Acute panceatisis

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The name pancreas (Greek pan: all, kreas: flesh or meat) was used because the organ contains neither cartilage nor bone. Physiology Exocrine pancreatic secretion contains multiple of enzymes( trypsinogen, chymotrypsinogen, procarbocypolypeptidase, amylase, cholesterol esterase, phospholipase) to digest proteins, carbohydrates and fats. Endocrine pancreatic secretes insulin, glucagon and somatostatin directly into blood.

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Nội dung Text: Acute panceatisis

Acute panceatisis What is the Pancreas: The pancreas is a vital gland that produces various enzymes and hormones. The name pancreas (Greek pan: all, kreas: flesh or meat) was used because the organ contains neither cartilage nor bone.
Physiology Exocrine pancreatic secretion contains multiple of enzymes( trypsinogen, chymotrypsinogen, procarbocypolypeptidase, amylase, cholesterol esterase, phospholipase) to digest proteins, carbohydrates and fats. Endocrine pancreatic secretes insulin, glucagon and somatostatin directly into blood. Definition of acute panceatitis Acute pancreatitis is inflammation of the pancreas and peripancreatic tissue from activation of potent pancreatic enzymes within the pancreas, particularly trypsin. Pathology of acute pancreatitis: The pathologic changes of acute pancreatitis include parenchymal and peripancreatic fat necrosis and an associated inflammatory reaction. Etiologies of acute pancreatitis: Abuse of ethanol Biliary tract stones Drugs
Endoscopic retrograde cholangiopancreatography Hypercalcemia Hypertriglyceridemia Idiopathic Infections Ischemia Parasites Postoperative Scorpion sting Trauma Symptoms of Pancreatitis: Abdominal pain, nausea, and vomiting (but pain does not decrease after vomitting) are the dominant symptoms of pancreatitis. Bowel sounds are usually diminished or absent.
Mayo-Robson's point (+) Mallet Guy- Ton That Tung's point (+) Cullen's sign (+) (a faint blue discoloration around the umbilicus) Turner's sign (+) (blue-red-purple or green-brown discoloration of the flanks)
Diagnosis Dual-phase (pancreatic protocol) CT scanning is useful in the initial evaluation of severe acute pancreatitis. The Ranson criteria may provide prognostic information. Ranson Criteria for Severity Assessment in Acute Pancreatitisa Alcoholic pancreatitis On admission Age >55 yr WBC count >16,000/mcL Blood glucose >200 mg/dL LDH >350 International Units/L AST >250 units/L During the first 48 hr of admission Fall in hematocrit >10% Serum calcium
Base deficit >4.0 mEq/L Increase in blood urea >5 mg/dL Fluid sequestration >6 L Arterial PO2 70 yr WBC count >18,000/mcL Blood glucose >220 mg/dL LDH >400 International Units/L AST >440 units/L During the first 48 hr of admission Fall in hematocrit >10% Serum calcium
Base deficit >5.0 mEq/L Increase in blood urea >2 mg/dL Fluid sequestration >6 L Arterial PO2
Hemorrhage Infection Obstruction of gastrointestinal tract (stomach, duodenum, c olon) Pancreatic ascites Disruption of main pancreatic duct Leaking pseudocyst Involvement of contiguous organs by necrotizing pancreatitis Massive intraperitoneal hemorrhage Thrombosis of blood vessels (splenic vein, portal vein) Bowel infarction Obstructive jaundice Systemic Pulmonary Pleural effusion Atelectasis
Mediastinal abscess Pneumonitis Adult respiratory distress syndrome Cardiovascular Hypotension Hypovolemia Sudden death Nonspecific ST-T changes in electrocardiogram simulating myocardial infarction Pericardial effusion Hematologic Disseminated intravascular coagulation Gastrointestinal hemorrhage Peptic ulcer disease Erosive gastritis Hemorrhagic pancreatic necrosis with erosion into major blood vessels
Portal vein thrombosis, variceal hemorrhage Renal Oliguria Azotemia Renal artery and/or renal vein thrombosis Acute tubular necrosis Metabolic Hyperglycemia Hypertriglyceridemia Hypocalcemia Encephalopathy Sudden blindness (Purtscher's retinopathy) Central nervous system Psychosis Fat emboli
Fat necrosis Subcutaneous tissues (erythematous nodules) Bone Miscellaneous (mediastinum, pleura, nervous system)