Head
Neck
Tail
Uncinate
process
Spleen
Body
INVESTIGATIONS OF PANCREAS
•
SERUM ENZYME LEVELS
•
PANCREATIC FUNCTION TESTS
•
MORPHOLOGY
•
ULTRASOUND SCAN
•
COMPUTERISED TOMOGRAPHY
•
MAGNETIC RESONANCE IMAGING
•
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY
•
ENDOSCOPIC ULTRASOUND
•
PLAIN RADIOGRAPHY
•
CHEST
•
UPPER ABDOMEN
INJURIES TO THE PANCREAS
•
THE PANCREAS, THANKS TO ITS SOMEWHAT PROTECTED LOCATION
IN THE RETROPERITONEUM, IS NOT FREQUENTLY DAMAGED
ACUTE PANCREATITIS
ACUTE INFLAMMATION OF PANCREAS IS ONE OF
CAUSES OF ACUTE ABD.PAIN.
IT’S A SERIOUS CONDITION THAT LEADS TO DEATH IN
10% OF CASES
.
AETIOLOGY
•
1.BILE DUCT STONES. 50%
•
2.EXCESS ALCOHOL INTAKE. 20%
•
3.TRAUMA . 5% ACCIDENTAL,OPERATIVE,ERCP.
•
4.RARE CAUSES
:VIRAL,HYPERPARATH,CORTICOSTEROID.
•
5.IDIOPATHIC
.
CLINICAL FEATURES
•
SYMPTOMS
•
1.SEVERE AGONIZING UPPER ABDOMINAL PAIN
RADIATED TO BACK.
•
2.VOMTING &RETCHING.
CLINICAL FEATURES
•
SIGNS
•
MAY SHOW HYPOVOL. SHOCK,TINGE OF JAUDICE,CYNOSIS.
•
PATIENT SITS LEANING FORWARD.
•
MILD TENDERNESS &RIGIDITIY,
•
BRUISING AROUND UMBLICUS(CULLEN SIGN),& IN THE LOIN(GREY
TURNER SIGN) ARE RARE LATE FEATURE.
•
UPPER ABD. SWELLING AFTER 2-3 WK (PANCREATIC PSEUDOCYST).
COMPLICATIONS
•
SYSTEMIC
•
1.SHOCK (LOSS OF PLASMA OR BLOOD)
•
2.ADRS
•
3.RENAL FAILURE
•
4.CONSUMPTION COAGULOPATHY
•
5.PARALYTIC ILEUS.STRESS ULCER
•
6.TETANY
•
LOCAL
•
1.PSEUDOCYST
•
2.ABSCESS
DIFFERENTIAL DIAGNOSIS
•
1.PERFORATED PEPTIC ULCER
•
2.ACUTE CHOLECYSTITIS & BILIARY
COLIC
•
3. ACUTE MESENTERIC VASCULAR
OCCLUSION
•
4.LEAKING AORTIC ANEURYSM
•
5. ACUTE M.I
INVESTIGATIONS
•
1.SERUM AMYLASE ELEVATE WITHIN FEW HOURS>1000 IU/DL. NR 100-
300
•
2.ARTERIAL BLOOD GASES
•
3.BIOCHEMICAL .BILIRUBIN ELEVETED.HYPOCAL.HYPOPROT.ELEVETED
B.UREA.HYPERGL.
•
4.BLOOD PICTURE .LEACOCYTOSIS.ELEVATED HAEMATOCRIT
•
5.PLAIN X-RAY OF ABDOMEN SHOWS DILATED SHORT SEGMENT OF
SMALL INTESTINE(SENTINEL LOOP).COLON CUT-OFF SIGN
•
6.U/S GALL STONE
•
7.CT VERY HELPFUL SHOWS ENLARGEMENT OF PANCREAS,OEDEMA
,NECROSIS.
•
8.ECG &CARDIAC ENZYME TO EXCLUDE M.I
•
RANSON CRITERIA
•
At admission:
•
1-age > 55 years.
•
2- WBC > 16000 cells/mm.
•
3- blood glucose > 11 mmol/L (>200 mg/dL )
•
4- serum AST > 250 IU/L.
•
5- serum LDH >350 IU/L.
•
Within 48 hours:
•
1- serum calcium < 2 mmol/L ( <8 mg/dL ).
•
2- hematocrit fall > 10%.
•
3- PaO2 <60% mmHg.
•
4- BUN increased by 1.8 or more mmol/L( 5 or more mg/dL ) after IV fluid
hydration.
•
5- base deficit > 4 mEq/L.
•
6- sequestration of fluid > 6 L.
--- If score > or = 3 severe pancreatitis.
--- If score < 3 severe pancreatitis is unlikely.
TREATMENT
•
CONSERVATIVE
•
SEVERE CASES ADMITTED TO ICU.TREATMENT IS SUPPORTIVE TO BODY
SYSTEM.”R”REGIMEN:
•
1.RELIEF OF PAIN BY PETHIDINE WITH ATROPINE
•
2.REPLACEMENT OF THE LOST FLUIDS BY CRYSTALLOIDS,PLASMA EVEN
BLOOD
•
3.REST OF PANCREAS &BOWEL BY NIL ORAL&NG SUCTION.SOMATOSTATIN
•
4.RESPIRATORY SUPPORT BY OXYGEN MASK,OR MECHANICAL
VENTILATION
•
5.RESISTANCE OF INFECTION BY PROPHYLACTIC ANTIBIOTIC
•
6.REASSESSMENT BY ERCP
•
7.IF VOMITING IS PROLONGED ,IV HYPERALIMENTATION
•
SURGICAL
•
1.DOUBTFUL DIAGNOSIS EXPLORATORY LAPAROTOMY
•
2.DRAINGE OF PANCREATIC ABSCESS ,OR PERSISTENT PSEUDOCYST
•
3.EXCISION OF NECROTIC TISSUE IN SEVERE NECROTIZING PANCREATITIS
PANCREATIC PSEUDOCYST
•
NATURE
COLLECTION OF PANCREATIC SECRETION &INFLAMMATORY
EXUDATE WITHIN A LINING OF INFLAMMATORY TISSUE
•
AETIOLOGY
DEVELOPS IN 10% OF CASES OF ACUTE PANCREATITIS AFTER
2-3 WK.NEXET CAUSE PANCREATIC TRAUMA
•
SITE
LESSER SAC
•
COMPLICATIONS
INFECTION ,HAEMORRHAGE,RUPTURE
•
CLINICAL FEATURES
•
-SMALL PAINLESS DISCOVERED BY U/S
•
-LARGE CAUSE DISCOMFORT ,UPPER ABD. SWELLING
•
INVESTIGATIONS
•
-BA-MEAL FORWARD DISPLACEMENT OF STOMACH
•
-U/S&CT
•
TREATMENT
•
1.MOST OF CYSTS RESOLVE SPONT.
•
2.PERSISTANT CYST .DRAINED AFTER 6WK TO STOMACH OR
JEJUNAM
PANCREATIC CARCINOMA
MALE>FEMLE.AGE 55-70.PROGNOSIS POOR
AETIOLOGY
UNKOWN.SMOKING,HIGH
PROTEIN,HIGH FAT FOOD
SPREAD
DIRECT CBD,LYMPH,BLOOD LIVER
LUNG,TRANSPERITONEAL
CLINICAL FEATURES
•
1.CA OF HEAD
PAINLESS OBST.
JAUNDICE,HEPATOMEGALLY,PALPABLE GB,ANOREXIA
&WT LOSS
•
2.CA OF BODY &TAIL
EPIGASTRIC PAIN
HEPATOMEGALLY,ANOREXIA &WT LOSS
•
INVESTIGATONS
•
1.LFT ELEVATED DIRECT BIL.&ALK.PH.LOW PROTHOMBIN
•
2.U/S DILATED INTRA &EXTRA HEPATIC
DUCT,METASTASES
•
3.CT
•
4.ERCP
TREATMENT
•
1.UNFIT FOR SURGERY
ENDOSCOPIC STENT
•
2.FIT FOR SURGERY & OPERABLE
WHIPPLE OPERATION
•
3.INOPERABLE TUMOR
CHOLECYSTOJEJENOSTOMY
