Pancreatitis

Pancreatitis

1. Causes of Acute Abdomen

   • Perforating Gastric/Duodenal Ulcer
   • Intestinal Obstruction
   • Ischemic bowel disease
   • Acute Appendicitis
   • Acute Cholecystitis & Gallstones
   • Acute Pancreatitis
   • Peritonitis
   • Aortic Dissection
   • Ectopic Pregnancy

2. Anatomy of the pancreas

3. Histology

4. Acute

   • Clinical findings
     • Mid epigastric pain radiating to the back
       • Pain elevated when leaning forward
     • Acute abdomen
     • Fever
     • Nausea and vomiting
     • Hypovolemic shock
     • Grey turner sign
     • Cullen's sign
   • Pathogenesis
     • It is mainly caused by alcohol and gall stones
     • Must be activation of proenzymes
       • Mechanism of activation
         • Obstruction of the main pancreatic duct or terminal CBD
           • Alcohol
           • gallstones
         • Chemical injury of acinar cells
           • Ex: Thiazide
         • Infectious injury of acinar cells
           • CMV
           • Mumps
         • mechanical injury to acinar cells
           • trauma
         • metabolic activation of the enzymes
           • hypercalcemia
           • ischemia
           • shock
           • Trypsin activates
             • proteases
               • damage acinar cell structure
             • lipases
               • produce fat necrosis
             • elastases
               • damage blood vessels and cause hemorrhage

5. Chronic

   • clinical findings
     • Sever pain radiating to the back
     • Type 1 diabetes Mellitus
     • Malabsorption
   • Pathogenesis
     • Majority are idiopathic
     • Known causes
       • Alcohol
       • Cystic fibrosis
       • Malnutrition
       • Autoimmune
     • Repeted attacks of acute pancreatitis produce duct obstruction
       • Calcified concentrations occur as well as dilation of the duct
   • happens in males more than females

6. Investigation

   • Blood tests
     • Amylase
     • Lipase
     • Glycoprotein 2
   • Imagining Studies
     • Abdominal ultrasound
     • Endoscopic ultrasound
     • Computed tomography of abdomen with contrast
     • MRCP
     • ERCP
   • Tests for Severity and Prognosis
     • C-reactive protein (CRP) 48 hours after symptom onset
     • liver function tests
     • Calcium
     • CBC
     • Blood urea nitrogen (BUN)
   • Glasgow criteria

7. Complications

   • Shock
   • ARDS
   • DIC
   • Pancreatic pseudocyst
   • Pancreatic abcess
   • Infections

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