Acute Abdomen

Pancreas Anatomy
1. Blood Supply
2. Pancreas Histology
Sympathetic and parasympathetic nerves of the abdomen "innervation"
Physiology of the Pancreas
1. Pancreatic secretory function
  1. Exocrine function
    1. Stimulated by chyme in the upper part of the small intestine
      1. Digestive enzymes for protein, carbohydrates and fats (CCK)
        Acini
        Vagus
      2. Aqueous component bicarbonates ions and water (Secretin)
        Epithelial cells of the ducts
    2. Secretin vs CCK
      1. 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.
    3. pancreatic exocrine dysfunction
      1. Decreased fecal elastase
  2. Endocrine function
    1. secretion of hormones directly into the blood ction
  3. Cellular Mechanisms
    1. CO2 diffuses to the interior of the cell from blood (carbonic anhydrase).
      1. 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.
pancreatitis
1. Causes
  1. Alcoholism
  2. Gall stones
  3. Medications (thiazides)
  4. Hypertriglyceridemia
  5. hypercalcemia
  6. Infections: mumps, coxackie, CMV
  7. Acute ischemia (shock)
  8. Trauma, blunt, iatrogenic
  9. Genes: PRSS1, SPINK1
  10. Idiopathic, 10-20%
2. Pathophysiology of pancreatitis
  2. Signs and symptoms
    1. Acute pancreatitis
      1. Upper abdominal pain
      2. Abdominal pain that radiates to your back
      3. Abdominal pain that feels worse after eating
      4. Fever
      5. Rapid pulse
      6. Nausea and Vomiting
      7. Tenderness when touching the abdomen
      8. Investigations
        Serum amylase
        Sensitivity 85%, specificity 70%
        Serum lipase
        Sensitivity 80%, specificity 75%
        Serum immunoreactive trypsin (SIT)
        Sensitivity 95% to 100%
    2. Chronic pancreatitis
      1. Upper abdominal pain
      2. Losing weight without trying
      3. Oily, smelly stools (steatorrhea)
      4. Serum amylase
        Less reliable than in acute disease
      5. Serum lipase
        Not clinically useful
      6. Serum immunoreactive trypsin (SIT)
        Decreased concentration
3. Complications
  1. SIRS (systemic inflammatory response syndrome)
  2. Pseudocyst
  3. Infected pancreatic necrosis
  4. Secondary DM
  5. Adenocarcinoma
  6. Septic shock
  7. Peritonitis
  8. Chronic pancreatitis
  9. DIC + ARDS
4. Lab investigations
  1. Decreased fecal elastase
5. Radiologic Studies
6. Management of acute pancratitis
  1. supportive care with fluid resuscitation, pain control, and nutritional support.
  2. Abdominal pain is often the predominant symptom in patients with acute pancreatitis and should be treated with analgesics.
7. Prognosis
  1. Acute pancreatitis
    1. expect complete recovery.
  2. Chronic Pancreatitis
    1. Acute pancreatitis can become chronic if pancreatic tissue sustains damage and scarring occurs. About 5% of patients need long-term treatment
      1. a lifetime of ongoing pain, nausea, and other gastrointestinal symptoms
  3. Increased Risk for Pancreatic Cancer
    1. Development of Diabetes
Causes

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Acute Abdomen

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	Created by Fatma Shwaylia about 6 years ago