Acute pancreatitis

Acute pancreatitis

1. anatomy of the pancreas

   • parts
     • head
       • neck
         • body
           • tail
   • blood supply
     • celiac
       • superior pancreaticoduodenal
         • inferior pancreaticoduodenal
           • superior mesentric artery
   • nerve supply
     • celiac plexus
       • superior mesentric plexus

2. physiology of pancreas

   • endocrine
     • insulin
       • beta cells
         • stimulates glucose uptake by tissues
     • glucagon
       • alpha cells
         • increases blood glucose levels
     • somatostatin
       • delta cells
         • inhibits many hormones
   • exocrine
     • proteases
       • digestion of proteins
     • amylases
       • digestion of carbohydrates
     • lipases
       • digestion of fats

3. signs and symptoms

   • acute abdomen
     • possible location of pain in different diseases
   • nausea and vomiting
     • dehydration
   • fever
     • grey-turner and cullen

4. investigations

   • low Hb
     • anemia
   • enzymes
     • amylase and lipases
   • high WBC's
     • fever

5. pathogenesis,causes and risk factors

   • duct obstruction
     • caused by
       • alcohol
       • gallstones
       • leads to
         • imparied blood flow
           • ischemia
   • acinar cell injury
     • caused by
       • alcohol
       • viruses
       • trauma
       • leads to
         • release of eznymes
   • defect intracellular transport
     • caused by
       • metabolic injury
       • alcohol
       • leads to
         • trapping of enzymes inside the cell
           • activation of the enzymes intracellulary
             • proteases
               • proteolysis
             • elastases
               • hemorrhage
             • lipases
               • fat necrosis
             • interstitial inflammation
               • edema

6. management

   • NG tube
     • empty the stomach
   • fluid resuscitation
     • replace the fluids
   • mepridine
     • analgesic
   • prophylactic antibiotics
     • to prevent infection

7. epidemiology

   • range
     • 5-80 cases worldwide
       • highest incidence in USA and finland
         • 73.4 per 100000
   • most important risk factor
     • alcohol
       • median age of onset
         • 39

8. complications

   • hypovoluemic shock
   • perforation
   • chronic pancreatitis
   • DIC
   • Ranson criteria for diagnosis and prognosis

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