Pancreatitis

Pte JP
49 Dolor epigastrico de inicio subito
Irradiado a Rspalda Se alivia al sentarse hacia adelante con los brazos alrededor del abdomen.

Nausea y Vomito Fiebre

 APP
Colelitiasis conocida Ingesta OH (80-120 u semana)

AF
hipertrigliceridemia

Examen
Chocado :
BP 90/50 FC 120 Frio, calambres y sudoracion profusa

Dolor Epigastrico + defensa muscular RI metalicos / hipoactivos

Pancreas

Differential Diagnosis
Pancreatitis Colecistitis Colangitis Ascendente Vicera hueca Perforada Obstruction Intestinal AA roto Appendicitis Perforacion Cecal E ectopico Roto Isquemia mesenterica Diverticulitis IM Neumonia

Funcion
Exocrina
precursor enzimas digestivas
lipasas

Endocrin
Hormonas metabolicas
Insulina celulas Glucagon celulas

Pancreatitis
Inflammatoria Destructiva Auto-perpetuada Perdidas de liquido en 3er espacio Rapidamente progresiva Puede progresar a hemorragica o pancreatitis necrotizante

Get Smashed!
G allstones E thanol T rauma
S teroids M umps A utoimmune (eg PAN) S corpion venom (Trinidadian - Tityus trinitatis) H yperlipidaemia / hypercalcaemia / hypothermia E RCP D rugs (azathioprines)

Investigation
Bloods Arterial FBC Blood U+Es Abdominal Gases CRP Xray Glucose Amylase Calcium

USS CT

Modified Glasgow criteria

GB > 15.0 x 109/L GlucosA >10 mmol /L LDH >600iu/L AST >200iu/L Urea >16mmol/L Ca2+ serico<2mmol/L albumina <32g/L PaO2 <8.0kPa
Greater = poorer prognosis

Management
Primeras 24 horas Simptomatic:
Fluid Depleted (third space losses)
IV access Aggressive fluid resiscitation Strict input/output balance

Catheter, helps with input/output NG tube for vomiting/ileus Analgesia Morphine/Pethidine

Treatment
Subsequent days Initally observations hourly Daily FBC, U+Es, Ca2+,Glucose, amylase, ABGs ?HDU/ITU ?Antibiotics May reduce septic complications Do not forget alcohol withdrawal therapy if due to excess alcohol
Chlordiazepoxide 20mg qds PO Pabrinex IV

MR JP
Managed perfectly by on-call House officer Day 3 developed severe vomiting BNO 3/7 Abdominal distension Tetany Carpopedal spasm

Complications
Early
Shock ARDS Renal failure DIC Hypocalcaemia Hyperglycaemia

Further complications
Medium term
Pancreatic Necrosis Pancreatic pseudocyst

Long Term
Chronic pancreatitis Diabetes

Mr JP
Seen in clinic 6 weeks later Stopped drinking Cholecystectomy Statins No further attacks!