Acute Abdomen

Acute Abdomen

1. Pancreas Anatomy

   • Blood Supply
   • Pancreas Histology

2. Sympathetic and parasympathetic nerves of the abdomen "innervation"

3. Physiology of the Pancreas

   • Pancreatic secretory function
     • Exocrine function
       • Stimulated by chyme in the upper part of the small intestine
         • Digestive enzymes for protein, carbohydrates and fats (CCK)
           • Acini
             • Vagus
         • Aqueous component bicarbonates ions and water (Secretin)
           • Epithelial cells of the ducts
       • Secretin vs CCK
         • Secretin induces bicarbonate secretion via activation of cystic fibrosis transmembrane conductance regulator (CFTR).
           • Secretin increases cAMP & opens CFTR Cl- channels
             • leads to
               • outflow of Cl- into the duct lumen.
       • pancreatic exocrine dysfunction
         • Decreased fecal elastase
     • Endocrine function
       • secretion of hormones directly into the blood ction
     • Cellular Mechanisms
       • CO2 diffuses to the interior of the cell from blood (carbonic anhydrase).
         • CO2 combines water to form carbonic acid.
           • It, in turn, dissociates into bicarbonate ions and hydrogen ions.
             • H+ are exchanged for sodium which supplies the sodium ions → ductal lumen → electrical neutrality.

4. pancreatitis

   • Causes
     • Alcoholism
     • Gall stones
     • Medications (thiazides)
     • Hypertriglyceridemia
     • hypercalcemia
     • Infections: mumps, coxackie, CMV
     • Acute ischemia (shock)
     • Trauma, blunt, iatrogenic
     • Genes: PRSS1, SPINK1
     • Idiopathic, 10-20%
   • Pathophysiology of pancreatitis
     • Signs and symptoms
       • Acute pancreatitis
         • Upper abdominal pain
         • Abdominal pain that radiates to your back
         • Abdominal pain that feels worse after eating
         • Fever
         • Rapid pulse
         • Nausea and Vomiting
         • Tenderness when touching the abdomen
         • Investigations
           • Serum amylase
             • Sensitivity 85%, specificity 70%
           • Serum lipase
             • Sensitivity 80%, specificity 75%
           • Serum immunoreactive trypsin (SIT)
             • Sensitivity 95% to 100%
       • Chronic pancreatitis
         • Upper abdominal pain
         • Losing weight without trying
         • Oily, smelly stools (steatorrhea)
         • Serum amylase
           • Less reliable than in acute disease
         • Serum lipase
           • Not clinically useful
         • Serum immunoreactive trypsin (SIT)
           • Decreased concentration
   • Complications
     • SIRS (systemic inflammatory response syndrome)
     • Pseudocyst
     • Infected pancreatic necrosis
     • Secondary DM
     • Adenocarcinoma
     • Septic shock
     • Peritonitis
     • Chronic pancreatitis
     • DIC + ARDS
   • Lab investigations
     • Decreased fecal elastase
   • Radiologic Studies
   • Management of acute pancratitis
     • supportive care with fluid resuscitation, pain control, and nutritional support.
     • Abdominal pain is often the predominant symptom in patients with acute pancreatitis and should be treated with analgesics.
   • Prognosis
     • Acute pancreatitis
       • expect complete recovery.
     • Chronic Pancreatitis
       • Acute pancreatitis can become chronic if pancreatic tissue sustains damage and scarring occurs. About 5% of patients need long-term treatment
         • a lifetime of ongoing pain, nausea, and other gastrointestinal symptoms
     • Increased Risk for Pancreatic Cancer
       • Development of Diabetes

5. Causes

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