PANCREATITIS

ThS. BS. HỒ ĐẶNG ĐẶNG KHOA

khoahdd.bmngoai@pnt.edu.vn
 Mục tiêu học tập
• Biết cách phân biệt viêm tụy cấp và viêm tụy mạn

• Lựa chọn phương pháp điều trị thích hợp

Tài liệu tham khảo

1) Bài giảng bệnh học Ngoại khoa (Trường Đại học Y khoa Phạm Ngọc Thạch)
2) Cấp cứu Ngoại tiêu hóa (Trường Đại học Y dược TPHCM)
3) Schwartz
4) Sabiston
5) Current
6) SRB
 CONTENT
• Anatomy

• Evolution

• Diagnosis

• Management
ANATOMY
EVOLUTION
EVOLUTION
EVOLUTION
EVOLUTION
EVOLUTION
EVOLUTION
EVOLUTION
CAUSES
CAUSES
ANATOMY
COMPLICATIONS
COMPLICATIONS
COMPLICATIONS
COMPLICATIONS
COMPLICATIONS
What are the types of pancreatitis?
What are the types of pancreatitis?
 Acute / Chronic pancreatitis

Progressive inflammatory
Initiating event
changes

Injury to acinar cells impairs Chronic irreversible

release of proenzymes (in
zymogen granules) inflammation

Premature activation of Fibrosis with calcification

enzymes

Autodigestion Loss of pancreatic function

 SYMPTOMS

AP CP
Dull, boring mid- Mid upper abd pain,
epigastric, radiates to chronic, intermittently
back severe, may rad to
back
Usually sudden onset
Diarrhea, weight loss

Nausea / vomiting
Steatorrhea, diabetes
 SYMPTOMS

ACUTE PANCREATITIS CHRONIC PANCREATITIS

- Fever (76%) - +/- epigastric tender mass
- Tachy (65%) or fullness (pseudocyst)
- Abd tenderness - Advanced: malnutrition,
guarding (68%) decreased subcut fat.
- +/- jaundice
- Severe: hemedynamic
instability, hematemesis
 LABS

ACUTE PANCREATITIS CHRONIC PANCREATITIS

- Amy/Lip: 3x above. - CBC, LFTs
- Gallstone panc: ALP, - Amy/Lip: slightly high
Bili, AST, ALT - Compression of duct: high
- Ca, Cholesterol, TG bili and ALP
- CBC - Adv: low serum trypsin,
steatorrhea
- Poss: high Ca, high TG
 IMAGING
• WHEN TO OBTAIN IMAGING:
- Uncertain diagnosis
- Severe disease
• CHOICE:
- Ultrasound: most useful initial test, gallstone
(sensitivity 70-80%)
- Abdominal CT: if severe acute pancreatitis, good for
assessing complications
IMAGING
IMAGING
CT SCAN
CT SCAN
CT SCAN
DIAGNOSIS
 MEDICAL TREATMENT

ACUTE PANCREATITIS CHRONIC PANCREATITIS

- NPO - Behavior modification
- IVF + Cessation of EtOH
- Pain relief and tobacco use will help
- Antibiotics: pain relief in early stages, not
+ If infected pancreatic in late
necrosis - Pain control
+ Antibiotic prophylaxis in - Restoration of digestion
severe pancreatitis is and absorption
controversial - +/- insulin
OPTIONS FOR PANCREATITIS TREATMENT ?
ALGORITHM FOR MEDICAL MANAGEMENT
ALGORITHM FOR MEDICAL MANAGEMENT
ALGORITHM FOR MEDICAL MANAGEMENT
NUTRITIONAL MANAGEMENT
CHRONIC PANCREATITIS
NUTRITIONAL MANAGEMENT
NUTRITIONAL MANAGEMENT
PROGNOSTIC SCORING SYSTEMS
PROGNOSTIC SCORING SYSTEMS
ATLANTA CRITERIA
SURGICAL TREATMENT
SURGICAL TREATMENT
SURGICAL TREATMENT
SURGICAL TREATMENT
SURGICAL TREATMENT
SURGICAL TREATMENT
SURGICAL TREATMENT
SURGICAL TREATMENT
SURGICAL TREATMENT
SURGICAL TREATMENT
HOW TO PREVENT PANCREATITIS ?