2132434546767788790Acute Pancreatis.pptx

Acute pancreatitis

1. ACUTE PANCREATITIS

2. The pancreas is located behind the stomach in the upper left abdomen. It is surrounded by other organs including the small intestine, liver, and spleen. ANATOMY

3. The pancreas is made up of 2 types of glands: Exocrine . The exocrine gland secretes digestive enzymes. These enzymes are secreted into a network of ducts that join the main pancreatic duct. It runs the length of the pancreas. Endocrine . The endocrine gland consists of the islets of Langerhans. It secretes hormones into the blood .

4. Functions of the pancreas The pancreas has digestive and hormonal functions: The enzymes secreted by the exocrine gland in the pancreas help break down carbohydrates, fats, and proteins. These enzymes go down the pancreatic duct into the bile duct in an inactive form. When they go into the duodenum, they are activated. The exocrine tissue also secretes a bicarbonate. It neutralizes stomach acid in the duodenum. There are 3 main hormones secreted by the endocrine gland in the pancreas. Insulin and glucagon help control the level of glucose in the blood. Somatostatin regulates growth hormone

5. PATHOGENESIS The pancreatic acinar cells secrete 3 types of digestive enzymes: Amylases Lipases Proteases Normally these enzymes are released in inactive form (zymogens/pro enzymes)and get activated by enteropeptidase once they get entered in duodenum via pancreatic duct Also, they remain stored in granules present in acinar cells and remain in inactive form by enzymes known as protease inhibitors

6. PATHOGENESIS Pancreatitis develop in 2 ways: 1. Obstruction in the pancreatic duct: It causes back pressure of digestive enzymes in the pancreas which alters the secretion process of zymogens in a way that lysosomes get fused with zymogens containing granules and cleave protease inhibitors. This will activate proteases and lipases which start destruction of the pancreatic tissue, a process known as ‘autodigestion’

7. PATHOGENESIS 2. Damage to the acinar cells It causes release of zymogens which get activated by lysosomes and ultimately cause destruction of pancreatic tissue

8. ETIOLOGY Gall stones can dislodge from gallbladder and cause obstruction in the pancreatic duct Ethanol causes ductal epithelial cells to release a very thick type of bicarbonate secretion that causes plug in the pancreatic duct and promotes pancreatitis Trauma causes release of zymogens from acinar cells and proteases leading to zymogen activation and pancreatitis Steroids increase ductal epithelial secretions which obstruct the pancreatic duct

9. ETIOLOGY Mumps virus release zymogens from acinar cells which get fused with lysosomes as a result proteases get activated and cause pancreatitis Autoimmune diseases form antibodies which destroy acinar cells leading to inadvertent release of zymogens and their activation to form proteases that cause pancreatitis Scorpion bite destroys acinar cells which promote pancreatitis In hypercalcemia , high calcium concentration can cause direct activation of zymogens leading to pancreatitis Drugs including sulfa drugs, anti HIV drugs & antidiabetic drugs cause pancreatitis by unknown mechanisms

10. MORPHOLOGY Leukocytosis (inflammatory molecules stimulate bone marrow to increase production of WBCs) Edema caused by increased vascular permeability Liquefactive necrosis (lipases break down the pancreatic fat and make the tissue liquid ) Fibrous tissue surrounds the liquefactive necrosis that form pseudocysts (fluid filled cavities) Pancreatic abscess (pseudocysts surrounded by bacteria) Breakdown of lipids into free fatty acids which combine with calcium present in blood (saponification) leading to hypocalcemia Lipases and proteases will extend their activity to lipid and proteins of nearby blood vessels causing their destruction and blood accumulation in and near pancreas causing hemorrhage to form

11. CLINICAL SIGNIFICANCE Symptoms include: Persistent epigastric pain that radiates to the back Inflammation all over the GI tract leading to abdominal distension Nausea and vomiting Jaundice Fever (inflammatory molecules stimulate hypothalamus to raise body temp)

12. COMPLICATIONS

13. DIAGNOSIS

14. TREATMENT Painkillers to relief pain Rest the bowel and food is avoided Nutrition given through IV fluids