medicine ppt

1. MANAGEMENT
OF
ACUTE PANCREATITIS
JOHNY WILBERT, M.Sc[N]
LECTURER,
APOLLO INSTITUTE OF HOSPITAL
MANAGEMENT AND ALLIED SCIENCE

2. Management of acute pancreatitis is directed
toward relieving symptoms and preventing or
treating complications.

3. PAIN MANAGEMENT
• Adequate administration of analgesia.
• Parental opioids such as morphine , fentanyl,
or hydromorphone.

4. PROVIDE VIGROUS FLUID
REUSCITATION
• Colloids and crystalloids are administered to
replace volume losses.
• Fresh frozen plasma.

5. RESPIRATORY CARE
• Oxygen administration.
• Intubation.
• Mechanical ventillation.

6. CORRECT ELECTROLYTE AND
METABOLIC ABNORMALITIES
• Correct hypocalcemia and
hyperglycemia.
• Insulin administration.

7. NUTRITIONAL SUPPORT
• Withhold oral intake.
• Parental nutrition.
• Nasogastric suction.

8. PHARMOCOLOGICAL THERAPY
• Histamine 2 antagonists. Eg; ranitidine.
• Proton pump inhibitors. Eg; pantoprazole.
• Antibiotics

9. BILIARY DRAINAGE
• Placement of biliary drains( for external
drainage) and stents ( indwelling tubes) in the
pancreatic duct through endoscopy has been
performed to reestablish drainage of the
pancreas. This has resulted in decreased pain
and increased weight gain.

10. SURGICAL TREATMENT
• CHOLECYSTECTOMY;
for gallstone pancreatitis.
• Incision and drainage of infection and
pseudocyts.
• Debridment or pancreatectomy to remove
necrotic pancreatic tissue.

12. SURGICAL TREATMENT
OF
CHRONIC
PANCREATITIS

13. PANCREATICOJEJUNOSTOMY
with a side to side anastomosis or joining of
the pancreatic duct to the jejunum , allows
drainage of the pancreatic secretions in to the
jejunum.

14. SPHINCTERO PLASTY
Revision of the sphincter of the ampulla of
vater by a sphincteroplasty.
Internal drainage of a pancreatic cyst into
the stomach ,insertion of a stent and wide
resection or removal of the pancreas.

15. A WHIPPLE RESECTION
Resection of the part of pancreas head also
called pancreaticoduodenectomy.

16. PANCREATECTOMY
Removal of enter pancreas.

17. SPHINCTEROTOMY
Remove the stone and gall bladder at the
same time. In addition , an attempt is made to
improve the drainage of the common bile duct
and pancreatic duct by dividing the sphincter
of oddi, a muscle that is located at the ampulla
of vater.

18. A T- tube usually is placed in the common
bile duct , requiring a drainage system to
collect the bile post operatively.