This document provides an overview of chronic pancreatitis, including its pathophysiology, etiology, clinical features, diagnosis, and management. It discusses how chronic pancreatitis represents a continuous inflammatory and fibrosing process of the pancreas resulting in permanent dysfunction. The main causes are alcohol use and genetic factors. Patients present with abdominal pain in 95% of cases and can develop weight loss, steatorrhea, and diabetes. Diagnosis involves tests of pancreatic function and imaging tests looking for features like calcification. Treatment focuses on pain control, managing maldigestion with pancreatic enzyme replacement, and addressing complications like pseudocysts and stenosis.
Pancreatitis is a dreaded condition associated with development of acute and sudden inflammation of the pancreas.
Pancreatic enzymes are released in the abdomen and cause inflammation by the damage from digestion of normal body structures, especially fat in the abdomen.
Mortality ranges from 3 percent in patients with interstitial edematous pancreatitis to 17 percent in patients who develop pancreatic necrosis.
Revised Atlanta classification of Acute PancreatitisDr M Venkatesh
The most important change in Atlanta classification is the categorization of the various pancreatic collections.
In acute IEP, collections that do not have an enhancing capsule are called APFCs; after development of a capsule, they are referred to as
pseudocysts
In necrotizing pancreatitis,a collection without an enhancing capsule is called an ANC (usually in the first 4 weeks) and thereafter a WON, which has an enhancing capsule.
The most important distinction between collections in necrotizing pancreatitis and those associated with acute IEP is the presence of nonliquefied material in collections due to necrotizing pancreatitis.
Pancreatitis is a dreaded condition associated with development of acute and sudden inflammation of the pancreas.
Pancreatic enzymes are released in the abdomen and cause inflammation by the damage from digestion of normal body structures, especially fat in the abdomen.
Mortality ranges from 3 percent in patients with interstitial edematous pancreatitis to 17 percent in patients who develop pancreatic necrosis.
Revised Atlanta classification of Acute PancreatitisDr M Venkatesh
The most important change in Atlanta classification is the categorization of the various pancreatic collections.
In acute IEP, collections that do not have an enhancing capsule are called APFCs; after development of a capsule, they are referred to as
pseudocysts
In necrotizing pancreatitis,a collection without an enhancing capsule is called an ANC (usually in the first 4 weeks) and thereafter a WON, which has an enhancing capsule.
The most important distinction between collections in necrotizing pancreatitis and those associated with acute IEP is the presence of nonliquefied material in collections due to necrotizing pancreatitis.
Acute Pancreatitis (According to American College of Gastroenterology 2013 gu...Jibran Mohsin
This Presentation focuses on definition, new classification, different scoring systems for severity, rationale for radiological signs and new management recommendations as per 2013 American College of Gastroenterology guidelines
An inflammatory condition of the pancreas
Acute pancreatitis is a reversible process,
whereas Chronic pancreatitis (CP) is irreversible
Acinar Cell Injury
Pancreatitis -a detailed study ( medical information )martinshaji
Pancreatitis is the Inflammation of the pancreatic parenchyma. Acute condition of diffuse pancreatic inflammation & auto digestion, presents with abdominal pain, and is usually associated with raised pancreatic enzyme levels in the blood &urine. this is a detailed study pancreatitis describing factors such as definition , epidemiology , etiology , pathophysiology , treatment , prevention , imaging techniques , diagnosis , lab investigations , images , drugs , control etc
please comment
thank u
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
3. Chronic pancreatitis represents a continuous,
prolonged, inflammatory and fibrosing process of
the pancreas with irreversible morphologic changes
resulting in permanent endocrine and exocrine
pancreatic dysfunction.
-Harrisons 18th Ed.
Acute pancreatitis and chronic pancreatitis are assumed to be
different disease processes, and most cases of acute
pancreatitis do not result in chronic disease.
7. Ductal obstruction hypothesis
Chronic
alcohol use
acinar and
ductal cell
protein rich
pancreatic
juice, low in
volume and
HCO3
formation
of protein
precipitates
– plug
calcificatio
n of ppt –
ductal
stone
formation
ductule
obstruction
parenchym
al damage
Pancreatic ductal stone are seen in
alcoholic, tropical, hereditary, idiopathic
Sleisenger and Fordtran’s - 9th edition.
8. Toxic metabolic hypothesis
(alcohol) Direct injurious effect on acinar and ductal cells
Increased membrane lipid peroxidation (oxidative stress),
free radical production
Increase acinar cell sensitivity to pathogenic stimuli
Stimulate CholeCystoKinin(CCK) production (duodenal I
cells) – activation of proinflammatory transcription factor
9. Necrosis fibrosis hypothesis
Repeated episodes of acute pancreatitis with cellular
necrosis or apoptosis, healing replaces necrotic tissue
with fibrosis
Evidence from natural history studies - more severe and
frequent attacks
10. • Cystic fibrosis is assosiated with
abnormalities of HCO3 secretion, ductal
dilatation, ppt formation, pancreatic atrophy
• Seen in 50% of idiopathic CP, not common
in alcoholic CP
CFTR –
cystic fibrosis
trans-membrane
conductance
regulator
• Seen in pediatric Idiopathic CP, hereditary
Pancreatitis, Tropical Pancreatitis; but not
in chronic alcoholic pancreatitis
SPINK1 - serine
protease inhibitor
Kazal type 1
Genetic forms
• Once trypsinogen is activated to trypsin,
becomes resistant to inactivation and
activate other proenzymes leading to
episodes of acute pancreatitis– like
necrosis fibrosis theory
PRSS1 – cationic
trypsinogen gene
12. TROPICAL PANCREATITIS
Africa, India, Brazil
A disease of early childhood and youth
> 90% before age of 40yrs
Prevalence in endemic areas: 1 in 500-800
Abdominal pain, malnutrition, exocrine and endocrine insufficiency
Pancreatic caliculi – 90%
50% SPINK1 gene mutation.
13. AutoImmune Pancreatitis
5% of CP, more in males, middle age
12 – 50% ass. With other autoimmune diseases
abdominal pain, weight loss, jaundice
Imaging studies show focal or diffuse (sausage
shaped) enlargement
Diagnosis – clinical, imaging, IgG4, autoantibodies
Treatment – glucocorticoids 1-2m and tappering in 3-
4m
14. Idiopathic Pancreatitis
Early onset
• 20yr mean age, male=female
• 96% pain
• Calcification, exocrine or endocine insufficiency
develop slowly over time – 25, 26 -27.5 yrs
• CFTR, SPINK1 genes
Late onset
• Pain is less frequent 54%-75%
• Age of onset 56yrs, m=f
• 90% calcification is seen
15. Diabetes mellitus
1% of DM from CP
In DM - pancreas is smaller,
• abnormal duct in 40-50% ,
• abnormal pancreatic function in 40-50%
Insulin is a trophic factor for exocrine function of the
pancreas
Insulin deficiency + microangiopathy of DM lead to
pancreatic damage
DM and CP cause effect relation is not clear
16. • Chronic pancreatitis is a relapsing condition that
presents with abdominal pain, occurring in 95% of
cases.
• Pain can be episodic, lasting hours to days, or it can
persist for months or even years. The pain is
characteristically steady in the epigastrium, and it
frequently radiates to the back.
• Weight loss, Steatorrhea.
Clincal features
17. Diagnosis
▪ No single test is adequate
▪ Tests for function
▪ Tests for structure
▪ Both are more accurate in advanced
disease .
18. Tests of function – hormone stimulation
• Direct Tests
• Secretin/ secretin CCK test
• Indirect Tests
• Fecal elastase
• Fecal chymotrypsin
• Serum trypsinogen (trypsin)
• Fecal fat
• Blood glucose
Tests of structure
• Plain film of the abdomen
• CT
• Ultrasonography
• MRI, particularly MRCP
• ERCP
19.
20. Routine labarotory tests
Serum amylase and lipase
• May be elevated in acute exacerbations
• Also found increased in pseudocyst, ductal
stricture, internal pancreatic fistula,pancreatic
carcinoma,cholecystitis,ectopic pregnancy
21. Classics of Chronic pancreatitis
Pancreatic calcification
Steatorrhea
Diabetes mellitus
Found in less than a third of pts with CP
• abnormal secretin stimulations test when >60 %
affected
• Serum trypsinogen < 20ng/ml,
• Fecal elastase < 100mcg/mg stool - severe
exocrine insuf.
22. • Pancreatic calcifications are shown in 25-59% of patients.
• This feature is pathognomonic for chronic pancreatitis.
• Calcification is punctate or coarse, and it may have a focal, segmental, or
diffuse distribution.
chronic pancreatitis with
marked calcification of the
pancreatic parenchyma.
Plain films
23. The anatomic proximity of the pancreatic head and stomach antrum is
constant, and enlargement of the pancreatic head usually causes
effacement of the antrum. This finding has been termed the pad sign.
Upper gastrointestinal tract barium
study shows a reverse 3 in the
duodenum due to chronic pancreatitis.
Pancreatic carcinoma can have a
similar appearance
Upper GI tract barium series
24. Currently, CT is regarded as the
imaging modality of choice for the
initial evaluation of suggested
chronic pancreatitis.
The diagnostic features of:
• pancreatic enlargement,
• pancreatic calcifications,
• pancreatic ductal dilatation,
• thickening of the peripancreatic
fascia, and
• bile duct involvement
are depicted well on CT scans.
CT Findings
25. The sensitivity of plain film for detection of pancreatic calcifications
is about 80 %, which is higher than that of sonography but lower
than that of CT.
CT Findings
26. • Ultrasonography is the first
modality to be used in
patients presenting with
upper abdominal pain,
although the direct diagnosis
of chronic pancreatitis is not
always possible.
• In early disease, the pancreas
may be enlarged and
hypoechoic, with ductal
dilatation. Later, the pancreas
becomes heterogeneous,
with areas of increased
echogenicity and focal or
diffuse enlargement.
Chronic pancreatitis in phase of
exacerbation - an uneven outline of the
gland and heterogeneous structure
of pancreatic tissue.
ULTRASOUND
27. • In late stages of the disease, the pancreas becomes atrophic and
fibrotic, and it shrinks. These changes result in a small, echogenic
pancreas with a heterogeneous echotexture.
• Pseudocysts may occur, and focal hypoechoic inflammatory
masses may mimic pancreatic neoplasia.
• Calculi and calcification in the gland result in densely echogenic
foci, which may show shadow
ULTRASOUND
28. ERCP is the most sensitive and specific technique in the investigation of
chronic pancreatitis, although it is invasive and may cause an acute episode
of pancreatitis and ascending cholangitis.
Endoscopic retrograde cholangiopancreatography (ERCP)
ERCP of normal
pancreatic and
biliary ducts.
ERCP
29. Endoscopic retrograde cholangiopancreatography (ERCP)
Mild pancreatitis
may present with
minimal dilation of
the main
pancreatic duct
and some clubbing
of the side
branches of the
duct
ERCP
30. Chronic Pancreatitis
Endoscopic retrograde cholangiopancreatography (ERCP)
The patient with
moderately-
staged chronic
pancreatitis
shows moderate
dilation of the
main pancreatic
duct (1.5 times
the normal size)
This is
accompanied by
moderate
clubbing of the
side branches of
the main
pancreatic duct
ERCP
31. Chronic Pancreatitis
Endoscopic retrograde cholangiopancreatography (ERCP)
A characteristic "chain of
lakes" appearance of the
main pancreatic duct can
be noted on ERCP in
patients with severe
chronic pancreatitis.
The main pancreatic duct
is enlarged (greater than
1.5 times) with increased
tortuosity.
There is severe clubbing
and dilation of the side
branches.
Stone formation and
occlusion of the
pancreatic duct may
occur in this stage of the
disease
ERCP
32. Chronic Pancreatitis
MRI, particularly MRCP,
is a noninvasive
technique.
The combination of
pancreatic parenchyma
imaging sequences
with MR angiography
and secretin-enhanced
MRCP offers the
possibility of a
comprehensive
examination within a
single diagnostic
modality for evaluation
of the full range of
pancreatic diseases. (A) MRCP demonstrates a "double duct" stricture with proximal dilatation
of the common bile duct and pancreatic duct (arrow). A cystic lesion is seen
between the common bile duct and the duodenal wall. (B) Fat-suppressed
TSE T1-weighted image. Unenhanced (C) and delayed gadolinium-
enhanced (D) T1-weighted images, demonstrate diffuse enhancement of the
sheetlike mass, which corresponded to fibrotic tissue.
Groove pancreatitis
MRI
35. Treatment of maldigestion
▪ Pancreatic enzyme replacement
▪ 2-3 enteric coated with meals
▪ adjuvants with conventional tablets – H2 blockers, PPI,
Na bicarbonate,
▪ Steatorrhea can be abolished if 10 % of normal
lipase amount can be delivered to the duodenum
at the right time.
37. Chronic Pancreatitis
Complications of chronic pancreatitis include:
• Pseudocyst formation
• Fistula formation
• Pseudoaneurysms of large arteries close to the
pancreas
• Stenosis of the common bile duct
• Splenic and/or portal venous obstruction
• Diabetes can develop in 70-90% of patients with
chronic calcific pancreatitis
Complications