं, भोजयेच्चैन
 ववदाररगतर्ाददससद्र्ेनपयसा ||६||

35. COMPLICATIONS
 Systemic
Include Multiorgan Failure
Multidisplinary team of ICU is required to
manage this condition

36. LOCAL COMPLICATIONS
 Acute fluid collection
 Sterile and infected pancreatic necrosis
 Pancreatic abscess
 Pancreatic Ascites
 Pancreatic Effusion
 Heamorrhage
 Portaal or splenic vein thromosis
 Peudocyst

37. CHRONIC PANCREATITIS
 Chronic inflammatory disease of pancrease
leading irreversible progressive destruction of
pancreatic tissue.
 Disease accure more frequently in men than
women 4 :1 . Mean age after 40 yr.

38. AETIOLOGY
 Alcohol consumption
 Pancreatic duct obstruction secondary to
strticture after trauma
 After acute episode of pancreatitis
 Congenital abnormalties
 Hereditary
 Autoimmune pancreatitis

39. CLINICAL PRESENTATION
यच्छीतलं शुक्लससरावनद्र्ं गुरु न्स्थरं
शुक्लनखाननस्य ||१०||
न्स्नग्र्ं महच्छोफयुतं ससादं
कफोदरं तत्तु चचरासभवृद्चर्|११|

40. CLINICAL PRESENTATION
 Pain is outstanding symptom
Site- depends upon main focus of disease.
Head- Epigastrium, Rt. Subcostal
Body andTail- Lt. subcostal , back.
Radiation – usually Lt. shoulder
character – Dull and Gnawing

41. Contd…
 Pain may accompanies with Nausea and
vomiting.
 Weight Loss
 Steatorrhoea in more than 30% cases.
 DM

42. INVESTIGATION
 In early stage rise in serum amylase
 Test of pancreatic function merely confirm
when more than 70 % of gland is distroyed.
 Abdominal X- Ray
 CT
 MRI
 ERCP
 MRCP

43. TREATMENT
 Along with medical some endoscopic ,
radiological ,or surgical intervention are
indicated mainly to relive obstruction of
pancreatic duct, bile duct ,or duodenum , or
in dealing with complication. ( pseudocyst,
abscess , fistula , ascites or varicel
hemorrhage)

44. SURGERY
 If mass in Head-
PANCREATODUODENECTOMY or BEGER
PROCEDURE
 If duct is markedly dilated- LONGITUDINAL
PANCEATOJEJUNOSTOMY or FREY
PROCEDURE
 If disease limited to tail - PANCREATECTOMY

45. PROGNOSIS

46. PROGNOSIS

47. उदरचचककन्त्सतम्
 र्श्लेष्मोदररणंतुवपप्पल्याददकषायससद्र्ेनसवपयषोप
स्नेह्य,
 स्नुहीिीरववपक्वेनानुलोम्य,त्रत्रकटुकमूत्रिारतैलप्र
गाढेन ,
 मुष्ककाददकषायेणास्थापयेदनुवासयेच्च,
शणातसीर्ातकीककण्वसषयपमूलकबीजकल्कै र्श्चोप
नाहयेदुदरं,
 भोजयेच्चैनंत्रत्रकटुकप्रगाढेन कु लत्थयूषेणपायसेन
वा, स्वेदयेच्चाभीक्ष्णम ्||७||