Acute Pancreatitis www.medicalppt.blogspot.com

Acute Pancreatitis www.medicalppt.blogspot.com - Acute...

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Unformatted text preview: Acute Pancreatitis Craig Henson, PGY5 Mary Imogene Bassett Hospital 20 October 2008 Published by www.medicalppt.blogspot.com Introduction Anatomy Organogenesis Physiology Epidemiology Etiology Pathogenesis Classification Clinical Presentation Diagnosis Severity Assessment Management Issues Anatomy 12-15 cm long L1-L3 Associated structures IVC posterior to neck D1-4 wrap around head Aorta posterior, Celiac trunk superior, SMA inferior Splenic v. and a. intimately related CBD Arterial supply Splenic a. Superior pancreaticoduodenal a. (from gastroduodenal; celiac) Inferior pancreaticoduodenal a. (from SMA) Ducts: Wirsung and Santorini Pain fibers from splanchnic nerves Organogenesis Endodermal origin Day 31 dorsal pancreatic bud develops form duodenal loop Day 32-33 ventral pancreatic bud develops Ventral bud rotates with rotation of stomach and lengthening of duodenum Rotation is to the right and posterior to duodenum Dorsal bud anterior head, body and tail Ventral bud posterior head and uncinate process Main duct (Wirsung) from fusion of dorsal and ventral ducts www.embryology.ch Physiology Enyzymes Cell Type Target/Function Exocrine Acinar Amylase Carbohydrates Trypsin, Chymotrypsin, Elastase Proteins; cleaving AA bonds Carboxypeptidase Cleave AAs off end of peptide Lipase Triglycerides Phospholipase A2 Phospholipids Cholesterol Esterase Neutral lipids Endocrine Islet Cells Insulin gluconeogenesis, glycogenolysis & ketogenesis glycogenesis & protein synthesis Glucagon Opposite of insulin Somatostatin Inhibits: GI secretion, secretion and action of all GI endocrine peptides, cell growth NomenclatureAtlanta Classification System Acute Pancreatitisacute inflammatory process of the pancreas with variable involvement of other regional tissues or remote organ systems Severity Mildminimal organ dysfunction; uneventful recovery; normal parenchyma on CT Severeorgan failure and/or necrosis, abscess, pseudocyst Predicted severeRansons score > 3, APACHE II > 8 Local Complications Acute Fluid Collections Pancreatic Necrosis Acute Pseudocyst Pancreatic Abscess Organ Failure and Systemic Complications ShockSBP < 90mmHg Pulm InsufficiencyPaO2 < 60mmHg Renal FailuureCreat > 2mg/dL GI Bleeding > 500ml in 24hrs DICPlt < 100, fibrinogen < 1, FSP > 80 Severe Metabolic DisturbancesCa ++ < 7.5 System recently criticized: Bollen et al. BJS. 2008;95:6-21. Epidemiology 300,000 cases per year in US 3000 deaths per year in US Contributes to additional 4000 deaths per year $2 billion in annual health costs 80% of cases are mild and require little to no intervention 10-20% are severe Mortality rate of severe acute pancreatitis 10-30% Within first week SIRS After 1-3 weeks MSOF + infection (predominantly Gram...
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This note was uploaded on 12/27/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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Acute Pancreatitis www.medicalppt.blogspot.com - Acute...

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