Professional Documents
Culture Documents
Dr-Monther Abureden
General surgeon-MOH
Liver and kidney transplant surgeon
DEFINITIONS
Inflammation of
glandular parenchymal lead to injury
and destruction of acinar components
Acute: reversible
Chronic :
progressive
Acute Pancreatitis
CLASSIFICATION
Mild
Moderate
Sever 25%
Acute pancreatitis
Etiology:
1-Gallbladder stones
2-immoderate alcohol
consumption
3-hyperlipedemia
4-drug induce
5- infectious causes:
mumps,coxaki B
6-Post ERCP
7-Heredatery
pathophysiology
1-The critical step:
Pancreatic outflow
obstruction
2-Activation of pancreatic enzymes
3-Autodigestion
4-Release of cytotoxines
5-Activation of inflammatory response
6-Organ failure
The Pancreas
Diagnosis
pain,vomiting
Diagnosis
24 h
3x Normal levels of amylase
lipase
(10 140 U/L)
Abdominal Pain
Vomiting
( 50 150 U/Dl)
or
Acute Pancreatitis
phtsical examination
Cyanosis, Dyspnea
Bowel sounds decreased or absent
Low-grade fever, Leukocytosis
Hypotension, Tachycardia
Jaundice
Abnormal lung sounds - Crackles
Discoloration of abdominal wall Turners
or Cullens sign
SIGNS OF SHOCK
Prognosis Ransons
(Severe > 3)
Ransons Score
5 on Admission
Age > 55 y
Glucose >200 mgldl
WBC > 16000
LDH > 350 iu/l
AST > 250 iu/l
APACHE II scale
age
temperature
mean arterial pressure
heart rate
PaO2
arterial pH
serum potassium
serum sodium
serum creatinine
hematocrit
white blood cell count
Glasgow Coma Scale score
chronic health status
Assesment of severity
25%Sever
1-CRP:
>130 mg/l(first 72h)=complicated
pancreatitis
2-Hematocrit:!!!!!!!!
bad sign: necrosis
bad sign:dehydrated
3-Ct scan
Complications
Local
Pancreatic fluid collection:
temporary,persistant
Pancreatic necrosis
Significant hemorrhage
Systemic
INFLAMMATORY PROCESS
Syestamatic Inflammatory Syndrome
Multiple Organ
Dysfunction:Respiratory,CVS,Renal
failur
Managments
Fluid
Pain killer
Abs
Nutrition
ERCP
Cholecystectomy
Fluid
Urine output,
H.R
BP,
CVP
Pain
NSAIDs
weak opioid
strong opioid
epidural anasthesia
Antibiotics
Nutrition
Early
Enteral feeding(no sepsis)
ERCP
cholangitis
Cholecystectomy
Chronic pancreatitis
Dynamic disease:
progressive loss of pancreatic
parenchyma caused by inflammation
and tissue destruction and subsequent
synthesis of fibrotic tissue
Causes
TIGARO
Toxic: Alcohol, Ca,lipid,smoking,uremia
Idiopathic
Genetic
Autoimmune
Radiation
Obstruction
Dynamic disease
Stage A:
Recurrent abdominal pain+_mild impairment
of pancreatic function
Stage B:
more frequent attaches ,more
sever+significant impairment in pancreatic
function
Stage C:
End stage .less sever less frequent
attachesBUT marked impairment of endocrine
and exocrine function
pathogenesis
???
Necrosis-fibrosis hypothesis
Protein plug hypothesis
Oxidative stress theory
Toxic metabolic theory
.
Diagnosis
History: recurrent attaches of
abdominal pain
Epigastric and radiating to the back
Weight loss:fear,malabsorbtion
Steatorrhea(late,90% lost)
Imaging
Imaging
plain x ray
ERCP
gold stander image
Dilated TortuosMultiple side branches
managemant
Conservative
Endoscopic
surgery
pain
1-stop Alcohol intake
2-Analgesia:NSAIDSOpioids
3-celiac plexus neurolysis
malnutreition
Frequent meals
protein: High
sugar :High
Fat: medium chain fatty acids?
Endoscopic treatment
Sone:extraction
Stricture:dilatation and stenting
surgery
Drainage procedures
Resection procedures
QUIZ