|
q
Gallstones.
q
Alcohol.
q
Idiopathic.
q
Local
obstructive factors:
§
Duodenal diverticulum.
§
Stenosis of papilla of
Vater.
§
Pancreatic head
carcinoma.
q
Drugs
e.g. azathioprine, corticosteroids.
q
Infections
e.g. mumps.
q
Iatrogenic
(ERCP).
q
Hyperlipidemia.
q
Miscellaneous:
trauma, scorpion bite.
N.B. In gallstones, there
are 2 postulated mechanisms:
Bile & bacteria à Activate complements à Cell lysis à Necrosis initiated. Pathogenesis: 
Released enzymes spread via lymphatics to
abdominal tissues à Ca+
deposition in necrotic cells à
Hypocalcemia à
Tetany.
Clinical
features
Pain:
õ
Epigastric / upper
abdomen.
õ
May radiate to back
between scapulae.
õ
Relieved by leaning
forward.
Nausea,
vomiting.
P/E
Tenderness,
guarding, rigidity of abdomen.
Rarely,
body wall ecchymosis occur
in:
Umbilical
(Cullen’s sign) / in flanks (Grey Turner’s sign).
Differential
diagnosis:
q
Acute
cholecystitis.
q
Peptic
ulcer (PU).
q
Inferior
MI.
q
Acute
appendicitis.
Investigations:
o
S-amylase
should be ↑↑
>5x than normal (to rule out acute cholecystitis & PU).
o
CT
scan: most valuable
technique.
o
US.
o
MRI.
o
APACHE
II score:
·
(Acute Physiology,
Age, Chronic Health Evaluation): used to
grade severity.
o
ERCP:
sometimes preformed.
Complications:
Other
complications:
õ
Recurrent
attacks.
õ
Pancreatic
abscess: circumscribed intra-abdominal collections of pus, near
pancreas.
õ
Paralytic ileus.
treatment:
Ø
Nasogastric
suction à
↓ Vomiting & abdominal distention.
Ø
Treat
shock + fluid replacement.
Ø
Analgesia.
Ø
PAF
inhibitors.
Ø
If
infection
à
Treat it.
Ø
If pancreatic abscess
à
Surgical drainage.
Ø
If severe necrosis
à
Surgical drainage.
Ø
If pseudocyst à
Conservative treatment (aspiration
+ follow-up by US). If fails
à
Surgical drainage.
Prognosis:
Mortality rate: 1% in
mild cases – 50% in severe cases.
written
by:
Khalid Bin Yaroof. FMHS, UAE University.
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