Acute pancreatitis

Send This

Download

Comment

Favourite

more

Rating :

Rate It:

Embed :

Khushbu on Aug 14, 2012 Says :

very informative PPT on pancreatitis. good and explanatory images.

Post a comment

Post Comment on Twitter Post Comment on SlideWorld

Comments:

Subscribe to follow-up comments

Notes

Hide Notes

Slide 1 :

Acute Pancreatitis By, Diwakar Manandhar, Intern, NMCTH

Slide 2 :

Introduction Pancreas is derived from a Greek word – “Pan”, “Keras”. Vital organ – Exocrine and Endocrine function. For a long time, its function was not known and was thought to act as a cushion for stomach.

Slide 3 :

Development There are 9 key steps that occur during the embryogenesis Day 26 – dorsal pancreatic duct arise from the dorsal aspect of the duodenum. Day 32 – ventral bud arises from the base of hepatic diverticulum. Day 37 – contact occurs between the two buds and fusion 6wks Week 6 - ventral bud forms head and uncinate process. Week 6 – duct fuses. Week 6 – ventral duct and distal portion of dorsal duct fuse to form Duct of Wirsung. Week 6 – proximal portion of dorsal duct forms Duct of Santorini Month 3 – Acini appear. Month 3-4 – islets of Langerhans appear and become functional.

Slide 4 :

Slide 5 :

Anatomy

Slide 6 :

Blood supply

Slide 7 :

Histology

Slide 8 :

Epidemology Pancreatitis can occur at any age Affects male more often then females Peak in the young men and older women Worldwide, incidence ranges from 5-80 per 1,00,000 population with highest incidence in U.S. and Finland

Slide 9 :

Pancreatitis Inflammation of the gland parenchyma Acute and Chronic Acute condition, presenting with abdominal pain and usually associated with raised pancreatic enzymes in blood or urine as a result of pancreatic inflammation Premature activation of the pancreatic enzyme in the pancreas

Slide 10 :

Etiology Gall stones Alcohol abuse Post ERCP Abdominal trauma Ampullary tumor Hyperparathyroidism Hypercalcemia Drugs (corticosteroids, azathioprine, etc.) Viral infection(mumps, coxsackie B) Dyslipidemia

Slide 11 :

Pathogenesis

Slide 12 :

Anything that injures the acinar cells, impairs zymogen granules, damage duct epithelium and delay enzmatic secretion – pathology Severity – Mild (interstitial oedema minimal MOF) – Severe ( Pancreatic necrosis with MOF) Inflammation releases mediators in circulation causing – Hemodynamic instability, RDS, Pleural effusion, GI Hemorrhage, Renal faliure, DIC Fat necrosis

Slide 13 :

Slide 14 :

Presentation Symptoms Epigastric pain Nausea, vomiting, retching Hiccups Signs GC? confused, patient in agony; leaning foreward Vitals? RR , Pulse , BP , Temp Pallor+, Icterus+, Cyanosis+

Slide 15 :

Cont.. Systemic findings PA? Distended, Cullen’s sign, Grey-turner’s sign. Tenderness+, rebound tenderness+, Mass+, Gaurding+, rigidity+ Shifting dullness+ Bowel Sound Chest? Pleural Effusion Limbs? soft, red, tender nodules in the lower limbs

Slide 16 :

Slide 17 :

Differential Diagnosis Perforated peptic ulcer Biliary colic Acute cholecystitis Myocardial infarction Pneumonia

Slide 18 :

Investigation CBC ? TC , Neutrophils , Hb , PCV Blood Glucose KFT is deranged due to the hemodynamic instability

Slide 19 :

Cont.. Serum amylase is increased; if increased 3-4 times indicates the disease If amylase level doesn’t increase; doesn’t rule out pancreatitis It starts to raise withen few hrs and then starts to decline by 4-8 days Also increased in salivary gland inflammation, upper GIT perforation, torsion of intra-abdominal viscus, mesenteric infarction, retroperitoneal Hge, Renal failure, Ectopic pregnancy Serum Amylase

Slide 20 :

Cont.. Serum Lipase It is more specific for pancreatitis then amylase It begins to elevate by 4-8 hrs, and peaks at 24 hrs and remains elevated for 7days

Slide 21 :

X-Ray Abdominal Xray ? Sentinel sign ? Colon cutoff sign ? Renal halo sign ? Calcified gall stone ? Pancreatic calcification Chest Xray ? pleural effusion

Slide 22 :

Colon cutoff sign

Slide 23 :

Renal halo sign

Slide 24 :

Calcifications

Slide 25 :

Ultrasonography Swollen pancreas Gall stones

Slide 26 :

CT Unenhanced CT ? pancreatic inflammation, fluid collection, necrosis, calcification. Indication : diagnostic uncertainty : differentiate between interstitial and necrotizing pancreatitis. : in patient with organ failure, signs of sepsis, progressive clinical deterioration. : localized complication.

Slide 27 :

Other investigations Endoscopic Ultrasound MRCP Laparotomy

Slide 28 :

Ranson’s criteria Score 0 to 2 : 2% mortality Score 3 to 4 : 15% mortality Score 5 to 6 : 40% mortality Score 7 to 8 : 100% mortality

Slide 29 :

Gall stone pancreatitis At admission: age > 70 years white blood cell count > 18000 cells/mm3 blood glucose > 12.2 mmol/L (> 220 mg/dL) serumAST > 250 IU/L serum LDH > 400 IU/L At 48 hours: Calcium (serum calcium < 2.0 mmol/L (< 8.0 mg/dL) Hematocrit fall > 10% Oxygen (hypoxemia PO2 < 60 mmHg) BUN increased by 2mg/dl Base deficit > 5 mEq/L Sequestration of fluids > 4 L

Slide 30 :

SEVERITY APACHE II Best test Can be done at 24 hrs., can be repeated Balthazar’s (CT scan criteria) Glasgow’s criteria

Slide 31 :

Management Mild Pancreatitis Intravenous fluid therapy Frequent non invasive monitoring Nil by mouth Analgesic Antiemetic Antibiotic are not indicated

Slide 32 :

Cont.. Severe acute pancreatitis. Admission in ICU Analgesic Aggressive fluid resuscitation – vitals, UO, CVP O2 therapy, with serial blood gas analysis Hematological and biochemical parameters( LFT, RFT, clotting time, Mg, Ca, Glucose) NG Antibiotic prophylaxis.( cefuroxime, imipenam, ciprofloxacin + metronidazole)

Slide 33 :

Cont.. CT ? organ failure, clinical deterioration of sign, sepsis. ERCP? Sphinterotomy/ balloon dilation and stone removal (Hx of jaundice, cholangitis, dilation of common bile duct.) Supportive Rx? inotropes, ventilator support, hemofiltration. Nutritional support ? Enteral feeding.

Slide 34 :

Surgery Surgery is indicated for (i) infected pancreatic necrosis (ii) diagnostic uncertainty (iii) complications Infection is diagnosed based on 2 criteria Gas bubbles on CT scan (present in 20 to 50% of infected necrosis) Positive bacterial culture on FNA (fine needle aspiration, usually CT or US guided) of the pancreas

Slide 35 :

If sepsis worsens despite appropriate management then necrosectomy should be preformed. Closed continuous lavage Closed drainage Open packing Closure and relaparotomy

Slide 36 :

Complications Local complications: Acute fluid collection Sterile pancreatic necrosis Infected pancreatic necrosis Pancreatic abscess Pancreatic pseudocyst Pancreatic ascites Pancreatic effusion Portal/ splenic vein thrombosis

Slide 37 :

Systemic complication: Neurological ? confusion, encephalopathy Pulmonary ? ARDS CVS ? shock, arrhythmias Hematological ? DIC Metabolic ? Hypocalcaemia, hyperglycemia GI ? ileus Misc. ? subcutaneous fat necrosis

Slide 38 :

Thank you

Acute Coronary Syndr...

Acute Hepatitis B Wh...

Acute Coronary Syndr...

Acute Diarrhea and E...

Acute Myocardial Inf...

Acute care of ischem...

Free Powerpoint Templates

	reds_dm@hotmail.com 10 Months ago.



566 Views, 0 favourite
PowerPoint Presentation on Acute pancreatitis
More By User Flag as inappropriate Select your reason for flagging this presentation as inappropriate. If needed, use the feedback form to let us know more details. Cancel