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Pancreatitis

Pancreatitis. Mateja Grizelj Mentor: A. Žmegač Horvat. Case. 40-year-old woman with a 4-day history of epigastric pain with radiation to the back. She has been vomiting, and on examination there is tenderness with guarding in the epigastrium.

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Pancreatitis

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  1. Pancreatitis Mateja Grizelj Mentor: A. Žmegač Horvat

  2. Case 40-year-old woman with a 4-day history of epigastric pain with radiation to the back. She has been vomiting, and on examination there is tenderness with guarding in the epigastrium. There have been no previous similar attacks. The serum amylase is 798 U/L (normal <125 U/L).

  3. Classification • Acute pancreatitis • Chronic pancreatitis

  4. Acute pancreatitis Pathogenesis : • Gallstones • Alcohol • Idiopathic • Hypercalcaemia, hyperlipidaemia • Post-surgical, post-ERCP • Drugs

  5. Clinical features • Epigastric, upper abdominal pain • Nausea, vomiting • Epigastric tenderness, guarding and rigidity • Ascites • Cullen´s sign, Grey Turner´s sign – ecchymoses • Multiorgan failure

  6. Diagnosis Blood test - raised serum amylase Radiology: 1.X-ray (to exclude peptic ulcer) 2.Ultrasound – gallstones 3.Contrast-enhanced spiral CT or MRI – pancreatic necrosis

  7. Glasgow criteria • Age >55 yrs • WBC count >15 x109/L • Blood glucose >200 mg/dL (no diabetic history) • Serum urea >16 mmol/L (no response to iv. fluids) • Arterial oxygen saturation <76 mmHg • Serum calcium <2 mmol/L • Serum albumin <34 g/L • LDH >219 units/L • AST/ALT >96 units/L

  8. Treatment • ERCP, stone removal • Prophylactic antibiotics: cefuroxime or aztreonam • Analgesia: pethidine or tramadol, NOT morphine (increases sphinter of Oddi preasure – may aggravate pancreatitis) • Feeding: nasojejunal tube • Surgery

  9. Complications and prognosis • Hyperglycaemia, hypocalcaemia • Renal failure • Shock Mortality • Mild cases - 1% • Severe cases - 50%

  10. Chronic pancreatitis • Irreversible morphological change • Impairment of function • Chronic calcifying pancreatitis • Alcohol

  11. Clinical features • Abdominal pain • Severe weight loss • Diabetes • Steatorrhoea • Icterus • Pseudocysts

  12. Diagnosis • Radiology: x-ray, CT, ultrasound • Biochemical tests

  13. Treatment • Stop drinking alcohol • Analgesia • Surgery • Pancreatic supplements

  14. Case 40-year-old woman with a 4-day history of epigastric pain with radiation to the back. She has been vomiting, and on examination there is tenderness with guarding in the epigastrium. There have been no previous similar attacks. The serum amylase is 798 U/L (normal <125 U/L). • What is the most likely diagnosis? • What further specific questions would you ask to determine the aetiology?

  15. References • Interna medicina, Božidar Vrhovac • Kumar and Clark`s Clinical Medicine, Parveen Kumar and Michael Clark

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