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Poorly Pancreas
What is this?
History of Presenting
Complaint
• Tummy pain
• S: umbilical region
• O: Original episode, onset of the pain happened that ...
What do we want to ask about to
find the cause of the pancreatitis?
• G – gallstones
• E – ethanol
• T - trauma
• S – stru...
How to establish pancreatitis
severity?
• Assess ABC
• P – PaO2
• A – Age >55years
• N – Neutrophils, WCC>15x109/L
• C – C...
Management
• Acute Pancreatitis has a 12% mortality rate
• Import to call a specialist when someone presents
to A&E
• Pati...
Management
• IV Access. Provide Saline.
• Analgesia:
• Pethidine 75-100mg/4h intramuscular
• Morphine
• Hourly Observation...
Management
• If assessed as severe or symptoms worsen transfer directly
to ITU
• Antibiotics may be useful in severe disea...
Pancreas
• Greek derivation
• ‘Pan’ means ‘all’ and ‘kreas’ because of the
homogeneous appearance of the pancreas
Anatomy of the pancreas
• Head, uncinate process, neck, body and tail
Physiology of the Exocrine
Pancreas
Exocrine
Extracellular Matrix
Blood Vessels and Ducts
Endocrine Pancreas
The Exocrine ...
Acute Pancreatitis
• Acute injury of the pancreas resulting in
inflammation
• Severe episodes (10% of cases) carry a 40-50...
Typical Presentation
• Symptoms
• Central abdominal pain
• Epigastric pain
• Pain radiates to back – inflammation to the r...
Predicting the severity of an
attack
• CRP >200ng/L in first 4 days = 80% predictive of a
severe attack
• Obesity – increa...
Treatment
• Nasogastric Suction – prevents abdominal distention,
vomiting and aspiration pneumonia
• Analgesia: Tramadol/o...
Complications
• Early
• Shock
• Hypocalcaemia
• ARDS
• Renal Failure
• DIC (Disseminating Intravascular Coagulation)
• Sep...
Complications
• Late Complications (post 1 week)
• Abscesses
• Bleeding
• Thrombosis
• Fistulae
• Recurrent Oedematous pan...
Acute Pancreatitis
• http://ec.libsyn.com/p/2/d/0/2d0f7c4c37ecd431/PO
Tcast-_-
P0019.m4v?d13a76d516d9dec20c3d276ce028ed
50...
Pancreatitis
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Pancreatitis

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Pancreatitis

  1. 1. Poorly Pancreas
  2. 2. What is this?
  3. 3. History of Presenting Complaint • Tummy pain • S: umbilical region • O: Original episode, onset of the pain happened that afternoon • C: gripping • R: radiates to epigastrium and as high as the 5th intercostal space • A: No vomiting, nausea, weight loss, fever • T: constant • E: Nothing made it better or worse • S: Between 8 and 10/10
  4. 4. What do we want to ask about to find the cause of the pancreatitis? • G – gallstones • E – ethanol • T - trauma • S – structural abnormality • M -mumps • A – autoimmune (PAN) • S – Scorpion venom • H –hyperlipidaemia, hypothermia, hypercalcaemia • E – ERCP, emboli • D –Drugs (Also pregnancy or idiopathic)
  5. 5. How to establish pancreatitis severity? • Assess ABC • P – PaO2 • A – Age >55years • N – Neutrophils, WCC>15x109/L • C – Calcium <2mmol/l • R – renal function; urea >16mmol/L • E – Enzymes: LDH >600iu; AST>200iu/L • A- Albumin <32g/L (serum) • S – sugar blood glucose >10mmol/L
  6. 6. Management • Acute Pancreatitis has a 12% mortality rate • Import to call a specialist when someone presents to A&E • Patient must be nil by mouth
  7. 7. Management • IV Access. Provide Saline. • Analgesia: • Pethidine 75-100mg/4h intramuscular • Morphine • Hourly Observations • Pulse, BP, urine output • Daily Observations: • FBC, U&Es, Ca2+, glucose, amylase, ABG
  8. 8. Management • If assessed as severe or symptoms worsen transfer directly to ITU • Antibiotics may be useful in severe disease • Give oxygen is O2 drops • Suspected abscess or pancreatic necrosis – consideration for parenteral nutrition with or without laparotomy & debridement • Suspected gallstones/worsening jaundice – indication for ERCP and gallstone removal • Monitor using repeat CT
  9. 9. Pancreas • Greek derivation • ‘Pan’ means ‘all’ and ‘kreas’ because of the homogeneous appearance of the pancreas
  10. 10. Anatomy of the pancreas • Head, uncinate process, neck, body and tail
  11. 11. Physiology of the Exocrine Pancreas Exocrine Extracellular Matrix Blood Vessels and Ducts Endocrine Pancreas The Exocrine Pancreas -Acinar cells – digestive enzyme secretion -Centroacinar/ductal cells – secretion of electrolytes
  12. 12. Acute Pancreatitis • Acute injury of the pancreas resulting in inflammation • Severe episodes (10% of cases) carry a 40-50% mortality rate • Premature/exaggerated enzyme response within the pancreas • Possibly triggered by acute increase in intracellular calcium
  13. 13. Typical Presentation • Symptoms • Central abdominal pain • Epigastric pain • Pain radiates to back – inflammation to the retroperitoneum • Pain can be made better by sitting forwards • Vomiting – common • Signs • Tachycardia, fever, jaundice, shock, ileus, rigid abdomen with or without tenderness, • Cullen’s sign (peri-umbilical) and Grey Turner’s sign (flank) • Widespread abdominal tenderness and guarding • Jaundice/cholangitis – indication of gallstone involvement
  14. 14. Predicting the severity of an attack • CRP >200ng/L in first 4 days = 80% predictive of a severe attack • Obesity – increases the inflammation • Ranson (gallstone) Glasgow (alcohol) scoring 80% sensitivity (only after 48hours of presentation) • Acute Physiology and Chronic Health Evaluation II (APACHE II) – high sensitivity as early as 24hours after symptoms
  15. 15. Treatment • Nasogastric Suction – prevents abdominal distention, vomiting and aspiration pneumonia • Analgesia: Tramadol/opiates; morphine and diamorphine cause theoretical contraction of sphincter of Oddi. • Nasogastric/Nasojejunal feeding • If in Multi-organ failure – positive pressure ventilation and renal support required – mortality in this group> 80% • Gallstones: sphincterectomy and stone extraction
  16. 16. Complications • Early • Shock • Hypocalcaemia • ARDS • Renal Failure • DIC (Disseminating Intravascular Coagulation) • Sepsis – can be managed by percutaneous drainage • Glucose • Multiple organ failure
  17. 17. Complications • Late Complications (post 1 week) • Abscesses • Bleeding • Thrombosis • Fistulae • Recurrent Oedematous pancreatitis • Pancreatic necrosis and pseudocyst (fluid in lesser sac) • Surgical debridement or minimally invasive necrosectomy
  18. 18. Acute Pancreatitis • http://ec.libsyn.com/p/2/d/0/2d0f7c4c37ecd431/PO Tcast-_- P0019.m4v?d13a76d516d9dec20c3d276ce028ed 5089ab1ce3dae902ea1d01cd8631d2ca58602b&c _id=3207887

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