2. Review of the previous class
• Burn
• Classification of burn wound
• Hospital admission criteria for burn patient
• Fluid management of burn patient
• Monitoring of burn patient
• Complication of burn
3.
4. Pancreatitis
Pancreatitis is the inflammation of pancreatic parenchyma.
Acute pancreatitis is defined as an acute condition presenting
with abdominal pain, a threefold or greater rise in the serum
levels of the pancreatic enzymes amylase or lipase, and/or
characteristic findings of pancreatic inflammation on contrast-
enhanced CT.
The underlying cellular level pathology is premature activation of
pancreatic enzyme which leads to autodigestion.
5. Classification
• Acute pancreatitis is categorized as
Mild (interstitial oedematous pancreatitis)
Severe (necrotizing pancreatitis)
• In interstitial oedematous pancreatitis there is oedema of the
gland and minimal organ dysfunction.
• In severe pancreatitis there is pancreatic necrosis, severe
systemic inflammatory response and often multi organ failure.
• In mild case mortality is 1% and in severe case it is 20-50%
6. Chronic pancreatitis
• Chronic pancreatitis is defined as a continuing inflammatory
disease of the pancreas characterized by irreversible
morphological change typically causing pain and/or permanent
loss of function.
• Here both exocrine and endocrine function may be
compromised.
7. Causes of acute pancreatitis
• Gallstones (50-70%)
• Alcoholism (25%)
• Post ERCP (1-3%)
• Abdominal trauma
• Following biliary, upper gastrointestinal or cardiothoracic
surgery
• Ampullary tumour
• Drugs (corticosteroids, azathioprine, asparaginase, valproic
acid, thiazides, oestrogens)
9. Clinical features
• Pain – pain in epigastrium which is severe, constant and
refractory to usual analgesic reaching maximum intensity
within minutes and persists for hours or even days. Pain may
radiates to back and some patient may get relief by sitting or
leaning forward.
• Nausea, repeated vomiting, retching
• Hiccough
10.
11. Clinical features (Cont…)
• Temperature normal or subnormal
• Tachycardia, tachypnoea, hypotension
• Features of profound shock
• Swinging pyrexia suggest cholangitis
• Grey turner’s sign (bluish discoloration of flank
• Cullen sign (bluish discoloration of umbilicus)
• Features of complication
12.
13. Investigation
• Serum amylase (three times above normal)
• Serum lipase – more specific
• Contrast enhanced CT scan of abdomen
• Investigation for evaluation of cause
• Investigation for assessment of severity
14.
15.
16. Assessment of severity
Mild acute pancreatitis:
no organ failure;
no local or systemic complications.
Moderately severe acute pancreatitis:
organ failure that resolves within 48 hours (transient
organ failure); and/or
local or systemic complications without persistent organ failure.
Severe acute pancreatitis:
persistent organ failure (>48 hours);
single organ failure;
multiple organ failure.
18. Management
• There is no role of surgery during the initial period of
resuscitation and stabilization.
• If hemodynamic instability – Ionotropic support
• Renal failure- Hemofiltration
• Respiratory failure- Ventilatory support
• Disseminated intravascular coagulation- Correction of
coagulopathy.
19.
20.
21. Chronic pancreatitis
• Mean age 40 years
• Male : female- 4:1
Aetiology:
High alcohol consumption
Pancreatic duct obstruction by stone, stricture
Hereditary pancreatitis
Idiopathic
DM
Autoimmuno pancreatitis
22. Clinical feature
• Pain at epigastric of subcostal region which may radiates to
shoulder.
• Nausea and vomiting
• Weight loss
• Loss of both exocrine (steatorrhoea) and endocrine function
(DM)
