Acute pancreatitis

anatomy of the pancreas
1. parts
  1. head
    1. neck
      1. body
        tail
2. blood supply
  1. celiac
    1. superior pancreaticoduodenal
      1. inferior pancreaticoduodenal
        superior mesentric artery
3. nerve supply
  1. celiac plexus
    1. superior mesentric plexus
physiology of pancreas
1. endocrine
  1. insulin
    1. beta cells
      1. stimulates glucose uptake by tissues
  2. glucagon
    1. alpha cells
      1. increases blood glucose levels
  3. somatostatin
    1. delta cells
      1. inhibits many hormones
2. exocrine
  1. proteases
    1. digestion of proteins
  2. amylases
    1. digestion of carbohydrates
  3. lipases
    1. digestion of fats
signs and symptoms
1. acute abdomen
  1. possible location of pain in different diseases
2. nausea and vomiting
  1. dehydration
3. fever
  1. grey-turner and cullen
investigations
1. low Hb
  1. anemia
2. enzymes
  1. amylase and lipases
3. high WBC's
  1. fever
pathogenesis,causes and risk factors
1. duct obstruction
  1. caused by
    1. alcohol
    2. gallstones
    3. leads to
      1. imparied blood flow
        ischemia
2. acinar cell injury
  1. caused by
    1. alcohol
    2. viruses
    3. trauma
    4. leads to
      1. release of eznymes
3. defect intracellular transport
  1. caused by
    1. metabolic injury
    2. alcohol
    3. leads to
      1. trapping of enzymes inside the cell
        activation of the enzymes intracellulary
        proteases
        proteolysis
        elastases
        hemorrhage
        lipases
        fat necrosis
        interstitial inflammation
        edema
management
1. NG tube
  1. empty the stomach
2. fluid resuscitation
  1. replace the fluids
3. mepridine
  1. analgesic
4. prophylactic antibiotics
  1. to prevent infection
epidemiology
1. range
  1. 5-80 cases worldwide
    1. highest incidence in USA and finland
      1. 73.4 per 100000
2. most important risk factor
  1. alcohol
    1. median age of onset
      1. 39
complications
1. hypovoluemic shock
2. perforation
3. chronic pancreatitis
4. DIC
5. Ranson criteria for diagnosis and prognosis

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Acute pancreatitis

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