B.2 Flashcards
characteristics of acute pancreatitis
severe complications and high mortality
types:
-edematous
-hemorrhagic
-supporative (with abscess)
pancratitis etiology?
alcohol abuse: 40%
cholithiasis and cholidocholithiasis: 35-40%
other:
-Trauma
-Iatrogenic
-Tumor
-idiopathic
-Viral
-HyperCalcemia
-hypertriglyceridemia
signs and symptoms of pancreatitis?
- severe upper belt-like pain
- Nausea
- vomiting
- meteorism
- cullen sign: edema and bruising around umbilicus
- grey-turner sign: bruising of flank
-fever
types of Acute pancreatitis?
Interstitial: no CT sign
- conservative th. is successful –> reversible in 48-72hrs
Necrotizing:
- abd. pain and tenderness
- grey-turner and cullen signs
-organ dysfunction
organ dysfunction in pancreatitis?
- SHOCK
- Resp. insufficiency
- Renal insufficiency
- G.I bleeding
- DIC
- Thrombocytopenia
- metabolic disorders
Sevirity of Pancreatitis?
mild: no organ failure
moder-severe: organ failure but resolves in 48h
severe: CRP>150 and organ failure >48h
diagnosis of Pancreatitis?
clinical
upper abd pain ( belt like)
diagnosis of Pancreatitis?
lab
increase in Se amylase >3x
increase in lipase > 3x
- serum
- urine
- peritoneal
- pleural
enzymes peak:24h
enzymes normalize: 7-10days
diagnosis of Pancreatitis?
imaging
US:
- biliary tract looking for gallstone
CT:
- if suspecting complications –> sepsis MOF
CXR
AXR
ERCP
needle biopsy
Pancreatitis differential diagnosis?
acute abd illness
gastritis
gastic ulcer
enteritis
ilius
MI
cholecystitis
pancreatitis complications?
Local:
- Pancreatic and Peripancreatic necrosis
- Pseudocysts
- Peripancreatic fluid
Global:
- SIRS
- Sepsis
- MOF
Abdominal comp. synd
what is abdominal comparment synd?
sustained IAP >20mmHg
includes:
- ileus
- Peritonitis
- decrease erfusion in abd. organs and retroperitoneal organs
treatment:
conservative
surgical
Pancreatitis treatment?
-NPO
- Jejunal feeding
- Epidural anesthesia
- IV fluids
Prevention/Treatment of MOF?
Fluid resuscitation: (decr. SIRS and MOF)
- ringer’s lactate
- within 24-48h
- 250-500 ml/h
ventilation: for ARDS
fluid balance and CVVH: for renal insuf
norepi (vasopressors) and inotrops:
for cardiovascular instability
pain management of pancreatitis?
thoracic epidural analgesia:
- th8-10
- ASAP
- slective segmental splanthectomy (improves splanchnic perfusion)
IV analgesix:
- opioid –> pethidine (to reduce sphincter constriction)
- NSAIDs
