Exocrine Function
common bile duct
HEAD BODY
TAIL
ampulla
pancreatic duct
pancreatic enzymes
Enzyme Secretion
acinus
Enzyme Secretion
Neural
acetylcholine VIP GRP
Hormonal
CCK gastrin
Secretin (hormonal)
H2O bicarbonate
Acute Pancreatitis
Pathogenesis
acinar cell injury
Acute Pancreatitis
Pathogenesis
premature enzyme activation
Acute Pancreatitis
Pathogenesis
SEVERITY Mild
Nausea & Vomiting Weakness Tachycardia +/- Fever; +/- Hypotension or shock
- Grey Turner sign - flank discoloration due to
retroperitoneal bleed in pt. with pancreatic necrosis (rare)
Cullens sign
Acute Pancreatitis
Clinical Presentation
Abdominal pain
- Epigastric - Radiates to the back
Acute Pancreatitis
Differential Diagnosis
Acute Pancreatitis
Diagnosis
Symptoms
- Abdominal pain
Laboratory
- Elevated amylase or lipase > 3x upper limits of normal
Radiology
- CT
Prognosis
Many different scoring systems
- Ranson (most popular & always taught in medschool) No association found with score, and mortality or length
of hospitalization
Ranson Criteria
Admission
Age > 55 WBC > 16,000 Glucose > 200 LDH > 350 AST > 250
5% mortality risk with <2 signs 15-20% mortality risk with 3-4 signs 40% mortality risk with 5-6 signs 99% mortality risk with >7 signs
Therapy
hospitalization. fasting. Hydration with electrolytes. SNG vomits. analgesics. (paracetamol and morphines) realimetacion enteral starting 48 hours. prevent thromboembolism with low molecular
weight heparin.
cholecystectomy
Complications Local
Necrosis
- Sterile - Infected - abscess
Complications Systemic
Pulmonary
Pleural effusions Atelectasis Mediastinal abscess ARDS
Gastrointestinal
- Erosive gastritis - Blood vessel erosion - Portal vein thrombosis
Cardiovascular
- Hypotension - Sudden death - Pericardial effusion
Renal
- Oliguria - Azotemia - Renal artery/vein
throbosis
Hematologic
GRACIAS