The document provides information on pediatric pancreatitis. It discusses the following key points in 3 sentences:
Pancreatitis is uncommon in children but can be caused by trauma, developmental anomalies, infections, drugs/toxins, or hereditary/metabolic factors. It involves inflammation and damage to the pancreas that can lead to complications like pseudocysts, hemorrhage, necrosis, and multi-organ failure. The diagnosis is challenging in children as it requires considering clinical presentation, blood tests showing elevated pancreatic enzymes, and imaging findings on ultrasound, CT, or MRCP to identify abnormalities in the pancreas.
Pancreatitis is an inflammatory condition of the pancreas. Two major forms : acute pancreatitis (is reversible) and chronic pancreatitis(is irreversible).
This document discusses the approach to patients with upper gastrointestinal bleeding and its management. It covers the following key points in 3 sentences:
The document outlines sources of GI bleeding, signs of blood loss severity, immediate assessment steps, diagnostic testing, endoscopic treatment options for variceal and non-variceal bleeding, risk stratification tools like the Rockall score, and angioembolization as a treatment option. Management involves fluid resuscitation, identifying the bleeding source, stopping active bleeding endoscopically, treating underlying causes, preventing rebleeding, and considering a second look endoscopy or other interventions based on risk stratification. Outpatient management may be appropriate for low risk patients while higher risk patients require intensive
Insulinomas are rare tumors of the pancreas that produce excess insulin, causing hypoglycemia (low blood sugar). Symptoms include confusion, dizziness, and seizures. Insulinomas most commonly occur in adults ages 40-60 and are usually benign. Diagnosis involves blood tests during hypoglycemic episodes and imaging scans to locate tumors. Surgery to remove the tumor is the primary treatment, while medications may help if the tumor cannot be fully removed.
The document defines acute liver failure in children and discusses its causes, presentation, management, and complications. Acute liver failure is characterized by liver dysfunction within 8 weeks without preexisting liver disease and includes coagulopathy and hepatic encephalopathy. Common causes include viral hepatitis, acetaminophen toxicity, and idiosyncratic drug reactions. Management involves supportive care to maintain organ function, treatment of specific causes, and potentially liver transplantation for severe cases.
This document provides information on chronic liver disease in infants and children. It discusses the classification, etiology, differential diagnosis, and specific diseases that cause chronic liver disease. Some key points include:
- Chronic liver disease is seen in children of all ages and is defined as liver disease lasting more than 3-6 months. Cirrhosis refers to late-stage scarring of the liver.
- Common causes in infants include neonatal hepatitis, biliary atresia, and progressive familial intrahepatic cholestasis. In children, common causes are hepatitis B, hepatitis C, Wilson's disease, and autoimmune hepatitis.
- Clinical features may include jaundice, hepatomegaly, spl
This case presentation discusses a 7-year-old girl with a history of recurrent abdominal pain diagnosed with chronic pancreatitis. Imaging revealed pancreatic divisum and genetic testing found a CFTR mutation, which is also present in her father who has hereditary pancreatitis. Pancreatic divisum is a congenital anomaly that can cause pancreatitis, especially when accompanied by genetic mutations like CFTR. Management may include enzyme supplementation, monitoring for diabetes, and potentially surgery depending on symptoms. Genetic testing is recommended for recurrent pancreatitis of unknown cause to identify mutations that increase risk.
Renal colic is a sudden, severe, dull pain that originates in the costovertebral angle and may radiate to the groin or abdomen. It is caused by obstruction of the ureter, usually by a kidney stone. Patients experience intermittent, colicky pain that is exacerbated by movement and relieved briefly by analgesics. Examination may reveal abdominal tenderness over the kidney area. Investigations include urinalysis, kidney imaging tests like ultrasound or CT scan to detect stones. Treatment focuses on pain relief, increasing fluid intake, and allowing stones to pass spontaneously when possible. Surgery is considered for larger stones or if conservative measures fail.
Pancreatitis is an inflammatory condition of the pancreas. Two major forms : acute pancreatitis (is reversible) and chronic pancreatitis(is irreversible).
This document discusses the approach to patients with upper gastrointestinal bleeding and its management. It covers the following key points in 3 sentences:
The document outlines sources of GI bleeding, signs of blood loss severity, immediate assessment steps, diagnostic testing, endoscopic treatment options for variceal and non-variceal bleeding, risk stratification tools like the Rockall score, and angioembolization as a treatment option. Management involves fluid resuscitation, identifying the bleeding source, stopping active bleeding endoscopically, treating underlying causes, preventing rebleeding, and considering a second look endoscopy or other interventions based on risk stratification. Outpatient management may be appropriate for low risk patients while higher risk patients require intensive
Insulinomas are rare tumors of the pancreas that produce excess insulin, causing hypoglycemia (low blood sugar). Symptoms include confusion, dizziness, and seizures. Insulinomas most commonly occur in adults ages 40-60 and are usually benign. Diagnosis involves blood tests during hypoglycemic episodes and imaging scans to locate tumors. Surgery to remove the tumor is the primary treatment, while medications may help if the tumor cannot be fully removed.
The document defines acute liver failure in children and discusses its causes, presentation, management, and complications. Acute liver failure is characterized by liver dysfunction within 8 weeks without preexisting liver disease and includes coagulopathy and hepatic encephalopathy. Common causes include viral hepatitis, acetaminophen toxicity, and idiosyncratic drug reactions. Management involves supportive care to maintain organ function, treatment of specific causes, and potentially liver transplantation for severe cases.
This document provides information on chronic liver disease in infants and children. It discusses the classification, etiology, differential diagnosis, and specific diseases that cause chronic liver disease. Some key points include:
- Chronic liver disease is seen in children of all ages and is defined as liver disease lasting more than 3-6 months. Cirrhosis refers to late-stage scarring of the liver.
- Common causes in infants include neonatal hepatitis, biliary atresia, and progressive familial intrahepatic cholestasis. In children, common causes are hepatitis B, hepatitis C, Wilson's disease, and autoimmune hepatitis.
- Clinical features may include jaundice, hepatomegaly, spl
This case presentation discusses a 7-year-old girl with a history of recurrent abdominal pain diagnosed with chronic pancreatitis. Imaging revealed pancreatic divisum and genetic testing found a CFTR mutation, which is also present in her father who has hereditary pancreatitis. Pancreatic divisum is a congenital anomaly that can cause pancreatitis, especially when accompanied by genetic mutations like CFTR. Management may include enzyme supplementation, monitoring for diabetes, and potentially surgery depending on symptoms. Genetic testing is recommended for recurrent pancreatitis of unknown cause to identify mutations that increase risk.
Renal colic is a sudden, severe, dull pain that originates in the costovertebral angle and may radiate to the groin or abdomen. It is caused by obstruction of the ureter, usually by a kidney stone. Patients experience intermittent, colicky pain that is exacerbated by movement and relieved briefly by analgesics. Examination may reveal abdominal tenderness over the kidney area. Investigations include urinalysis, kidney imaging tests like ultrasound or CT scan to detect stones. Treatment focuses on pain relief, increasing fluid intake, and allowing stones to pass spontaneously when possible. Surgery is considered for larger stones or if conservative measures fail.
Brief explanation of each *refer harrison textbook for details causes of TIN
Acute interstitial nephritis
Chronic interstitial nephritis
Reflux nephropathy
Papillary necrosis
Sickle-cell nephropathy
Interstitial cystitis is a long-term
(chronic) inflammation of the bladder wall.
Treatment results vary. Some people respond well to simple treatments
and dietary changes. Others may require extensive treatments or surgery.
This document provides information about renal tuberculosis, including its diagnosis and management. It begins with a brief history of tuberculosis and then focuses on renal tuberculosis. Key points include:
- Renal tuberculosis is most commonly caused by hematogenous spread from a pulmonary infection and presents with symptoms of urinary tract inflammation like dysuria, back/flank pain, or hematuria.
- Diagnosis involves urine analysis showing pyuria and sterile cultures, imaging like intravenous pyelography showing calcifications and abnormalities, and culture of urine or tissues.
- Radiological findings include calcifications, cavitary lesions, infundibular strictures, and evidence of destruction like a "putty kidney". Management involves antibiotic therapy but can be complicated
Acute kidney injury and chronic kidney disease in childrenSameekshya Pradhan
Acute kidney injury (AKI) and chronic kidney disease can affect children. AKI is defined as a rapid deterioration of renal function over hours to days. It has various etiologies including pre-renal, renal, and post-renal causes. Management involves treating life-threatening complications, maintaining fluid/electrolyte balance, supportive care, and dialysis. Chronic kidney disease develops over months to years and requires long-term management to delay progression.
Nephrotic syndrome refers to a constellation of clinical features including heavy proteinuria, hypoalbuminemia, edema, and hyperlipidemia. The main causes are minimal change disease, membranous glomerulopathy, focal segmental glomerulosclerosis, membranoproliferative glomerulonephritis, and diabetic nephropathy. Treatment depends on the underlying cause but often involves corticosteroids as first line therapy. Renal biopsy is needed to identify the specific cause and guide management.
Approach to right iliac fossa(RIF) painasifiqbal545
Approach to right iliac fossa(RIF) pain.FULL DISCUSSION ON APPENDICITIS WITH OTHER DIFFERENTIAL DIAGNOSIS OF IT. AS WELL AS CLINICAL REASONING DIAGNOSIS AND TREATMENT.
1. Diarrhea is a common disease in childhood that can be caused by infections, non-infectious factors, or a combination of both. Infectious causes include viruses like rotavirus and bacteria like E. coli, while non-infectious causes include improper diet, weather factors, and feeding issues.
2. The pathogenesis of infectious diarrhea involves mechanisms like enterotoxins produced by bacteria that increase intestinal fluid secretion, or viruses and bacteria that directly invade and damage the intestinal mucosa. This leads to reduced nutrient absorption and an osmotic diarrhea.
3. Clinical manifestations of diarrhea range from mild cases involving changes in stool frequency and consistency, to more severe cases accompanied by dehydration
This document discusses chronic kidney disease (CKD) in pediatrics. It defines CKD as kidney damage lasting at least 3 months as determined by structural abnormalities and/or a glomerular filtration rate below 60 mL/min/1.73m2. The stages of CKD are described based on GFR. Common causes in children include congenital abnormalities and glomerulonephritis. The pathogenesis involves hyperfiltration injury and other factors like proteinuria that accelerate kidney damage. Management aims to address complications through careful monitoring, nutrition, treatment of mineral bone disorders, and controlling blood pressure and electrolyte abnormalities.
This document discusses Meige syndrome, which involves involuntary contractions of the muscles around the eyes (blepharospasm) and mouth (oromandibular dystonia). It can be primary or secondary to conditions like neuroleptic medication use or brain injuries. Pathophysiology may involve dopaminergic/cholinergic hyperactivity or decreased inhibitory neurons in the cortex. Diagnosis involves tests like EMGs and imaging to rule out other causes. Treatment options include anticholinergics, dopamine antagonists, Botox injections, and deep brain stimulation. Differential diagnoses include other movement disorders or neurological/psychiatric conditions.
This document provides information on portal hypertension, including its definition, causes, presentations, investigations, and management. Some key points:
- Portal hypertension is defined as a sustained elevation of portal pressure above 12 mm Hg. It can be caused by conditions affecting blood flow pre-sinusoidally (e.g. portal vein thrombosis), sinusoidally (e.g. cirrhosis), or post-sinusoidally (e.g. Budd-Chiari syndrome).
- Common presentations include esophageal varices, splenomegaly, ascites, and features of hepatic encephalopathy. Investigations include liver function tests, ultrasound, and endoscopy to identify varices.
-
HIV-associated nephropathy (HIVAN) is a type of renal disease that predominantly affects people of African descent with HIV. It is characterized by collapsing focal segmental glomerulosclerosis and severe tubular injury. The pathogenesis involves direct infection and damage of kidney cells by HIV as well as immune complex deposition. While the disease often progresses to renal failure if left untreated, early diagnosis and treatment with antiretroviral therapy can stabilize renal function and prevent worsening of kidney disease for many patients.
1. Abdominal tuberculosis refers to tuberculosis infection of the gastrointestinal tract, mesenteric lymph nodes, peritoneum, and organs like the liver and spleen.
2. It is commonly caused by Mycobacterium tuberculosis or M. bovis bacteria and spreads via ingestion, hematogenous spread, or lymphatic spread.
3. Common presentations include abdominal pain, fever, weight loss, and the formation of masses, strictures, or ascites in the abdomen. Investigations include imaging tests, blood tests, and microbiological analysis of samples.
1. Nephrotic syndrome and nephritic syndrome are conditions affecting the nephrons of the kidney. Nephrotic syndrome is characterized by massive proteinuria, hypoalbuminemia, edema, hyperlipidemia, and lipiduria. Nephritic syndrome features hematuria and acute kidney injury.
2. The document discusses the causes, pathophysiology, and management of nephrotic syndrome. Common causes include minimal change disease, membranous glomerulopathy, and focal segmental glomerulosclerosis. Treatment involves managing symptoms with diuretics, ACE inhibitors, and in some cases immunosuppressants like corticosteroids.
3. Membranous glomer
This document discusses renal tubular acidosis (RTA). It begins by explaining the different types of RTA, including proximal (Type 1), distal (Type 2), and combined (Type 3). It then covers the clinical presentation, diagnostic evaluation, and management of RTA. Key points include that children with RTA often present with failure to thrive, polyuria, and polydipsia. Diagnosis involves assessing for a normal anion gap metabolic acidosis along with electrolyte abnormalities. Treatment focuses on bicarbonate replacement and addressing complications like hypercalciuria. With early diagnosis and treatment, most children can see improved growth and development.
Clinical approach to a patient with abdominal painAbino David
1. This document provides guidance on evaluating a patient presenting with abdominal pain by examining the location of pain, nature of pain, potential causes, and relevant history and physical exam findings.
2. Key aspects of the physical exam include inspection of the abdomen, palpation of organs, percussion to detect fluid, and auscultation of bowel sounds.
3. Differential diagnosis depends on characteristics of pain such as duration, relation to eating, and radiation to other areas. Potential causes range from gastrointestinal conditions to referred pain from other organs.
Acute pancreatitis is inflammation of the pancreas that is usually reversible. It is commonly caused by gallstones or alcoholism. Symptoms include severe abdominal pain, vomiting, and fever. Diagnosis is based on elevated serum amylase and lipase levels. Severity is assessed using scoring systems like Ranson criteria or CT severity index. Mild cases are treated conservatively with IV fluids and analgesics while severe or infected cases require intensive care monitoring, antibiotics, and possibly surgical debridement of pancreatic necrosis.
Acute kidney injury (AKI), formerly known as acute renal failure, is defined as a sudden deterioration of kidney function resulting in the inability to maintain fluid and electrolyte homeostasis. It can be caused by prerenal issues affecting blood flow to the kidneys, intrinsic renal parenchymal damage, or postrenal urinary tract obstruction. The incidence of AKI varies globally and it commonly occurs in critically ill children with coexisting conditions. Etiologies include pre-renal causes like decreased intravascular volume, intrinsic renal diseases affecting glomeruli or tubules, and post-renal obstruction. Diagnosis involves lab tests of kidney and liver function as well as imaging studies. Treatment focuses on fluid management, electrolyte
This document discusses the imaging features of common benign and malignant hepatic lesions. It begins by outlining the objectives and introducing the increasing detection of hepatic masses on imaging. It then covers the classification and workup of hepatic lesions. The main body discusses the imaging appearance and diagnostic criteria of common benign lesions like hemangiomas, FNH, and cysts. It also covers malignant lesions such as HCC, metastases, and their characteristic enhancement patterns and imaging findings on ultrasound, CT, and MRI that are used for diagnosis.
The document describes a case of a 55-year-old male patient presenting with breathlessness, palpitations, and fatigue for 1 year along with black sticky stools. Examinations revealed pallor and erythematous spots in the oral cavity. Investigations showed microcytic hypochromic anemia and occult blood in stool. Endoscopy revealed dilated vessels in the GI tract. CT angiogram showed abnormal vascular structures. The patient was diagnosed with hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome) based on the presence of epistaxis, telangiectasias, GI bleeding, and family history.
Brief explanation of each *refer harrison textbook for details causes of TIN
Acute interstitial nephritis
Chronic interstitial nephritis
Reflux nephropathy
Papillary necrosis
Sickle-cell nephropathy
Interstitial cystitis is a long-term
(chronic) inflammation of the bladder wall.
Treatment results vary. Some people respond well to simple treatments
and dietary changes. Others may require extensive treatments or surgery.
This document provides information about renal tuberculosis, including its diagnosis and management. It begins with a brief history of tuberculosis and then focuses on renal tuberculosis. Key points include:
- Renal tuberculosis is most commonly caused by hematogenous spread from a pulmonary infection and presents with symptoms of urinary tract inflammation like dysuria, back/flank pain, or hematuria.
- Diagnosis involves urine analysis showing pyuria and sterile cultures, imaging like intravenous pyelography showing calcifications and abnormalities, and culture of urine or tissues.
- Radiological findings include calcifications, cavitary lesions, infundibular strictures, and evidence of destruction like a "putty kidney". Management involves antibiotic therapy but can be complicated
Acute kidney injury and chronic kidney disease in childrenSameekshya Pradhan
Acute kidney injury (AKI) and chronic kidney disease can affect children. AKI is defined as a rapid deterioration of renal function over hours to days. It has various etiologies including pre-renal, renal, and post-renal causes. Management involves treating life-threatening complications, maintaining fluid/electrolyte balance, supportive care, and dialysis. Chronic kidney disease develops over months to years and requires long-term management to delay progression.
Nephrotic syndrome refers to a constellation of clinical features including heavy proteinuria, hypoalbuminemia, edema, and hyperlipidemia. The main causes are minimal change disease, membranous glomerulopathy, focal segmental glomerulosclerosis, membranoproliferative glomerulonephritis, and diabetic nephropathy. Treatment depends on the underlying cause but often involves corticosteroids as first line therapy. Renal biopsy is needed to identify the specific cause and guide management.
Approach to right iliac fossa(RIF) painasifiqbal545
Approach to right iliac fossa(RIF) pain.FULL DISCUSSION ON APPENDICITIS WITH OTHER DIFFERENTIAL DIAGNOSIS OF IT. AS WELL AS CLINICAL REASONING DIAGNOSIS AND TREATMENT.
1. Diarrhea is a common disease in childhood that can be caused by infections, non-infectious factors, or a combination of both. Infectious causes include viruses like rotavirus and bacteria like E. coli, while non-infectious causes include improper diet, weather factors, and feeding issues.
2. The pathogenesis of infectious diarrhea involves mechanisms like enterotoxins produced by bacteria that increase intestinal fluid secretion, or viruses and bacteria that directly invade and damage the intestinal mucosa. This leads to reduced nutrient absorption and an osmotic diarrhea.
3. Clinical manifestations of diarrhea range from mild cases involving changes in stool frequency and consistency, to more severe cases accompanied by dehydration
This document discusses chronic kidney disease (CKD) in pediatrics. It defines CKD as kidney damage lasting at least 3 months as determined by structural abnormalities and/or a glomerular filtration rate below 60 mL/min/1.73m2. The stages of CKD are described based on GFR. Common causes in children include congenital abnormalities and glomerulonephritis. The pathogenesis involves hyperfiltration injury and other factors like proteinuria that accelerate kidney damage. Management aims to address complications through careful monitoring, nutrition, treatment of mineral bone disorders, and controlling blood pressure and electrolyte abnormalities.
This document discusses Meige syndrome, which involves involuntary contractions of the muscles around the eyes (blepharospasm) and mouth (oromandibular dystonia). It can be primary or secondary to conditions like neuroleptic medication use or brain injuries. Pathophysiology may involve dopaminergic/cholinergic hyperactivity or decreased inhibitory neurons in the cortex. Diagnosis involves tests like EMGs and imaging to rule out other causes. Treatment options include anticholinergics, dopamine antagonists, Botox injections, and deep brain stimulation. Differential diagnoses include other movement disorders or neurological/psychiatric conditions.
This document provides information on portal hypertension, including its definition, causes, presentations, investigations, and management. Some key points:
- Portal hypertension is defined as a sustained elevation of portal pressure above 12 mm Hg. It can be caused by conditions affecting blood flow pre-sinusoidally (e.g. portal vein thrombosis), sinusoidally (e.g. cirrhosis), or post-sinusoidally (e.g. Budd-Chiari syndrome).
- Common presentations include esophageal varices, splenomegaly, ascites, and features of hepatic encephalopathy. Investigations include liver function tests, ultrasound, and endoscopy to identify varices.
-
HIV-associated nephropathy (HIVAN) is a type of renal disease that predominantly affects people of African descent with HIV. It is characterized by collapsing focal segmental glomerulosclerosis and severe tubular injury. The pathogenesis involves direct infection and damage of kidney cells by HIV as well as immune complex deposition. While the disease often progresses to renal failure if left untreated, early diagnosis and treatment with antiretroviral therapy can stabilize renal function and prevent worsening of kidney disease for many patients.
1. Abdominal tuberculosis refers to tuberculosis infection of the gastrointestinal tract, mesenteric lymph nodes, peritoneum, and organs like the liver and spleen.
2. It is commonly caused by Mycobacterium tuberculosis or M. bovis bacteria and spreads via ingestion, hematogenous spread, or lymphatic spread.
3. Common presentations include abdominal pain, fever, weight loss, and the formation of masses, strictures, or ascites in the abdomen. Investigations include imaging tests, blood tests, and microbiological analysis of samples.
1. Nephrotic syndrome and nephritic syndrome are conditions affecting the nephrons of the kidney. Nephrotic syndrome is characterized by massive proteinuria, hypoalbuminemia, edema, hyperlipidemia, and lipiduria. Nephritic syndrome features hematuria and acute kidney injury.
2. The document discusses the causes, pathophysiology, and management of nephrotic syndrome. Common causes include minimal change disease, membranous glomerulopathy, and focal segmental glomerulosclerosis. Treatment involves managing symptoms with diuretics, ACE inhibitors, and in some cases immunosuppressants like corticosteroids.
3. Membranous glomer
This document discusses renal tubular acidosis (RTA). It begins by explaining the different types of RTA, including proximal (Type 1), distal (Type 2), and combined (Type 3). It then covers the clinical presentation, diagnostic evaluation, and management of RTA. Key points include that children with RTA often present with failure to thrive, polyuria, and polydipsia. Diagnosis involves assessing for a normal anion gap metabolic acidosis along with electrolyte abnormalities. Treatment focuses on bicarbonate replacement and addressing complications like hypercalciuria. With early diagnosis and treatment, most children can see improved growth and development.
Clinical approach to a patient with abdominal painAbino David
1. This document provides guidance on evaluating a patient presenting with abdominal pain by examining the location of pain, nature of pain, potential causes, and relevant history and physical exam findings.
2. Key aspects of the physical exam include inspection of the abdomen, palpation of organs, percussion to detect fluid, and auscultation of bowel sounds.
3. Differential diagnosis depends on characteristics of pain such as duration, relation to eating, and radiation to other areas. Potential causes range from gastrointestinal conditions to referred pain from other organs.
Acute pancreatitis is inflammation of the pancreas that is usually reversible. It is commonly caused by gallstones or alcoholism. Symptoms include severe abdominal pain, vomiting, and fever. Diagnosis is based on elevated serum amylase and lipase levels. Severity is assessed using scoring systems like Ranson criteria or CT severity index. Mild cases are treated conservatively with IV fluids and analgesics while severe or infected cases require intensive care monitoring, antibiotics, and possibly surgical debridement of pancreatic necrosis.
Acute kidney injury (AKI), formerly known as acute renal failure, is defined as a sudden deterioration of kidney function resulting in the inability to maintain fluid and electrolyte homeostasis. It can be caused by prerenal issues affecting blood flow to the kidneys, intrinsic renal parenchymal damage, or postrenal urinary tract obstruction. The incidence of AKI varies globally and it commonly occurs in critically ill children with coexisting conditions. Etiologies include pre-renal causes like decreased intravascular volume, intrinsic renal diseases affecting glomeruli or tubules, and post-renal obstruction. Diagnosis involves lab tests of kidney and liver function as well as imaging studies. Treatment focuses on fluid management, electrolyte
This document discusses the imaging features of common benign and malignant hepatic lesions. It begins by outlining the objectives and introducing the increasing detection of hepatic masses on imaging. It then covers the classification and workup of hepatic lesions. The main body discusses the imaging appearance and diagnostic criteria of common benign lesions like hemangiomas, FNH, and cysts. It also covers malignant lesions such as HCC, metastases, and their characteristic enhancement patterns and imaging findings on ultrasound, CT, and MRI that are used for diagnosis.
The document describes a case of a 55-year-old male patient presenting with breathlessness, palpitations, and fatigue for 1 year along with black sticky stools. Examinations revealed pallor and erythematous spots in the oral cavity. Investigations showed microcytic hypochromic anemia and occult blood in stool. Endoscopy revealed dilated vessels in the GI tract. CT angiogram showed abnormal vascular structures. The patient was diagnosed with hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome) based on the presence of epistaxis, telangiectasias, GI bleeding, and family history.
This document discusses several unusual CT manifestations of common abdominal diseases:
1. Solitary rectal ulcer syndrome appears as a solitary linear ulcer on rectosigmoidoscopy in young patients with rectal bleeding.
2. Giant ulcers in the ileum and colon seen on CT in AIDS patients are caused by cytomegalovirus.
3. Ovarian torsion presents on CT as an adnexal mass rotated to the midline and contralateral side with deviation of the uterus and free fluid. The twisted vascular pedicle may also be seen.
4. Chemotherapy-induced pseudocirrhosis appears on CT as diffuse hepatic fibrosis without masses in patients receiving chemotherapy for cancer.
The document provides information about acute renal failure (ARF), including:
- ARF is the rapid loss of kidney function over hours to days, resulting in failure to excrete waste and electrolyte imbalance.
- The main causes of ARF are pre-renal (decreased renal perfusion), intrinsic renal (damage to the kidneys), and post-renal (obstruction of urinary outflow).
- Evaluation involves laboratory tests like urinalysis and blood work to determine the specific cause and guide treatment, which ranges from intravenous fluids to dialysis depending on severity.
The document provides information about acute renal failure (ARF), including:
- ARF is the rapid loss of kidney function over hours to days, resulting in failure to excrete waste and electrolyte imbalance.
- The main causes of ARF are pre-renal (decreased renal perfusion), intrinsic renal (damage to the kidneys), and post-renal (obstruction of urinary outflow).
- Evaluation involves laboratory tests like urinalysis and renal indices to help determine the underlying cause and guide treatment, which depends on the identified etiology. Dialysis may be needed for severe cases.
Pancreatic neoplasms can be either solid tumors like adenocarcinomas or cystic neoplasms. Pancreatic adenocarcinoma has an extremely low 5-year survival rate of only 6% and is usually diagnosed at an advanced stage. Risk factors include smoking, chronic pancreatitis, diabetes and family history. Imaging tests like CT, MRI and EUS are used to stage the cancer and determine resectability. Surgical resection through a pancreatoduodenectomy or distal pancreatectomy offers the only chance for cure if the cancer is localized.
The document discusses the embryology, anatomy, clinical features, investigations and imaging findings of acute pancreatitis. Regarding embryology, it describes how the pancreas develops from dorsal and ventral buds that fuse. For anatomy, it outlines the relationships of different parts of the pancreas. It also summarizes the etiology, pathophysiology and scoring systems used to classify severity of acute pancreatitis. Imaging findings on ultrasound, CT and MRI are summarized to diagnose and characterize acute pancreatitis and its complications.
1) The document discusses various benign hepatic tumors classified by their cell of origin into hepatocellular, cholangiocellular, or mesenchymal tumors.
2) It provides details on common tumor types such as focal nodular hyperplasia and hepatic adenoma. It notes focal nodular hyperplasia typically appears as a solitary lesion in young females while hepatic adenoma has a higher risk of bleeding and transforming to HCC.
3) Imaging features of many tumors are described, including the typical arterial phase enhancement of focal nodular hyperplasia on CT/MRI and the risk of hemorrhage seen within hepatic adenomas.
CARCINOMA COLON - Dr. ZAHID IQBAL MIR
Dr. Zahid Iqbal Mir, MBBS MS (General Surgery), DNB (General Surgery) has done his MBBS and masters in General Surgery from the prestigious Govt Medical College Jammu and DNB in General Surgery from NBEMS New Delhi. He is a passionate surgeon, earlier practising at Government Medical College, Jammu as Registrar in Department of General Surgery. Nowadays working as Senior Resident in Department of General Surgery, Government Medical College & Hospital, Sector 32, Chandigarh and a rising name in field of surgery.
He is an enthusiastic, enigmatic and dedicated teacher as well. He is not just a resolute learner, but also an awe inspiring guiding light for his juniors, which makes him the most loveable and respected senior.
Currently he is running “LOVE FOR SCALPEL” for PGMEE aspirants on most of the social platforms, which is gaining immense popularity among residents, medical graduates and undergraduates.
The document discusses various types of pancreatic tumors including benign and malignant exocrine tumors as well as endocrine tumors. It provides details on:
- The embryology, anatomy, blood supply, nerve supply and functions of the pancreas.
- Classification systems for benign exocrine tumors such as serous cystic neoplasms, mucinous cystic neoplasms, and intraductal papillary mucinous neoplasms.
- Signs, investigations and management of insulinomas, which are the most common pancreatic endocrine tumors causing hypoglycemia.
The document provides an overview of surgical conditions of the pancreas, including congenital abnormalities, injuries, pancreatitis, and tumors. It discusses the anatomy and functions of the pancreas. Key conditions covered include acute and chronic pancreatitis, pancreatic pseudocysts, and exocrine pancreatic cancer. Diagnostic tests and treatment approaches are outlined for each condition.
This document provides an overview of gallbladder disease, including evaluation and treatment options. It discusses common conditions like cholelithiasis (gallstones), choledocholithiasis (gallstones in the common bile duct), cholecystitis (inflammation of the gallbladder), and cholangitis (infection of the biliary tree). Diagnostic tools like ultrasound and treatments including medications, ERCP, and cholecystectomy are covered. Rare and serious conditions such as emphysematous cholecystitis are also mentioned. The goal is to improve understanding of disease pathology and presentation, diagnostic modalities, and treatment options.
This document describes a case of Fournier's gangrene in a 43-year-old man. The patient presented with flu-like symptoms but upon examination was found to have necrotic scrotal tissue with surrounding erythema and crepitus, indicating necrotizing fasciitis. Treatment for Fournier's gangrene requires aggressive antibiotic therapy, early and repeated surgical debridement of necrotic tissue, and wound care. Scores like LRINEC and FGSI can help predict patient prognosis and risk of mortality from this rare but life-threatening infection.
This document discusses the classification and treatment of liver tumors. It outlines four main categories of liver tumors: primary solid benign tumors, primary solid malignant neoplasms, cystic neoplasms, and metastatic tumors. Hepatocellular carcinoma and focal nodular hyperplasia are described as two of the most common primary benign and malignant liver tumors respectively. Surgical resection or liver transplantation are identified as the primary treatments for hepatocellular carcinoma when the liver function and extent of disease are suitable.
A 20-year-old girl presented with chronic diarrhea, fever, weight loss, and loss of appetite for 4 weeks. Colonoscopy and biopsy revealed diffuse large B-cell lymphoma of the duodenum and stomach. Imaging showed thickening and nodularity of the third part of the duodenum with enlarged lymph nodes. The patient was diagnosed with primary diffuse large B-cell lymphoma of the duodenum and stomach, stage II, and started on CHOP chemotherapy.
A 28-year-old woman with a history of rheumatoid arthritis for 5 years presented with abdominal pain, vomiting, and difficulty swallowing. Examination found signs of connective tissue disorder. Testing found poorly differentiated adenocarcinoma of the esophagus with metastasis to the sacrum. Mixed connective tissue disorder can cause esophageal dysfunction like reflux and strictures due to replacement of smooth muscle by fibrosis. Long-standing reflux and stasis may lead to cancer, as seen in this patient's terminal illness.
1. The document discusses carcinoma of the head of the pancreas, including its epidemiology, risk factors, pathology, clinical features, imaging, staging, and surgical management via the Whipple procedure.
2. It provides details of the Whipple procedure, including exposing and dissecting key structures like the superior mesenteric vein, Kocher maneuver, dividing vessels like the gastroduodenal artery, and transecting the stomach and jejunum.
3. The Whipple procedure involves a pancreaticoduodenectomy to resect the pancreatic head tumors while preserving stomach, duodenum, common bile duct, and pancreas.
1. The appendix is located in the lower right portion of the abdomen and functions as part of the immune system.
2. Appendicitis is usually caused by obstruction of the appendix and results in inflammation and infection. Left untreated, it can progress to perforation or gangrene.
3. Symptoms of appendicitis include abdominal pain that starts around the navel and moves to the lower right side, nausea, vomiting, loss of appetite, and fever. A physical exam may reveal tenderness in the lower right abdomen.
This document provides an overview of gallbladder and bile duct anatomy, ultrasound techniques, and common abnormalities. It discusses the anatomy of the gallbladder and bile ducts. Key points include the normal sonographic appearance of the gallbladder and distinguishing features of various gallbladder abnormalities like stones, polyps, and wall thickening. It also reviews bile duct anatomy and variants, ultrasound technique, and pathologies that can cause bile duct dilation or wall thickening such as stones, cancer, and cystic diseases. Evaluation of both the gallbladder and bile ducts is important using ultrasound.
This document provides information about immunization and vaccine-preventable diseases. It discusses:
1. Immunization is a process that uses vaccines to stimulate immunity against infectious diseases. It has proven effective at controlling and eliminating diseases like smallpox.
2. Major vaccine-preventable diseases that kill children include measles, polio, pertussis, Hib, and pneumococcal diseases. Immunization is one of the most cost-effective health interventions.
3. The document then provides details on specific diseases like pertussis, its symptoms, complications, and treatment with antibiotics or immunization. It emphasizes the importance of clinical diagnosis and avoiding severe outcomes in infants.
The document discusses diarrhea as a leading cause of death among children under 5, providing statistics on prevalence and causes of different types of diarrhea like acute watery diarrhea, acute invasive diarrhea, and persistent diarrhea. It outlines signs and symptoms, causes, complications, and treatments for different forms of diarrhea. The document emphasizes the importance of oral rehydration therapy and continued feeding to treat diarrhea and prevent more serious outcomes like dehydration and malnutrition.
This document discusses infant feeding principles and the benefits of exclusive breastfeeding for the first 6 months. It provides information on breastmilk composition, the importance of early initiation and exclusive breastfeeding, positioning and attachment for breastfeeding, and challenges and difficulties some mothers may face. The document emphasizes that breastmilk provides ideal nutrition and protection against illness for infants and has numerous health, developmental and economic benefits for both mother and baby.
The document provides information on acute respiratory infections (ARIs) in children under 5 years old. It discusses the definition of ARIs, signs of respiratory distress, normal respiratory defense mechanisms, how ARIs spread rapidly in children, common sites of infection, etiological agents, how ARIs harm children, the relationship between ARIs and malnutrition, methods for assessing and classifying pneumonia severity according to IMCI guidelines, treatment principles including antibiotics and other supportive care, prevention strategies, and acute epiglottitis.
The document summarizes health programs and progress in Bangladesh. It notes that Bangladesh has achieved significant reductions in under-5 and maternal mortality rates through effective interventions. Key interventions include oral rehydration therapy for diarrhea, immunizations, integrated management of childhood illness, and newborn health programs. Bangladesh has also seen major declines in malnutrition and fertility rates. Overall, Bangladesh has made major improvements in health indicators through the efforts of the government and development partners.
The document discusses Dengue fever (DF), a mosquito-borne viral disease. It provides details on the history, transmission, clinical presentation, diagnosis and treatment of DF. DF is common in tropical and sub-tropical regions and is caused by the dengue virus, which has four serotypes. While most cases are mild, infection with a second serotype increases the risk of severe dengue which can be fatal if not properly treated through fluid resuscitation. Prevention relies on controlling the mosquito vectors and avoiding mosquito bites. There is no vaccine available for all four serotypes.
- The document discusses hepatitis and acute liver failure. It notes that hepatitis viruses like hepatitis A, B, C, D, and E can cause hepatitis and affect millions worldwide, killing 1.4 million people per year. Hepatitis A is commonly the cause in children, while hepatitis B and C can lead to liver cancer and chronic liver disease.
- It provides information on the functions of the liver, defines hepatitis as inflammation of the liver that can be self-limiting or progress to fibrosis, and lists the various causes of infectious and non-infectious hepatitis. Hepatitis B in particular is described in terms of epidemiology, transmission, pathogenesis, and interpretation of hepatitis B markers.
The document discusses enteric fevers such as typhoid and paratyphoid. It notes that typhoid occurs only in humans and causes around 21 million cases and 200k deaths worldwide each year. The causative agents are Salmonella typhi and Salmonella paratyphi. Symptoms of typhoid fever typically last 4 weeks and include rose colored spots, abdominal tenderness, diarrhea, and possible complications like bleeding or perforation. Diagnosis involves blood, stool, or bone marrow cultures. Treatment is with antibiotics like ceftriaxone for 14 days. Relapse can occur in 15% of cases.
This document provides information about renal diseases. It notes that kidney disease can be a silent killer but childhood nephrotic syndrome is mostly curable and acute post-streptococcal glomerulonephritis (APSGN) mostly recovers and does not recur. It also discusses hematuria in children, age-related kidney diseases, preventing acute renal failure (ARF), and learning objectives about renal diseases.
CXR is a commonly performed imaging test that uses ionizing radiation to visualize the inside of the body. It is useful for diagnosing and treating conditions. A standard CXR involves exposing the chest to a small dose of radiation for less than half a second to produce images. It requires no special preparation and carries minimal risk when used appropriately. The CXR must be evaluated systematically by examining bones, the heart, lungs, mediastinum, diaphragm and soft tissues to identify any abnormalities.
This document discusses various B vitamins, including their sources, functions, deficiency symptoms, diagnosis, and treatment. It provides details on thiamine (B1) and its role in energy production. Deficiencies of B1 can cause beriberi, which presents as acute or chronic peripheral neuropathy. It also covers riboflavin (B2) and its role in redox reactions as part of FAD. Riboflavin deficiency can result in ariboflavinosis with mouth sores and dermatitis. The document provides recommendations to prevent deficiencies through a balanced diet and vitamin supplements when needed.
The document discusses abdominal pain, its causes, characteristics, and approaches to diagnosis. It notes that abdominal pain can arise from abdominal wall or organs and may be difficult to localize. Common causes in children include constipation, gastroenteritis, and appendicitis, though some cases require urgent evaluation. Diagnosis involves considering characteristics of the pain, physical exam, and test results. Referred pain is also discussed.
This document discusses childhood injuries and accidents in children. Some key points:
- Injuries are unintentional or intentional damage to the body from things like thermal, mechanical, electrical or chemical energy.
- 95% of childhood injuries occur in low and middle income countries. Drowning is a major killer, especially in these countries.
- Injuries account for 14% of all childhood deaths globally. Road traffic accidents, drowning, falls and burns are among the leading causes.
- Childhood injuries place a significant burden on families and healthcare systems. Many result in lifelong disabilities or even death. Prevention programs can save over 1,000 child lives per day.
This document provides information about immunization against various infectious diseases. It discusses the importance of immunization in preventing millions of deaths per year from diseases like measles, polio, diphtheria, and pertussis. The document outlines the target diseases for immunization programs in Bangladesh and other vaccines available in the country. It also discusses vaccines still in development and provides details on diseases like pertussis, diphtheria, and poliomyelitis, including causes, symptoms, treatment and complications.
This document discusses infant feeding guidelines and the benefits of breastfeeding. It provides the following key points:
1) Exclusive breastfeeding is recommended for the first 6 months as breastmilk provides ideal nutrition and protects infants from illness. Undernutrition contributes to 45% of under-5 mortality globally.
2) Breastfeeding has significant health benefits for both mother and baby, including reducing the risks of obesity, diabetes, breast and ovarian cancer. It improves cognitive development and results in economic gains.
3) Proper breastfeeding techniques such as positioning, attachment and frequent feeding are important to ensure the baby receives enough milk from the breast. Common challenges can be addressed through counseling and support.
This document provides information on diarrhea among under-5 children. It discusses the global burden of diarrhea, key facts about diarrhea including causes and prevention. Specific diarrheal pathogens like rotavirus, cholera, and giardiasis are explained. Treatment of acute watery diarrhea and dysentery are also summarized. The document emphasizes continued feeding and oral rehydration therapy in treating diarrhea.
The document discusses acute respiratory infections (ARIs) in children under 5 years old. It defines ARI and describes the signs and symptoms, including fast breathing and chest indrawing. Common causes are viruses like RSV and bacteria like Streptococcus pneumoniae. ARIs often spread rapidly in young children due to anatomical factors. They are a major cause of mortality, responsible for around 900,000 child deaths per year. Proper treatment with low-cost measures can reduce the death toll from ARIs.
This document provides an overview of Bangladesh. It begins with a brief description of Bangladesh's location and geography, noting that it is located in South Asia on the Bay of Bengal and has the world's largest delta formed by the Ganges, Brahmaputra, and Meghna rivers. It then discusses Bangladesh's population, demographics, economy, industries, exports, infrastructure, education system, healthcare successes, challenges, and potentials. The document also profiles Bangladesh's climate, landscape, biodiversity, culture, and history. It concludes by outlining some of Bangladesh's current problems including corruption, poverty, pollution, and natural disasters.
Bangladesh has made significant progress in health outcomes for women and children through effective interventions. The under-5 mortality rate fell from 151 per 1000 live births in 1990 to 38 per 1000 in 2017, exceeding Millennium Development Goal 4. This was achieved through programs promoting oral rehydration therapy, immunizations, integrated management of childhood illness, and newborn health interventions. Bangladesh also reduced the maternal mortality ratio by 75% and exceeded Millennium Development Goal 5. Current challenges include further reducing child injuries such as drownings, improving nutrition, and addressing emerging issues like non-communicable diseases and environmental health hazards.
Here are the answers to the MCQs:
1. RSV is the commonest c/of bronchiolitis - True
2. ABT is usually required in B - False
3. Most B are later associated with BA - True
4. In EBF babies B is rare - True
5. Anticholingergic nebulization is beneficial in B - False
6. B is usually a killer D - False
7. SARS/MERS is caused by RSV - False
8. Antiviral Rx is beneficial in all B cases - False
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...rightmanforbloodline
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Versio
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
6. Background
Pancreatitis (P) is uncommon in children: significant MM
• 13/100k/y children (US). Adult incidence has increased
dramatically past 15y: changing trends in etiology,
increased referral, better Dx
Due to underreporting & underDx incidence in
children (& adults) is unknown
• Evaluate all abdo. pain with HI of suspicion
• P. starts with blockage of ducts & acinar damage
activation of enzymes autodigestion (inflam.,
hge., necrosis, pseudocyst (23% of AP; >50% a/with
traumatic P.)
MM. morbidity-mortality, hge. Hemorrhage, Dx. Diagnosis. HI. High index
7. Anatomy
• P. is 6in long & sits across back of abdo, behind stomach;
p. duct joins CBD at ampulla of Vater
• Has indistinct head, body, & tail. Abdo. aorta & IVC cushion
it from vertebrae. Crushing/blunt trauma can injure it
• Numerous cong. anomalies are seen
Pancreas divisum occurs in 5-15% popn.: unsuccessful
fusion of ventral & dorsal buds: accessory Santorini
duct drains majority of p.: smaller, inadequate drainage
may cause chr. pain & rec. P.
9. P. divisum with minor papilla stenosis causing rec. P. Note
bulbous shape of duct adjacent to cannula (santorinicele).
Dorsal duct outflow obs. is the probable c/of P.
10. P. is retroperitoneal, except just a part of tail coming through
mesenteric folds. Head is to Rt of L2, body over L1, & tail to Lt of T12
16. 50% asymptomatic till adulthood. A/with: GI problems, Down,
polyhydramnios. More risk for p./biliary Ca. CF: due obs. NB may have
complete obs.: not feeding; spits, cries. Adult: fullness after meal, NV.
Dx: USG, AXR, CT, Upper GI & small gut series. Rx. mostly surgery.
Complications. Jaundice, Ca, P. PUD, Perforation, peritonitis
18. Annular pancreas
A: Upper GI series, oblique v.: narrowing of duo- C-loop (arrows)
B: ERCP: small ducts (arrows) encircling d., consistent with annular p.
19. Ectopic p.: lacks anatomic continuity with main p.; usually in
stomach, duo-, jejunum, Meckel’s. Most are small & asymptomatic.
Incidence at laparotomy is 0.2%. Some develop pseudocyst,
insulinoma, Ca. SS: abdo. pain, bleeding, obs.
Meckel’s
E.P.
20. Functions of the P
Exocrine Function
• Lipase, amylase, trypsin & chymotrypsin, elastase,
kallikrein, phospholipase. Food in stomach: p. juice is
released into duodenum
Endocrine …
• Thousands of islets of Langerhans: (5% wt): 4 cell types: in
order of abundance:
– 1. beta (insulin and amylin)
– 2. alpha (glucagon)
– 3. delta (somatostatin)
– 4. gamma (pancreatic polypeptide)
21. Pancreas Disorders
• Pancreatitis
• Diabetes type 1 (autoimmune) & type 2
• CF: affects multiple systems
• Tumors: different cells. The commonest is from p. duct &
is often advanced at Dx. Islet cell: benign/Ca
(Gastrinomas, glucagonomas, insulinomas)
• Pseudocyst
• Enlarged p: may mean nothing, or, it can be due to an
anatomic defect. But other c/of an enlarged p. may
exist & require treatment
22. Ac. P: Requires 2:
1. Suggestive abdo. pain: acute, esp. in epigastrium
2. S. amylase and/or lipase activity x3
3. Compatible imaging
Rec. P.: 2 distinct episodes of AP. Interval with:
• Resolution of pain (≥1mo). Normal s. enzymes
Chr. P.: 1 of:
1. Abdo. pain of p. origin & imaging of p. damage
2. Evidence of exocrine p. insufficiency & imaging findings
3. ... endocrine ... & imaging …
4. Surgical/biopsy: features compatible with CP
PANCREATITIS
23. AC. PANCREATITIS IN CHILDREN
Etiology (30% idiopathic). Many are a/with a systemic
illness. Some affect multiple organs
• Common: trauma (23%), dev. anomalies (15%),
multisystem d. (14%), drugs/toxins (12%):
• Less common
• Inf. (10%): MR, coxsackie B, EBV, CMV & HBV (primarily in organ
transplants); HIV, campylobacter, HAV, salmonella, mycoplasma.
Ascaris is a recognized c/of AP
• Hereditary/metabolic (4%):
• Biliary: rare
Most adult AP are c/by alcohol or g. stone
24. –Trauma: RTA, abuse, bicycle handlebars
–Cong.: p. divisum, malunion/maljunction, sphincter
anomaly, CD cysts, FAP
–Drugs/toxin: TPN, tetracycline, valproate,
immunosuppressants
–Hereditary: 2nd commonest cong. P. following CF.
AD. 20% no P. (variable penetrance)
–Metabolic: hyperTG, hyperCa
–Multisystem: Hypotension, ischemia. SLE, HSP, IBD,
(rarely) Kawasaki, Reye's
FAP. Familial adenomatous polyposis. CD choledochal
Etiology …
26. Pathophysiology
• AP: Inciters are unclear: acinar injury disruption of
ducts. Enzymes are activated: autodigestion
• Inflam. May be local/diffuse: ac., chr., necrotic, hgeic.
Interstitial edema. Severe P. necrosis, BV blockage
hge., & SIRS with MOF. Secretions often are walled
off by gr. tissue (pseudocyst; 10-23% in AP, 50% after
traumatic P. Mainly in lesser sac behind stomach).
Stomach, small gut, etc. may form part of capsule
CP: Chr. inflam. cell infiltration & irreversible fibrosis loss
of exocrine & endocrine functions seen when ≥90%
cells are destroyed
MOF. Multiorgan failure
27.
28.
29. p. in CT : enlarged (blue arrow) with indistinct shaggy borders.
Peripancreatic fluid (red a.) and extensive infiltration of surrounding
fat (black a.)
30. Modified Glasgow Criteria (severe P.)
Score >/= 3 indicates severe pancreatitis
PaO2 <8kPa (60mmhg)
Age >55years
Neutrophils: WBC >15 x109/l
Calcium <2mmol/l
Renal F. : Urea >16 mmol/l
Enzymes: AST/ALT >200 iu/L or LDH > 600 iu/L
Albumin <32g/l
Sugar: Glucose >10mmol/L
(‘PANCREAS’)
32. CF
Classical AP in adults: midepigastric pain radiating to back
• Children: quite varied; mostly: abdo. pain (90%), F. (76%)
NV (73%), tenderness (85%), guarding (68%), jaundice
(28%), distention (18%), SoB (10%), H&M (5%). Others:
HR, pallor, low BP (10%), rebound tenderness, & less
BS, diaphoresis, pulmo. Edema
These are nonspecific. Eating may exacerbate pain
• An acutely ill child may lie on his side with hips
& knees flexed. Pain typically increases for 24-
48h. Clinical course is variable
Typical posture of AP
33. Age 0-2y 3-10 11-20 Total
Cohort
Abdo. pain 42.9% 93.2% 93.4% 90%
Epigastric
tenderness
57.1% 86.4% 87.2% 85%
N/vomiting 28.6% 69.5% 78.1% 73%
Age group with presenting complaints
34.
35. Acute hemorrhagic pancreatitis
Rare in children
• Life-threatening; MR ~50% (shock, SIRS with MOF, ARDS,
DIC, massive GI hge., & systemic or peritoneal inf.
• PE: a bluish discoloration of flanks (Grey Turner sign) or
periumbilical region (Cullen) due to blood pooling in
fascial planes
Others: pleural e., H&M, coma
36.
37. Cullen’s and Grey Turner’s Signs in AP
63y M, no h/of alcohol abuse had ac., severe epig. pain. S. lipase was 1380U/l (22-51). US: g.
stones. He needed ICU. PE: jaundice and distention with ecchymosis (periumbilical and flank).
These are due to free enzymes causing fat necrosis and inflam. with retroperitoneal /abdo. hge.
that diffuses from retroperitoneum to umbilicus via round lig. and to subcut. tissues of flanks.
These, although nonsp., are a/with severe AP and high MR. CT confirmed necrotizing P. with
several ac. peripancreatic fluid collections (Balthazar grade E). He died of MO failure
38.
39. Dx
Pediatric P. is a Dx challenge!
• No single test! Mainly clinical.
• CF, blood tests, imaging
• Dx needs 2 or more of:
– Amylase & lipase
most common: levels rise; but, do not correlate with
severity. Other d. can also raise; so nonsp.
US & CT
most common imaging; to look for inflam. & are
preferred both for Dx & FU
Importantly, P. can sometimes appear normal
40. • s. amylase peaks at 48h, may be normal in 10-15%
Typically stay raised x4d. Amylase can rise in other
abdo. d., but not typically as high as in AP
• S. lipase is more specific than amylase in AP, & typically,
stay raised x8-14d
It can also rise in other d.; so, all lab. data are assessed
in cl. setting
41. Imaging
Imaging may be normal in 20% children with AP
• US: ducts, stones, margins. Primary screening (no IR/
sedation): a focally/diffusely enlarged, hypoechoic,
sonolucent, p.; dilated ducts; p. mass; peripancreatic
fluid; abscess; pseudocyst. Sensitivity is 50-80%;
specificity 90%
• ERCP is gold standard; also therapeutic (g. stones,
stenting, sphinterectomy). Essential for p. & biliary
anomalies Sens. & spec. 90-100%. Has substantial
observer variability, & may confuse AP for CP
42. Imaging …
• MRCP: non-invasive alternative to ERCP; no Rx option, no
IR: for g. stones, T, inf., inflam., ducts, c/of P
Secretin can enhance image
• CT is both highly sensitive and specific, risk of IR. Findings:
ductal/parenchymal calcifications, dilatation of main
ducts, pseudocyst & p. atrophy
contrast, it is better for CP, complications, trauma, T.
Often used to FU: an enlarged p.; ill-defined margins;
peripancreatic fluid; pseudocysts
45. Comparison of EUS of normal p. and EUS of CP.
Endoscopic ultrasound showed agreement with ERCP,
the gold standard, in 75% of cases
46. Radiography
• XR: nonsp. distended loop of small gut (sentinel loop), g.
stones, dilatation of t. colon (cutoff sign), ascites,
peripancreatic gas bubbles, ileus, L basal pleural e., &
blurring of L psoas margin
Histology
• AP: necrosis & inflam., hge. If severe: large, blue-black
hgeic. foci among yellow-white chalky areas of fat
necrosis
• CP: parenchymal damage & fibrosis; acinar destruction,
lymphocytic infiltration, & p. duct obs. Ducts are dilated
& obstructed with protein plugs
47. CP: destruction of acini replaced
by extensive fibrosis & relative
sparing of islets; with calculi
AP: Hemorrhage, necrosis, fat necrosis, neutrophils
50. Other lab. tests:
• Coagulopathies, leukocytosis, hypoCa, hyperglycemia,
bilirubin & GGT, Hct. & CRP (prognosis)
• Urinary trypsin activator peptide (TAP) may show severity
• A high s. lipase (>19 above upper normal) & a low albumin
& TLC have more morbidity. These 3 identify most at
risk of severe P. & can direct a more aggressive Rx
• Sweat chloride: in CF
• Genetic testing: for CF
51. No single drug. Mainly supportive. Admission may be needed
Uncomplicated AP usually resolve within 2-4d
Severe AP occur in 20% AP in children: more MM, longer
stay, aggressive Rx. Mn. children are more likely to have
comorbidities (CP & encephalopathy). Mn. can mask
typical early CF
Goal: to achieve FEB, analgesia, p. rest, meta. homeostasis
• Intractable V or ileus: NG suction for intestinal-pancreatic
rest (gastric contents in duodenum are the most potent
activator of p. enzymes). FEB
• ABT in inf., severe P.:
• Rx of complications
Management
52. • Analgesics: Tramadol is a central analgesic. Meperidine is
opioid (severe pain): risk of ampullary spasm
• AB: Imipenem & cilastatin in combination
Ceftriaxone has BS G-ve activity; lower efficacy against
G+ve; & higher against resistant MO
• Chr. relapsing P.: enzyme supplement, insulin, &
elemental or low-fat diets are useful
53. Nutrition
• Intractable V/ileus: bowel rest. Stomach content in duo- is
the most potent activator of p. enzymes
• Mild AP
– If pt. feels hungry; can start eating in a day or 2 if no NV,
& symptoms have resolved (amylase now normal)
– feeding small & slowly increasing low-fat, low-protein
soft diet appears safe, more calories; no transition
• Severe AP
– Severe P.: NPO & parenteral nutrition (avoid catabolism)
– Parenteral nutrition should be avoided, unless enteral
route is N/A, not tolerated, or not meeting calories
54. RATIONALE OF EARLY ENTERAL
NUTRITION
• The need to place p. at rest until complete
resolution of AP no longer seem imperative
– Bowel rest is a/with intestinal mucosal atrophy &
bacterial translocation: more inf. &complications
• Early enteral feeding maintains gut mucosal barrier,
prevents disruption, & prevents translocation of
bacteria that seed p. necrosis: less inf.
complications, organ failure & mortality
55. Route of enteral Nutrition
• Traditionally nasojejunal route has been preferred
to avoid the gastric phase of stimulation BUT
– Nasogastric route appears comparable in efficacy &
safety
MERITS OF NG ROUTE DEMERITS OF NG ROUTE
NGT placement is far easier than
NJ tube placement (requiring
interventional radiology or
endoscopy: expensive)
Slight increased risk of aspiration
(overcome by placing pt upright &
be placed on aspiration
precautions)
56. Surgery
• Generally, surgery is not needed in children; mostly done in
intractable pain in chr./relapsing P. (failed Rx, Mn., &
narcotic addiction), diffuse necrosis, hge., cong. defects
(p. divisum), ductal fistulae & AP induced ascites,
abscess, pseudocyst
• Goal: to alleviate pain & preserve functions:
– Distal pancreatectomy with Roux-en-Y pancreaticojejunostomy
(Duval procedure)
– Lateral pancreaticojejunostomy (Puestow procedure)
– Decompression of p. ducts, repair of p. divisum, sphincteroplasty
• A few cases benefitted with total pancreatectomy & ICT
ICT: islet cell transplantation
57. Pseudocysts
• CF: ANV from obs. of stomach/gut, F (inf). Rarely, hge. into
abdo./gut. Pain, tender epigas. mass or abdo. fullness.
Jaundice, chest pain, wt. loss, ascites. Post-traumatic: 60%
need surgery. If size is
<5cm: observe x4-6w as most resolve
>5cm: supportive x4-6w (cyst wall to mature) surgery
>10cm has risk for rupture
Chr. pseudocysts (>3mo): best Rx by internal drainage
– Cystogastrostomy: if adherent to back of stomach
– Cystoduodenostomy: if present in the head of p.
– Distal pancreatectomy: when it is in tail of p.
– Cystojejunostomy: other than above
62. Same pt., stents
were placed
following
ampullectomy.
P. resolved in
1w. Stents were
later removed
63. • Total pancreatectomy with ICT is being evaluated for CP.
ICT has no v. serious SE ("brittle diabetes,") (pt’s BGL
often swings quickly from high ~ low ~ high
CP need multispecialty care (gastroenterologists, surgeons,
nutritionists, psychologists, etc)
How long will AP last?
• Usually a week
• S/he needs not stay for that whole period. SS do improve
over time. A few have more severe d. & may end up
admitted for a month or more
64. Complications of AP
Immediate common
• Hypovolemic/septic shock a/with dysfunction of MOs
• Renal dysfunction
• Ascites, pleural e, ARDS, hypoCa, hge
Late common
• P. necrosis
• Infection
• Pseudocysts (homogeneous collection of amylase-rich
p. fluid that lacks an epithelium). 10-20% of AP
70. Fat embolism: Fat can enter blood from BM due to trauma, & if fat is
released by enzymatic digestion (AP). Common causes: 1. Fractures of
long bones &/or operative manipulation of fractures; 2. trauma to fat
or fatty liver; 3. AP. Fat emboli tend to be small and often cause small
infarcts adjacent to capillaries at the sites of blockage
71. Prognosis usually in children is excellent
Death is quite rare. But can happen. 1% in mild AP
• 20-50% in severe AP. More with underlying d. 1/3rd die in
1w (MOF); 2/3rd later (MOF & sepsis)
Recurrence
• Yes, it can occur in 10%. Even fewer will have multiple.
Another episode warrants additional testing to search
for known c/of recurrent AP
Prevention
• Some treatable c/of AP: gallstone d, hyperCa, high TG, &
abnormalities of ducts
72. CHR. PANCREATITIS IN CHILDREN
SS
• Frequent or chr. Abdo. Pain is the most common; can be
constant or come & go unpredictably
• Others: NV, wt. loss, D (oily motions). Some have trouble
digesting & may have poor growth, especially if quite
young at first episode of P
• DM generally takes many years to appear, but this, too, is
highly variable; some will DM in adolescence
73. Etiology of Chr. P in children
Some are life-long, not often Dx until adulthood
• Fibrosing P./TCP commonest in tropics
• CF
• Chr. Hereditary P. (usually Dx at adulthood)
– Hyperlipidemias
– Partial lipodystrophy
– Wilson's disease
– hemochromatosis
– Alpha-1 antitrypsin deficiency
• IEM: (esp. branched chain aminoacidemias)
• Idiopathic
74. CP: Dx
• As biopsy is impractical & potentially risky in many pts.,
clinical, lab., & radiologic criteria are essential for Dx.
• Lab. Direct: small gut intubation, using secretin, CCK or
nutrient stimulants to measure secretion: highly
sensitive and specific, but time-consuming and invasive
• Lab. Indirect: stool fat globules & assays for faecal
elastase, as well as other stool, breath, & urine/plasma
tests. They tend to lack sensitivity & specificity &
cannot DD between mild and moderate exocrine
dysfunction. Faecal elastase & a 72h faecal fat is
adequate
75.
76. CP: Management
Goals:
1. Dx and etiology
2. Analgesia
3. Long-term FU to monitor & Rx exocrine insufficiency, DM
4. No smoking and alcohol (risk of p. adenoCa)
Others: antioxidants, enzyme, octreotide, pancreatic
protease inhibitors. But, currently insufficient evidence
to recommend these
• Surgery is only indicated when there is chr., unremitting
pain unresponsive to medical Rx. Goal: adequate
drainage of p. ducts. This can be endoscopic or surgical.
Pancreatic resections have high MM & rarely required
77. DD: Ac. vs. Chr. Pancreatitis
Trait Ac. P Chr. P
Duration 2w Life long
Emergency May be life threatening; an
emergency (hge, shock)
Slowly developing
Etiologies Trauma (23%), dev.
anomalies (15%), sys. d.
(14%), drugs/toxins (12%),
viral (10%), etc. 25% is
unknown
Trauma, sys. d., cong.
anomalies
Pathogenesis Morphological changes are
reversible with good support
Calcifications and
destruction of architecture
Complications Permanent DM almost never
follows a single attack
DM , malabsorption
Lab High s amylase, lipase within
1-2d
Requires proof of irreversible
damage to P, loss of digestive
F or DM: by
CT/MRI, ERCP, endoscopic US
78. Peculiarities Of Pancreas
• Mixed gland
• Develops from 2 primordial buds
• Congenital anomalies can cause malignancy
• Minimally infected
• Disorders causes autodigestion
• Chronic pancreatitis is life-long
79. MCQ
• HyperCa is common in AP
• Imaging may be normal in AP
• Lipase is more specific than amylase
• DM is more common in AP
• 25% AP are idiopathic
80. • Inf. is a common c/of AP in children
• ERCP is a common cause of AP
• Most p. pseudocysts require drainage
• Gall stone pancreatitis is common in children
• An enlarged pancreas is always significant
MCQ