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Gastroenterologie > A.14. PANCREATITA ACUTA > Flashcards

A.14. PANCREATITA ACUTA Flashcards

1
Q

Definitia PA.

A

-inflamatie ACUTA PANCREATICA ce afecteaza si -organele peripancreatice +/- afect. Altor organe.

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2
Q

Incidenta PA:

A
  • reprez 2-3 % din patologia ACUTA ABDOMINALA;
  • mortalitatea difera in functie de SEVERITATEA BOLII (in medie- 5%; usoara- 3%, severa 17%);
  • predomina formele usoare (doar 20% sunt forme NECROTICO-HEMORAGICE).
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3
Q

Precizati ETIOLOGIA PA:

A
  1. ALCOOLICA;
  2. BILIARA;
  3. MEDICAMENTOASA;
  4. EREDITARA;
  5. AUTOIMUNA;
  6. HIPERLIPIDEMIA;
  7. VIRALA;
  8. CAUZE STRUCTURALE;
  9. IATROGENA .
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4
Q

Ce virus poate da PA?

A

-v. Urlian ( da si parotidita epidemica- oreonul)

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5
Q

Cum ne dam seama ca ETIOLOGIA PA este AUTOIMUNA?

A
  • prezenta IgG4 seric crescut
  • imagistic - aspect sausage like (eco si ct)
  • ex histopat. Sugestiv.
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6
Q

Ce MEDICAMENTE au documentatie certa ca fiind implicate in ETIOL. PA?

A
  • furosemid;
  • metronidazol;
  • 6-mercaptopurina;
  • azatioprina;
  • tetraciclina
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7
Q

Ce medicamente sunt posbile a fi implicate in PA?

A
  • eritromicina
  • amiodarona
  • amoxiciclina
  • piroxicam
  • paracetamol
  • ketoprofen
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8
Q

Cauze IATROGENE DE PA?

A
  • postchir

- post ercp

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9
Q

Fiziopatologie PA

A

-activare PREMATURA TRIPSINOGEN-> inflamatie -> lezare celule pancreatice => CHEMOCHINE, CITOCHINE, NEUTROF SI MACROFAGE.

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10
Q

Care sunt cauzele ACTIVARII PREMATURE A TRIPSINOGENULUI?

A
  • metabolizarea NEOXIDATIVA A alcoolului => acumul. De esteri etanolici, de ac grasi
  • blocarea ductului WIRSUNG PANCREATIC datorita inclavarii unui calcul in coledoc => reflux biliar in pancreas.
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11
Q

Semne si simptome de PA?

A
  • DUREREA - in bara, intensa, socogena, iradiere POST.
  • GREATA, VARSATURI
  • DURERE LA PALPARE IN ETAJUL ABD. SUP.
  • +/- FEBRA (SUPRAINF NECROZEI).
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12
Q

Semnele de soc din PA (F SEVERE):

A
  • tahicardie cu tahipnee si hTA;
  • oligurie, anurie, transpiratii profuze
  • alterarea starii de constienta.
  • ECHIMOZE -> PE FLANCURI- SEMNUL GREY TURNER
    - > PERIOMBILICAL- SEMNUL CULLEN.
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13
Q

Cum se pune dg. Pozitiv al PA?

A 
Biologic: 
1. Crestere lipaza > 3x VN;
2. Amilazemie;
3. Amilazurie
4. Semne de CITOLIZA
5. semne de COLESTAZA 
6. semne de HEMOCONCENTRATIE
7. semne de LEUCOCITOZA. 
Clinic: 
1.Durere in bara, intensa, puternica, socogena cu IRADIERE POST. 
2. Posibil ICTER OBSTRUCTIV (etiologie coledocolitiazica)
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14
Q

La ce este utila ECOGRAFIA din PA?

A
  • posibil semne de etiologie;

- posibil semne de complicatii (ascita, peritonita)

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15
Q

Investigatiile paraclinice care se efectueaza in PA sunt:

A
  • ECOGRAFIA
  • CT CU SDC.
  • RX ABD PE GOL
  • RMN
  • ECOENDOSCOPIA
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16
Q

Indicator de severitate in PA:

A
  • hiperglicemia;
  • hipocalcemie;
  • creste retentia AZOTATA.
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17
Q

Ecografic, pancreasul este :

A
  • in formele us: MARIT DE VOL, HIPOECOG/ INOMOGEN

- in formele sev: HIPERREFLECTOGEN BURSA OMENTALA, COLECTII PANCR, INOMOGEN, COMPLIC VASC.

18
Q

Cea mai buna met de dg IMG:

A
  • CT CU SCD

- evidentiaza NECROZA, POSIBILE COMPLICATII.

19
Q

De electie pt. EVALUAREA COLEDOCULUI DISTAL + CALCULI COLEDOCIENI utilizam:

A

ECOENDOSCOPIA

20
Q

Ecoendoscopia din PA ajuta pentru

A
  • a evalua coledocul distal si posibilii calculi;

- a diferentia o PA ce a aparut le fondul PC.

21
Q

Cand indicam CT IN PA?

A
  • cand formele CLINICE SEVERE nu se amelioreaza dupa 72 de ore de TRAT. CONSERVATOR- repetare la 7-10 zile la cei cu NECROZA PANCR SI PERIPANCR.
  • la.pac. cu evolutie BUNA initiala, dar care prezinta semne de evolutie NEFAVORABILA pe parcurs (febra, hipotens)-REPETARE DACA SE AGRAVEAZA STAREA PAC.
22
Q

Pe baza CT- SCOR DE SEVERITATE BALTHAZAR:

A
  • pancreas N
  • edem pancr
  • infiltr peripancr
  • colectie unica
  • colectie multipla
  • necr <30%
  • necr 30-50%
  • necr >50%
23
Q

Pe baza scorului BALTHAZAR, PANCREATITA prezinta 3 forme:

A
  • pancr.ac. usoara; 0-3 pct
  • pancr. ac. Moderata; 4-6 pct
  • pancr. Ac severa. 7-10.pct.
24
Q

Stadiul A -scor BALTHAZAR

A

-pancreas de aspect normal

25
Q

Stadiul B scor Balthazar

A

-edem pancreatic

26
Q

Stadiul C scor BALTHAZAR

A

-infiltrat peripancreatic

27
Q

Stadiul D scor BALTHAZAR

A

-colectie unica

28
Q

Stadiul E scor BALTHAZAR

A

-colectii mutiple.

29
Q

Diagnostic diferential al PA:

A
  • colica biliara
  • colica renala
  • ima inf
  • infarct e teromezenteric
  • UGD perforat
  • peritonita
  • anevrism aorta
  • pneumonie bazala
  • apendicita
30
Q

Evolutia si prognosticul PA:

A
  • 20% au evolutie spre complicatii( soc, abces, pseudochiste pancr) (f. Severe)
  • 80% evolutie buna cu restitutio ad integrum (f. usoare)
31
Q

Pentru evaluarea SEVERITATII se folosesc scorurile:

A
  • RANSON;
  • APACHE II;
  • ATLANTA.
32
Q

Scorul RANSON utilizeaza 11 criterii:

A

LA INTERNARE:

  • leucocitoza >16 000
  • varsta >55 ani
  • glicemie > 200mg%
  • LDH >350 U/I
  • ASAT >250 U/I
33
Q

Scorul APACHE II

A

Foloseste 12 variabile, varsta si antecedentele patologice; e mai complicat de calc.

34
Q

Scorul ATLANTA:

A

-fol. Criterii de sev. :
• insuf de organ( TAS<90 mmHg, PaO2< 60 mmHg, creatinina >2 mg%, HDS >500 ml/24h)
•complic locale (pseudochist, abces, necroza)
• 3 crit RANSON;
• 8 crit APACHE II

35
Q

Gold std pt evolutia pac la 48 de ore de la debut:

A

-evolutie buna PCR >150 mg% intr-o f severa de boala.

36
Q

PA COMPLICATII:

A
  • locale: necroza, pseudochist, abces, tromboza vase de vecinatate, infarct intestinal
  • sistemice: soc, pneumonie, abces mediastinal, IRA, necr tes. Grasos.
37
Q

Tratament PA.

A
  • nu exista trat ETIOLOGIC

- masuri suportive si tp complicatiilor

38
Q

Marusile suportive din TRATAREA PA:

A
  • reech HE CU ringer lactat sau ser 250-300 ml/h in primele 24-48 de h;
  • tp durerii (antalg usoare-> anestezie peridurala)
  • mentinere functii vitale
39
Q

Tratamentul dietetic PA

A
  • repaus alimentar
  • reluare alim la 24 de h de la disparitia durerii
  • alim fara lipide
  • alim parenterala in formele care nu au toleranta dig.
40
Q

TERAPII SPECIFICE DIN PA:

A
  • pancreatita acuta cu icter obstructiv +/- angiocolita -> dezobstruare prin ERCP in primele 72 de ore
  • pseudochiste pancr (simpt >6cm=> drenaj, asimpt -conservator)
  • in necr pancr sterila: trat conservator
  • in necr pancr suprainf: chir dupa min 2 sapt. plus atb

Gastroenterologie (14 decks)

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