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 abd. Pain radiated to back. 2.Vomting &retching. 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.AbscessDIFFERENTIAL DIAGNOSIS
1.Perforated peptic ulcer 2.Acute cholecystitis & biliary colic 3. Acute mesenteric vascular occlusion 4.leaking aortic aneurysm 5. Acute M.IINVESTIGATIONS
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
TREATMENTCONSERVATIVESevere cases admitted to ICU.Treatment is supportive to body system.”R”regimen:1.Relief of pain by pethidine with atropine2.Replacement of the lost fluids by crystalloids,plasma even blood3.Rest of pancreas &bowel by nil oral&NG suction.somatostatin4.Respiratory support by oxygen mask,or mechanical ventilation5.Resistance of infection by prophylactic antibiotic6.Reassessment by ERCP7.If vomiting is prolonged ,IV hyperalimentationSURGICAL1.Doubtful diagnosis exploratory laparotomy2.Drainge of pancreatic abscess ,or persistent pseudocyst3.excision of necrotic tissue in severe necrotizing pancreatitis