ACUTE PANCREATITIS Acute inflammation of pancreas is one of causes of acute abd.pain. It’s a serious condition that leads to death in 10% of cases.

AETIOLOGY 1.Bile duct stones. 50% 2.Excess alcohol intake. 20% 3.Trauma . 5% accidental,operative,ERCP. 4.Rare causes :viral,hyperparath,corticosteroid. 5.Idiopathic.

CLINICAL FEATURES SYMPTOMS 1.Severe agonizing upper abd. Pain radiated to back. 2.Vomting &retching. SIGNS May show hypovol. Shock,tinge of jaudice,cynosis.Patient sits leaning forward.mild tenderness &rigiditiy,bruising around umblicus(Cullen sign),& in the loin(Grey Turner sign) are rare late feature.upper abd. Swelling after 2-3 wk (pancreatic pseudocyst).

COMPLICATIONS SYSTEMIC 1.Shock loss of plasma or blood 2.ADRS 3.Renal failure 4.consumption coagulopathy 5.paralytic ileus.stress ulcer 6.tetany LOCAL 1.Pseudocyst 2.Abscess

DIFFERENTIAL DIAGNOSIS 1.Perforated peptic ulcer 2.Acute cholecystitis & biliary colic 3. Acute mesenteric vascular occlusion 4.leaking aortic aneurysm 5. Acute M.I

INVESTIGATIONS 1.Serum amylase elevate within few hours>1000 IU/dl. NR 100-300 2.Arterial blood gases 3.biochemical .bilirubin eleveted.hypocal.hypoprot.eleveted B.urea.hypergl. 4.blood picture .leacocytosis.elevated haematocrit 5.plain x-ray of abdomen shows dilated short segment of small intestine(sentinel loop).colon cut-off sign 6.U/S gall stone 7.CT very helpful shows enlargement of pancreas,oedema ,necrosis. 8.ECG &cardiac enzyme to exclude M.I

Ranson criteria

TREATMENT CONSERVATIVE Severe cases admitted to ICU.Treatment is supportive to body system.”R”regimen: 1.Relief of pain by pethidine with atropine 2.Replacement of the lost fluids by crystalloids,plasma even blood 3.Rest of pancreas &bowel by nil oral&NG suction.somatostatin 4.Respiratory support by oxygen mask,or mechanical ventilation 5.Resistance of infection by prophylactic antibiotic 6.Reassessment by ERCP 7.If vomiting is prolonged ,IV hyperalimentation SURGICAL 1.Doubtful diagnosis exploratory laparotomy 2.Drainge of pancreatic abscess ,or persistent pseudocyst 3.excision of necrotic tissue in severe necrotizing pancreatitis

PANCREATIC PSEUDOCYST NATURE collection of pancreatic secretion &inflammatory exudate within a lining of inflammatory tissue AETIOLOGY develops in 10% of cases of acute pancreatitis after 2-3 wk.nexet cause pancreatic trauma SITE lesser sac COMPLICATIONS infection ,haemorrhage,rupture CLINICAL FEATURES -Small painless discovered by u/s -Large cause discomfort ,upper abd. Swelling INVESTIGATIONS -Ba-meal forward displacement of stomach -U/S&CT TREATMENT 1.Most of cysts resolve spont. 2.persistant cyst .drained after 6wk to stomach or jejunam

PANCREATIC CARCINOMA Male>femle.Age 55-70.prognosis poor AETIOLOGY unkown.smoking,high protein,high fat food SPREAD direct CBD,LYMPH,BLOOD liver lung,Transperitoneal

CLINICAL FEATURES 1.CA of head painless obst. Jaundice,hepatomegally,palpable GB,anorexia &wt loss 2.CA of body &tail epigastric pain hepatomegally,anorexia &wt loss INVESTIGATONS 1.LFT elevated direct bil.&alk.ph.low prothombin 2.u/s dilated intra &extra hepatic duct,metastases 3.CT 4.ERCP

TREATMENT 1.Unfit for surgery endoscopic stent 2.Fit for surgery & operable Whipple operation 3.Inoperable tumor cholecystojejenostomy