Pancreatitis Mateja Grizelj Mentor A mega Horvat Case
- Slides: 15
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. There have been no previous similar attacks. The serum amylase is 798 U/L (normal <125 U/L).
Classification l l Acute pancreatitis Chronic pancreatitis
Acute pancreatitis Pathogenesis : l Gallstones l Alcohol l Idiopathic l Hypercalcaemia, hyperlipidaemia l Post-surgical, post. ERCP l Drugs
Clinical features l l l Epigastric, upper abdominal pain Nausea, vomiting Epigastric tenderness, guarding and rigidity Ascites Cullen´s sign, Grey Turner´s sign – ecchymoses Multiorgan failure
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
Glasgow criteria l l l l l Age >55 yrs WBC count >15 x 109/L Blood glucose >200 mg/d. L (no diabetic history) Serum urea >16 mmol/L (no response to iv. fluids) Arterial oxygen saturation <76 mm. Hg Serum calcium <2 mmol/L Serum albumin <34 g/L LDH >219 units/L AST/ALT >96 units/L
Treatment l l l 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
Complications and prognosis l l l Hyperglycaemia, hypocalcaemia Renal failure Shock Mortality • Mild cases - 1% • Severe cases - 50%
Chronic pancreatitis l l Irreversible morphological change Impairment of function Chronic calcifying pancreatitis Alcohol
Clinical features l l l Abdominal pain Severe weight loss Diabetes Steatorrhoea Icterus Pseudocysts
Diagnosis l l Radiology: x-ray, CT, ultrasound Biochemical tests
Treatment l l Stop drinking alcohol Analgesia Surgery Pancreatic supplements
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). 1. What is the most likely diagnosis? 2. What further specific questions would you ask to determine the aetiology?
References l l Interna medicina, Božidar Vrhovac Kumar and Clark`s Clinical Medicine, Parveen Kumar and Michael Clark
