Acute pancreatitis Tutorial Presentation.pptx

This slide contains detailed information on Acute pancreatitis with clinical approaches to managing it.

1. ACUTE PANCREATITIS INTERNAL MEDICINE TUTORIAL IKIRODAH OMOALUSE 160705043

2. PRESENTATION OUTLINE INTRODUCTION CLINICAL FEATURES Signs and Symptoms EPIDEMIOLOGY MANAGEMENT Diagnosis, Differentials, Treatment, Prognosis 05 ETIOLOGY 03 CONCLUSION 06 01 04 02

3. INTRODUCTION 01

4. INTRODUCTION Pancreatitis is an inflammatory process in which pancreatic enzymes auto digest the pancreatic gland. The gland sometimes heals without any impairment of function or any morphologic changes; this process is known as acute pancreatitis . Pancreatitis can also recur intermittently, contributing to the functional and morphologic loss of the gland and these recurrent attacks are referred to as chronic pancreatitis. Both forms may however present with acute clinical findings.

5. EPIDEMIOLOGY 02

6. EPIDEMIOLOGY Worldwide, the incidence of acute pancreatitis ranges between 5 - 80 per 100,000. The median age at onset varies per aetiology (between 31-69 years ). Generally, acute pancreatitis affects males more often than females. In males, it is more often related to alcohol. In females, it is more often related to biliary tract disease. Risk of incidence is about 3 times higher in blacks when compared to whites.

7. ETIOLOGY 03 Long-standing alcohol consumption and biliary stones cause most cases of acute pancreatitis.

8. ETIOLOGY Biliary tract disease Gallstones passing into the bile duct and temporarily lodging at the sphincter of Oddi. The risk of a stone causing pancreatitis is inversely proportional to its size. Acinar cell injury secondary to increasing pancreatic duct pressures and obstruction. ALCOHOL CONSUMPTION Direct toxic effect on the pancreatic acinar cells Stimulation of pancreatic secretion which causes intracellular accumulation of digestive enzymes and their premature activation and release. Constriction of the sphincter of Oddi by protein plugs.

9. ETIOLOGY Other known causes of acute pancreatitis include Trauma Metabolic – hyperlipidemia , hypercalcemia Drugs – azathioprine, sulfonamides , steroids, estrogens , tetracycline, etc. Toxic – scorpion venom Infections Viral - mumps virus, CMV, hepatitis, EBV, varicella-zoster virus, measles, rubella Bacterial - Mycoplasma pneumoniae, Salmonella, Campylobacter, Mycobacterium tuberculosis Helminthic - Ascaris

10. ETIOLOGY Other known causes of acute pancreatitis include Post Endoscopic retrograde cholangiopancreatography Congenital – pancreatic divisum , annular pancreas Vascular – ischemia, vasculitis Autoimmune – hereditary pancreatitis Others – tumours, post-operative trauma Idiopathic

11. CLINICAL FEATURES 04

12. SYMPTOMS ABDOMINAL PAIN U pper abdominal pain, sudden onset, sharp, severe, continuous, radiates to back, reduced by leaning forward FEVER NAUSEA AND VOMITING N on-projectile vomiting with accompanying anorexia. Diarrhea may also occur WEAKNESS

13. SIGNS Fever (usually low-grade) Tachycardia Tachypnea , dyspnea Hypotension Abdominal distension, tenderness, guarding Diminished or absent bowel sounds Jaundice Pale, diaphoretic, and confused – when severe Muscular spasm, rigidity Cullen sign - bluish discoloration around the umbilicus Grey-Turner sign - reddish-brown discoloration along the flanks Erythematous skin nodules (may be from focal subcutaneous fat necrosis; usually not more than 1cm in size and are typically located on extensor skin surfaces)

14. MANAGEMENT 05 Diagnosis, Differentials, Treatment, Possible Complications, Prognosis

15. DIAGNOSIS HISTORY Symptoms, progression, severity Rule out risk factors, possible aetiology, complications PHYSICAL EXAMINATIONS Elicit clinical signs of the disease Rule out complications and possible differentials

16. DIAGNOSIS INVESTIGATIONS Serum amylase and lipase (typically 3x elevated), other pancreatic enzymes Liver function tests, Serum bilirubin (high AST, elevated serum bilirubin) FBC (leukocytosis), EUCr , Blood glucose Serum cholesterol and triglycerides, LDH C-reactive protein Imaging – Abdominal USS, endoscopy, etc. Genetic testing

17. DIFFERENTIALS Cholelithiasis Acute peritonitis Malabsorption syndrome/process Acute Cholecystitis Chronic pancreatitis Irritable bowel syndrome Large bowel obstruction Pancreatic cancer Peptic Ulcer Disease Viral hepatitis

18. TREATMENT ANTIBIOTIC THERAPY Not routinely indicated except there is evidence of infection SUPPORTIVE THERAPY A nalgesics; anti-emetics; NPO until pain-free; monitoring of vitals; correction of electrolyte imbalance RESUSCITATION Admit and Resuscitate with the ABCD of resuscitation IV FLUID RESUSCITATION NUTRITIONAL SUPPORT SURGERY Cholecystectomy, drainage of pancreatic abcess

19. OTHER MODALITIES NGT tube insertion to relieve vomiting Pancreatic secretion inhibitors - somastostatin Omeprazole Respiratory support and/or ICU admission if severe Monitoring for complications with FBC, EUCr, ABG, LFTs, Blood glucose

20. POSSIBLE COMPLICATIONS Ascites Pancreatic pseudocyst Infection (pancreatic abscess) Pancreatic necrosis Intra-abdominal hemorrhage Colon perforation Multiorgan system failure (pulmonary failure, renal failure) Shock

21. SEVERITY Acute pancreatitis is broadly classified as either mild or severe . Severe acute pancreatitis is signalled by the following Evidence of organ failure (e.g., systolic blood pressure below 90 mm Hg, arterial partial pressure of oxygen 60 mm Hg or lower, elevated serum creatinine level, GI bleeding) Local complications (e.g., necrosis, abscess, pseudocyst)

22. PROGNOSIS Overall mortality in patients with acute pancreatitis is 10-15% Higher mortality is seen in biliary than alcoholic disease Type 2 DM is also associated with higher severity and mortality In severe disease with organ failure (about 20% of presentations), mortality is approximately 30%.

23. CONCLUSION 06

24. IN CONCLUSION Acute pancreatitis is an inflammatory process in which pancreatic enzymes auto digest the pancreatic gland. This condition presents with a characteristic abdominal pain and is usually associated with raised pancreatic enzyme levels. The mainstay of management is to provide aggressive supportive care, to decrease inflammation, to limit infection or superinfection, and to identify and treat complications as appropriate.

25. REFERENCES Bailey’s & Love’s Short Practice of Surgery, 25 th Edition, Page 1138-1146 TANG, J.C.F. (2021). Acute Pancreatitis Treatment & Management . Medscape.com. Available at https://emedicine.medscape.com/article/181364-overview

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