L11: Pancreatic Disorders Flashcards
Introduction to Pancreas
Complicated exocrine and endocrine gland
located in the upper abdominal region
It lies behind the peritoneum of the posterior
abdominal wall
Divided into head, body, and tail
Types of Diseases of Pancreas
1- Acute Pancreatitis.
2- Chronic Pancreatitis.
3- Pancreatic Tumors.
Def of Acute Pancreatitis
Acute inflammation of the pancreas characterized clinically by two of the
following:
- Symptoms: Characterized epigastric pain.
- Laboratory: Elevated serum amylase and lipase level more than 3 times upper limit of normal.
- Radiology: Consistent with pancreatitis, usually using CT or MRI.
Common Causes of Acute Pancreatitis
Rare Causes of Acute Pancreatitis
Ascaris blocking pancreatic outflow.
Ischemia from bypass surgery.
Infections other than mumps (EBV, CMV).
Pregnancy.
Idiopathic
Hereditary pancreatitis; AD.
Cystic fibrosis
Smoking.
Pathogenesis of Acute Pancreatitis
Pathology of Acute Pancreatitis
Severity of clinical features may not always correlate with pathology
….
Dx of Acute Pancreatitis
- The diagnosis of acute pancreatitis (AP) relies on:
Acute abdominal pain
Increased serum pancreatic enzymes
Imaging procedures. - Etiological diagnosis; A further aspect in diagnosis of
- AP is the identification of the etiological factor.
Clinical Dx of Acute Pancreatitis
- Acute abdominal pain
- Abdominal enlargement
- Tender rigid abdomen; guarding
- Cullen and Grey-Turner’s signs; internal hemorrhage.
- Hematemesis and melena
- Patients are agitated; continuously changing their posture.
- Fever: chemical, not due to infection.
- Jaundice: compression or obstruction of bile duct
- Tetany: transient hypocalcemia
- Hypovolemic shock: can lead to renal failure
- ARDS: Acute respiratory distress syndrome
- Coma.
Characters of Acute Abdominal Pain in Acute Pancreatitis
- Localized to the epigastrium, frequently radiates to the back.
- Usually severe.
- Sudden onset
- Persistent for at least one or two days.
- Often made worse by walking and lying supine and better by sitting and leaning forward.
- Nausea and vomiting.
- History of alcohol intake or biliary colic in the past.
Abdominal Enlargment of Acute Pancreatitis
- Paralytic ileus.
- Pancreatic ascites.
- Pseudo cyst or abscess.
Lab Dx of Acute Pancreatitis
Assessment of severity of acute pancreatitis
Rad Dx of Acute Pancreatitis
- Plain Radiographs
- Ultrasonography
- Computed tomography (CT)
- MRCP
- Endoscopic ultrasonography (EUS)
- ERCP
Plain Radiograoph
Rad Dx of Acute Pancreatitis
US
Rad Dx of Acute Pancreatitis
CT
Rad Dx of Acute Pancreatitis
MRCP
Rad Dx of Acute Pancreatitis
Non-invasive
EUS
Rad Dx of Acute Pancreatitis
- Help to detect small ampullary lesion and microlithiasis
ERCP
Rad Dx of Acute Pancreatitis
Endoscopic Retrograde Cholangiopancreatography (ERCP).
- In patient suspected to have biliary obstruction.
- Evidence of ascending cholangitis.
Classification of Acute Pancreatitis
1- Mild acute pancreatitis: is associated with minimal
organ dysfunction and uneventful recovery.
2- Severe acute pancreatitis: is associated with organ failure
Complications of Acute Pancreatitis
DDx of Acute Pancreatitis
TTT of Acute Pancreatitis
Pain Control in Acute Pancreatitis
- with meperidine up to 100/150mg intramuscularly every 3-4 hours as necessary. Better tolerated than morphine, which may induce spasm of the sphincter of Oddi
TTT of Complications of Acute Pancreatitis