Complications of acute pancreatitis

acute pancreatitis

1. Complications of acute pancreatitis

2. Local Fluid collection ( ascites / pleural effusion) Pancreatic pseudo cyst Pancreatic necrosis Infected pancreatic abscess Hemorrhage and pseudo aneurysm

3. Regional Venous thrombosis Paralytic ileus Intestinal obstruction Intestinal ischemia/ necrosis Cholestasis

4. Systemic Systemic inflammatory response syndrome Multiple organ dysfunction syndrome ARDS/ pulmonary failure. Renal failure Cardiovascular complication Hypocalcemia hyperglycemia

5. 7. Disseminated intravascular coagulopathy 8. Protein energy malnutrition 9. Encephalopathy

6. Local fluid collection Small collection – reactionary. Massive ascites and pleural effusion due to internal panceatic fistula. Treatment : ERCP to detect site of leakage followed by stenting Distal pancreatic resection or internal drainage in Roux en Y jejunostomy .

7. Pseudo cyst Peripancreatic fluid collection contained by fibrous granulation tissue contrast to cystic neoplasm having epithelialized wall. D’ Egidio classification: Type I Acute post necrotic cyst Type II Post necrotic cyst Type III Retention cyst

8. Complications of pseudocyst Infection Hemorrhage Mass effect Leaks

9. Management Type I percutaneous drainage Type II and III internal drainage

10. Pancreatic necrosis May be sterile or infected. Treated by debridement ( necrosectomy ).

11. Pancreatic abscess Arise from infection of pancreatic collection. Ideally should not contain necrotic debris. Must be differentiated from infected necrosum radiologically .

12. Clinical features of pancreatic abscess Fever Tachycardia Abdominal pain leucocytosis

13. Management Percutaneous drainage radiolgically Endoscopic drainage with placement of double j stent

14. SIRS &MODS SIRS : Tachypnea , tachychardia , leucocytosis and hyperthermia. Sepsis could be there. May progress to MODS Treatment is supportive care.