ACUTE PANCREATITIS

SPECIFIC LEARNING OBJECTIVES

Definition of pancreatitis

Aetiology

Pathogenesis

Clinical Presentation

Classification of Acute pancreatitis

Diagnosis

Differentiial diagnosis

Investigation

Complication

Homoeopathic remedies
DEFINITION;
“Acute pancreatitis can be defined as an acute inflammatory
disease of the pancreas resulting from variety of insults and
characterized clinically by sudden onset of upper abdominal
pain and biochemically by an increase of pancreatic enzymes in
the blood”.
AETIOLOGY
• I GET SMASHED
I – Idiopathic
G- Gall stones
E- Ethanol(Alcohol)
T- Trauma
S-Steroids
M-Mumps,Epstein barr & Cytomegalo virus
A-Autoimmune disease – SLE
S-Scorpion bite
H-Hypercalcemia,Hyperlipedemia,Hypertriglycermia
E-ERCP
D-
Drugs(Steriods,Azothiprine,NSAIDS,Diuretics,Furesomide,thiazides)
PATHOGENESIS
CLINICAL PRESENTATION
UPPER ABDOMINAL OR EPIGASTRIC PAIN
NAUSEA
FREQUENT AND EFFORTLESS VOMITING
DIARRHOEA
ANOREXIA
PERSISTENT RETECHING
HICCUPS
FEVER-LOW GRADE
GENERAL PHYSICAL EXAMINATION/ SIGNS
Appearance-gravely ill with profund shock,toxicity and
confusion.
VITALS- Tachypnea(and dyspnea)
Tachycardia
Hypotension
Temp-high/normal/low
ICTERUS
PALLOR,COLD Clammy skin
Diaphoresis,Dehydration
ABDOMINAL SIGNS
Distension of abdomen/Ascities
Abdominal tenderness, rebound tenderness, muscle guard
and rigidity
Palpable psuedocyst
Sluugish bowel sounds
CLASSIFICATION OF ACUTE
PANCREATITIS
 Mild acute pancreatitis(80% cases)
(Acute interstitial/edematous pancreatitis)
• Absence of organ failure
• Absence of local complication

Severe acute pancreatitis(20% cases)

• (Acute hemorrhagic Necrotizing(fulminant) pancreatities)
• Local complication +/-
• Organ failure defined as
• SBP <90mm Hg
• Pa02 < 60mm Hg
• GI bleed > 500ml /24hrs
• Cret > 2mg/dl after rehydration
• Ranson score > 3
• Or APACHE > 8
DIAGNOSIS

The diagnosis is made of 2

out 3criteria are present;
Characteristic findings of
Serum amylase and /or acute pancreatitis on USG or
Abdominal pain i.e upper
lipase activity atleast > Contrast enchanced
abdomen,persistent,constan
3times the upper limit of computed
t and radiating to back.
normal tomography(CECT) scan of
the abdomen
DIFFERENTIAL DIAGNOSIS
Acute cholecystitis

Acute intestinal obstruction

Acute appendicities

Ureteric colic

Intestinal perforation with peritonitis

INVESTIGATIONS
Plain x-ray of
abdomen
Ultrasonography
of abdomen

Serum amylase

ECG

MRI of abdomen
COMPLICATION
• ACUTE FLUID COLLECTION
• PSEUDOCYST
Local • PANCREATIC NECROSIS
• PANCREATIC ABSCESS

Regional • VASCULAR THROMBOSIS, AND BLEEDING

• PARALYTIC ILEUS,INTESTINAL
and OBSTRUCTION,CHOLESTASIS,INTESTINAL ISCHEMIA
AND NECROSIS
Intestinal
• SIRS
Systemic • MODS
• ENCEPHALOPATHY