The pancreas is a retroperitoneal organ divided into a head, neck, body, and tail. It has both exocrine and endocrine functions. The exocrine part secretes pancreatic juice to aid digestion, while the endocrine part contains islets of Langerhans that secrete insulin and glucagon. Pancreatitis is inflammation of the pancreas that can be acute or chronic. Acute pancreatitis commonly results from gallstones or alcohol and causes abdominal pain. Chronic pancreatitis is characterized by irreversible pancreatic tissue damage that can lead to diabetes and malnutrition over time. Treatment involves pain management, nutritional support, and sometimes surgery.
15 cm in length, 60-140 gm, consists of head, body & tail; pancreatic duct empty into duodenum or common bile duct
Histologically, consists of 2 components:
1) Exocrine: 80-85%, consists of numerous glands (acini) lined by columnar basophilic cells containing zymogen granules, which form lobules; ductal system
Trypsin, chemotrypsin, aminopeptidase, amylase, lipase
2) Endocrine: islets of Langerhans, which are invaded by capillaries. Islets consist of:
4 main cell types: B (insulin), A (glucagon), D (somatostatin), PP cells (pancreatic polypeptide)
2 minor cell types: D1 (VIP) & enterochromaffin cells (serotonin
Nursing assessment and Management clients with Pancreatic disordersANILKUMAR BR
The pancreas, located in the upper abdomen, has endocrine as well as exocrine functions .
The secretion of pancreatic enzymes into the gastrointestinal tract through the pancreatic duct represents its exocrine function.
The secretion of insulin, glucagon, and somatostatin directly into the bloodstream represents its endocrine function.
Pancreatitis (inflammation of the pancreas) is a serious disorder. The most basic classification system used to describe or categorize the various stages and forms of pancreatitis divides the disorder into acute or chronic forms.
Acute pancreatitis can be a medical emergency associated with a high risk for life-threatening complications and mortality, whereas chronic pancreatitis often goes undetected until 80% to 90% of the exocrine and endocrine tissue is destroyed.
Acute pancreatitis does not usually lead to chronic pancreatitis unless complications develop.
15 cm in length, 60-140 gm, consists of head, body & tail; pancreatic duct empty into duodenum or common bile duct
Histologically, consists of 2 components:
1) Exocrine: 80-85%, consists of numerous glands (acini) lined by columnar basophilic cells containing zymogen granules, which form lobules; ductal system
Trypsin, chemotrypsin, aminopeptidase, amylase, lipase
2) Endocrine: islets of Langerhans, which are invaded by capillaries. Islets consist of:
4 main cell types: B (insulin), A (glucagon), D (somatostatin), PP cells (pancreatic polypeptide)
2 minor cell types: D1 (VIP) & enterochromaffin cells (serotonin
Nursing assessment and Management clients with Pancreatic disordersANILKUMAR BR
The pancreas, located in the upper abdomen, has endocrine as well as exocrine functions .
The secretion of pancreatic enzymes into the gastrointestinal tract through the pancreatic duct represents its exocrine function.
The secretion of insulin, glucagon, and somatostatin directly into the bloodstream represents its endocrine function.
Pancreatitis (inflammation of the pancreas) is a serious disorder. The most basic classification system used to describe or categorize the various stages and forms of pancreatitis divides the disorder into acute or chronic forms.
Acute pancreatitis can be a medical emergency associated with a high risk for life-threatening complications and mortality, whereas chronic pancreatitis often goes undetected until 80% to 90% of the exocrine and endocrine tissue is destroyed.
Acute pancreatitis does not usually lead to chronic pancreatitis unless complications develop.
We all have good and bad thoughts from time to time and situation to situation. We are bombarded daily with spiraling thoughts(both negative and positive) creating all-consuming feel , making us difficult to manage with associated suffering. Good thoughts are like our Mob Signal (Positive thought) amidst noise(negative thought) in the atmosphere. Negative thoughts like noise outweigh positive thoughts. These thoughts often create unwanted confusion, trouble, stress and frustration in our mind as well as chaos in our physical world. Negative thoughts are also known as “distorted thinking”.
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Ethnobotany and Ethnopharmacology:
Ethnobotany in herbal drug evaluation,
Impact of Ethnobotany in traditional medicine,
New development in herbals,
Bio-prospecting tools for drug discovery,
Role of Ethnopharmacology in drug evaluation,
Reverse Pharmacology.
How to Create Map Views in the Odoo 17 ERPCeline George
The map views are useful for providing a geographical representation of data. They allow users to visualize and analyze the data in a more intuitive manner.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
This is a presentation by Dada Robert in a Your Skill Boost masterclass organised by the Excellence Foundation for South Sudan (EFSS) on Saturday, the 25th and Sunday, the 26th of May 2024.
He discussed the concept of quality improvement, emphasizing its applicability to various aspects of life, including personal, project, and program improvements. He defined quality as doing the right thing at the right time in the right way to achieve the best possible results and discussed the concept of the "gap" between what we know and what we do, and how this gap represents the areas we need to improve. He explained the scientific approach to quality improvement, which involves systematic performance analysis, testing and learning, and implementing change ideas. He also highlighted the importance of client focus and a team approach to quality improvement.
The Indian economy is classified into different sectors to simplify the analysis and understanding of economic activities. For Class 10, it's essential to grasp the sectors of the Indian economy, understand their characteristics, and recognize their importance. This guide will provide detailed notes on the Sectors of the Indian Economy Class 10, using specific long-tail keywords to enhance comprehension.
For more information, visit-www.vavaclasses.com
1. ANATOMY OF THE PANCREAS
The Pancreas is also called abdominal tiger.
Pancreas is an elongated retroperitoneal organ 15-20cm in
length, it leis against L1-L2 vertebrae, lies posterior to
stomach, separated by lesser sac.
2. PARTS
• It is divided into head, neck body tail
1. Ducts of the pancreas; this is the main duct of the pancreas
It joins the bile duct in the wall of the second part of the
duodenum to form hepato-pancreatic ampulla also called
ampulla of vater (Herring bone pattern).
2. Accessary pancreatic duct (Duct of santorini) It begins in
the head and open the duodenum at minor duodenal papilla
(6-8cm) from the pylorus.
5. FUNCTIONS
1. Exocrine part which secrete pancreatic juice which helps in
digestion of proteins, carbohydrates and fats.
-Acini cells 99%
2. Endocrine part which constituted islets of the pancreas which is
distributed more numerous in the tail of the pancreas.
-B Cells of the islets which secrete insulin
-Alpha Cells secrete glucagon
6. PANCREATITIS
Pancreatitis is the inflammation of the grand parenchyma of
the pancreas.
For clinical purposes, It is useful to divide pancreatitis into
acute, which presents as an emergency, and chronic , which
is a prolonged and frequently lifelong disorder resulting
from the development of fibrosis within pancreas.
10. ACUTE PANCREATITIS
• Acute pancreatitis is defined as the development of the
acute inflammation of normally existing pancreas and is
usually associated with abdominal pain and raised pancreatic
enzymes.
Risk factors
Excessive alcohol consumption
Cigarette smoking and Obesity
Family history of pancreatitis
12. Organisms known to cause infections includes the following:
• Escherisha coli 35%
• Klebsiella 25%
• Enterococcus 28%
• Others;Staphylococci , Pseudomanas aeruginosa , Protues ,
Enterobacter , Anaerobes, Candida (10%)
13. Pathophysiology
• Teological philosophy says nothing but the existence of the almighty is
to be taken as axiomatic, yet the presence of the foprocesses will
always result in pancreatitis.
• The pathophysiology of acute pancreatitis is characterized by a loss of
intracellular and extracellular compartmentation, by an obstruction of
pancreatic secretory transport and by an activation of pancreatic
enzymes. In biliary acute pancreatitis, outflow obstruction with
pancreatic duct hypertension and a toxic effect of bile salts contribute
to disruption of pancreatic ductules, with subsequent loss of
extracellular compartmentation.
14. • Alcohol induces functional alterations of plasma membranes and
alters the balance between proteolytic enzymes and protease
inhibitors, thus triggering enzyme activation, autodigestion and cell
destruction.
• . Once the disease has been initiated, the appearance of interstitial
edema and inflammatory infiltration are the basic features of acute
pancreatitis. The accumulation of polymorphonuclear granulocytes in
pancreatic and extrapancreatic tissue, and the release of leukocyte
enzymes play an essential role in the further progression of the
disease and in the development of systemic complications.
15. • Activation of different cascade systems by proteolytic activity, and
consumption of alpha 2-macroglobulin further characterize the
severe clinical course of acute pancreatitis.
• The two major causes of acute pancreatitis are biliary calculi, which
occur in 50–70% of patients, and alcohol abuse, which accounts for
25% of cases. Gallstone pancreatitis is thought to be triggered by the
passage of gallstones down the common bile duct. If the biliary and
pancreatic ducts join to share a common channel before ending at
the ampulla, then obstruction of this passage may lead to reflux of
bile or activated pancreatic enzymes into the pancreatic duct.
16. • Patients who have small gallstones and a wide cystic duct may be at a
higher risk of passing stones. The proposed mechanisms for alcoholic
pacreatitis include the effects of diet, malnutrition, direct toxicity of
alcohol, concomitant tobacco smoking, hypersecretion, duct
obstruction or reflux, and hyperlipidaemia. The remaining cases may
be due to rare causes or be idiopathic.
17. Clinical features of Acute pancreatitis
Classified as mild, severe and fulminant attacks;
1. Sudden onset of upper abdominal pain , which is referred
to the back and relieved by leaning forward.
2. Vomiting, high fever, tachypnea with cyanosis, severe
illness.
3. Abdominal distension and ascites may be present.
Hiccough when present is refractory
18. Conti….
4. Often milder jaundice due to cholangitis and other biliary
tract obstruction diseases.
5. Feature of shock and dehydration.
6. Oliguria, hypoxia and acidosis.
7. Haematemesis /malena due to duodenal necrosis, gastric
erosion , decreased coagulability /DIC.
8. Neurological derangements due to toxaemia , fat embolism,
hypoxia, ADs, milder psychosis to coma
19. On Examination
1. Tenderness, Guarding, rigidity.
2. Blumberg’s sign, Grey-Turner ‘s sign, Cullen’s sign, Fox sign.
3. Pleural effusion, pulmonary oedema , consolidation.
4. Features of rapid onset of ARDS is seen.
5. Paralytic ileus is common.
6. Chvosteck and Trousseau’s sign
25. Treatment
conservative Rx
• ABC - initiate IV lines
• Rehydration (250-400ml/hr of R/L or N/S, Dextrose saline,
plasma and fresh blood transfusion/ packed cells).
• Pain relievers e.g Pethidine and or others except Morphine.
• Severe haemorrhage episodes; Fresh frozen plasma and
platelet concentration (DIC and
26. Haemorrhage)
• NG aspiration, urinary catheterization to maintain and
monitor urine output 50ml/hr.
• Antibiotics like third generation cephalosporins ; Imipenem ,
Meropenem , Cefuroxime , Ceftriaxone and Cefotaxime.
• Calcium gluconate 10ml IV 8th hourly – hypocalcaemia.
27. • IV Ranitidine 50mg TDS or IV Omeprazole 40mg BD or IV
pantoprazole 80mg BD (stress ulcers and erosive bleeding ).
• Monitor arterial venous pressure line.
• Haemodialysis –Renal failure.
• Somatostatin/Octreotide –reduce pancreatic secretions.
• Steroids in initial phase – shock and respiratory ditress.
28. • Nasojejunal tube placement and feeding.
• Anti-cholinergics, Protease inhibitors and calcitonin.
29. Surgical management
• Laparotomy followed by;
• Percutaneous drainage
• Surgical drainage
• Open surgery is the gold standard for infected pancreatic necrosis.
• Laparotomy-necrosectomy
• Endoscopic necrosectomy
• Endoscopic retrograde cholangiopancreatography associated with
endoscopic sphincterotomy.
• Cholecystectomy
33. CHRONIC PANCREATITIS
• Chronic pancreatitis defined as progressive inflammatory
disease , in which there is irreversible destruction of
pancreatic tissue.
• It is usually progress with severe epigastric pain radiating to
the left shoulder and relieved by leaning forward.
• During the course of disease ,later lone ,there is exocrine and
endocrine pancreatic insufficiency.
34. Aetiology
Alcoholism ; 5-10% of 60 -70 cases of those who develop the
condition with alcohol intake.
Genetic and metabolic factors
Pancreatic duct obstruction resulting from stricture
formation of trauma.
After acute pancreatitis and Hereditory pancreatitis.
Pancreatic carcinoma on the duct and infantile malnutrition.
Pancreatic divisum and annular pancreas. Also Idiopathic
35. Clinical features of chronic pancreatitis
• Pain (epigastric and right subcostal pain with dull and gnawing
character)
• Nausea
• Weight loss ,and
• Others as in acute form type
37. Medical treatment of chronic pancreatitis
Treat the addiction; help the patient to stop alcohol
consumption and tobacco. Involve a dependent counsellor
or psychologist
Alleviate abdominal pain; Eliminate obstructive factors
(duodenum , bile duct , pancreatic duct) ,Escalate analgesia
in a stepwise fashion, for intractable pain , consider CT/EUS
–guided coeliac axis block.
38. Nutritional and pharmacological measures
-Diet ; low in fat and high in protein and carbohydrates
-Pancreatic enzyme with supplementation with meals
- Correct malabsorption of the fat-soluble vitamins and
vitamin B12
-Micronutrient therapy with methionine, vitamin C and E,
Selenium(may reduce pain and slow disease progression).
39. -Steroids (only in autoimmune pancreatitis, for relief of symptoms)
-Medium-chain triglycerides in in [patient with severe fat
malabsorption
- Reduce gastric secretions may help
Treat diabetes mellitus.
Surgical management
Pancreatico-jejunostomy
Necrotectomy
•
40. “Working together is essential for success ;Even freckles would make a
nice tan if they would get together”
41. References
• SRB’S Manual of surgery ,4th Edition. Chapter, 14,page 725.
Sriam Bhat M Ms (GENERAL SURGERY)
Jaypee Brother medical publishers (p) LTD
New Delhi.Panama City. London.phidadelphi (USA)
• Bailey’s and Love’s SHORT PRACTICAL OF SURGERY .26th Edition.
International student’s edition.
• D’Edigio A, Schein M. Surgical strategies in the treatment of
pancreatic necrosis and infection.Br J Surg.
