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Pte JP
49 Dolor epigastrico de inicio subito
Irradiado a Rspalda Se alivia al sentarse hacia adelante con los brazos alrededor del abdomen.
APP
Colelitiasis conocida Ingesta OH (80-120 u semana)
AF
hipertrigliceridemia
Examen
Chocado :
BP 90/50 FC 120 Frio, calambres y sudoracion profusa
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
Management
Primeras 24 horas Simptomatic:
Fluid Depleted (third space losses)
IV access Aggressive fluid resiscitation Strict input/output balance
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!