Pancreatitis
Acute pancreatitis
Chronic pancreatitis – absence of continuing inflammation with irreversible changes.
Acute Pancreatitis
Acute abdominal pain with raised pancreatic enzyme.
Pathogenesis
Pancreatic necrosis
Associate with gall stone.
Autodigestion of pancreas.
Can be haemorrhage.
Oedema and exudates.
Acute Pancreatitis –clinical features
Abdominal pain – epigastrium or upper abdomen.
Severe pain with abdominal rigidity.
Nausea and vomiting.
Severe case – multisystem failure.
Acute Pancreatitis –Investigation
Increase serum amylase – 5 times than normal.
Abdominal xray.
Ultrasound.
Exploratory laparotomy might need.
Acute Pancreatitis – Treatment
Nasogastric suction might need
No feeding, only IV nutrition.
Analgesia.
No special treatment.
Acute Pancreatitis – Complication
Pancreatic abscesses – secondary infection.
Pseudocysts – usually not required treatment.
Chronic pancreatitis
Continuing inflammatory disease, irreversible morphological changes, permanent impairment of function.
Cause – alcohol >85% cases.
Fibrosis and calcification of pancreatic acinar.
Not reversible but will arrest.
Risk factors – smoking, low protein and high fat diet.
Chronic pancreatitis - clinical features
Pain – continuing episodes
Episodes might precipitated by heavy alcohol drink.
Steatorrhoea – reduced lipase.
Chronic pancreatitis - Investigation
Ultrasound
CT
Xray – calcification can be seen
Chronic pancreatitis - Treatment
Stop drinking
Analgesics
Surgery – case with severe pain.
Diabetes might need to treat.
Steatorrhoea – low fat diet.
Acute cholecystits
Inflammation of gallbladder.
Associated with gallstone.
Inflammation is sterile, but soon gut organisms cultured.
Can be mild
Can be severe with localized peritonitis.