Acute and Chronic Pancreatitis PANCREAS Acute and Chronic Pancreatitis Ahmed Salam Lectures Medical Student “TSU” WWW.GREATASSIMPLEMEDICINE.COM

Definition: G.S.M MEDICAL LECTURES/Pancreatitis AHMED SALAM MD STUDENT Definition: The pancreas is a glandular organ in the digestive system and endocrine system of vertebrates. In humans, it is located in the abdominal cavity behind the stomach. It is an endocrine gland producing several important  hormones , including  insulin, glucagon, somatostatin, and pancreatic polypeptide which circulate in the blood. The pancreas is also a digestive organ, secreting pancreatic juice containing digestive enzymes that assist digestion and absorption of nutrients in the small intestine . These enzymes help to further break down the carbohydrates, proteins, and lipids in the chyme. WWW.GREATASSIMPLEMEDICINE.COM

Structure: G.S.M MEDICAL LECTURES/Pancreatitis AHMED SALAM MD STUDENT Structure: The pancreas is an  endocrine organ that lies in the upper left part of the abdomen. It is found behind the stomach .The pancreas is about 15 cm (6 in) long . consist of: head of pancreas. neck of pancreas.  body of pancreas. tail of pancreas. WWW.GREATASSIMPLEMEDICINE.COM

Acute pancreatitis: G.S.M MEDICAL LECTURES/Pancreatitis AHMED SALAM MD STUDENT Acute pancreatitis: Acute pancreatitis or acute pancreatic necrosis is a sudden inflammation of the pancreas. It can have severe complications and high mortality despite treatment. While mild cases are often successfully treated with conservative measures, such as fasting and aggressive intravenous fluid rehydration, severe cases may require admission to the intensive care unit or even surgery to deal with complications of the disease process. WWW.GREATASSIMPLEMEDICINE.COM

Pathophysiology : G.S.M MEDICAL LECTURES/Pancreatitis AHMED SALAM MD STUDENT Pathophysiology : The two types of acute pancreatitis are mild and severe, which are defined based on whether the predominant response to cell injury is inflammation (mild) or necrosis (severe). In mild pancreatitis, there is inflammation and edema of the pancreas. In severe pancreatitis, there is necrosis of the pancreas, and nearby organs may become injured. As part of the initial injury there is an extensive inflammatory response due to pancreatic cells synthesizing and secreting inflammatory mediators: primarily TNF-alpha and IL-1. A hallmark of acute pancreatitis is a manifestation of the inflammatory response, namely the recruitment of neutrophils to the pancreas. The inflammatory response leads to the secondary manifestations of pancreatitis: hypovolemia from capillary permeability, acute respiratory distress syndrome, disseminated intravascular coagulations, renal failure, cardiovascular failure, and gastrointestinal hemorrhage. WWW.GREATASSIMPLEMEDICINE.COM

Symptoms and signs: G.S.M MEDICAL LECTURES/Pancreatitis AHMED SALAM MD STUDENT Symptoms and signs: severe epigastric pain (upper abdominal pain) radiating to the back in 50% of cases nausea vomiting loss of appetite fever chills (shivering) hemodynamic instability, including shock tachycardia (rapid heartbeat) respiratory distress peritonitis hiccup WWW.GREATASSIMPLEMEDICINE.COM

Investigation: G.S.M MEDICAL LECTURES/Pancreatitis X-Ray. Ultrasound. AHMED SALAM MD STUDENT Investigation: X-Ray. Ultrasound. CT-Scan. Blood Investigation:  Full blood count Renal Function.  liver function, serum calcium, serum amylase and lipase. CRT. WWW.GREATASSIMPLEMEDICINE.COM

Management: Surgical intervention: G.S.M MEDICAL LECTURES/Pancreatitis AHMED SALAM MD STUDENT Management: Initial supportive care includes the following: Fluid resuscitation  Nutritional support Antibiotic: Antibiotics (usually of the imipenem class) should be used in any case of pancreatitis complicated by infected pancreatic necrosis but should not be given routinely for fever, especially early in the presentation. Antibiotic prophylaxis in severe pancreatitis is controversial; routine use of antibiotics as prophylaxis against infection in severe acute pancreatitis is not currently recommended. Surgical intervention: Gallstone pancreatitis : Cholecystectomy . WWW.GREATASSIMPLEMEDICINE.COM

“Necrosis” Acute pancreatitis G.S.M MEDICAL LECTURES/Pancreatitis AHMED SALAM MD STUDENT Acute pancreatitis “Necrosis” WWW.GREATASSIMPLEMEDICINE.COM

Chronic Pancreatitis: G.S.M MEDICAL LECTURES/Pancreatitis AHMED SALAM MD STUDENT Chronic Pancreatitis: Is a chronic inflammatory disease characterised by fibrosis and destruction of exocrine pancreatic tissue. Diabetes mellitus occurs in advanced cases because the islets of Langerhans are involved. WWW.GREATASSIMPLEMEDICINE.COM

Pathophysiology: G.S.M MEDICAL LECTURES/Pancreatitis AHMED SALAM MD STUDENT Pathophysiology: pancreatic fibrogenesis appears to be a typical response to injury. This involves a complex interplay of growth factors, cytokines,and chemokines, leading to deposition of extracellular matrix and fibroblast proliferation. In pancreatic injury, local expression and release of transforming growth factor beta (TGF-beta) stimulates the growth of cells of mesenchymal origin and enhances the synthesis of extracellular matrix proteins, such as collagens, fibronectin, and proteoglycans. WWW.GREATASSIMPLEMEDICINE.COM

Symptoms and signs: G.S.M MEDICAL LECTURES/Pancreatitis AHMED SALAM MD STUDENT Symptoms and signs: abdominal pain. steatorrhea.  weight loss. Malabsorption. The patient may also complain about pain related to their food intake, especially those meals containing a high percentage of fats and protein. WWW.GREATASSIMPLEMEDICINE.COM

Investigation: G.S.M MEDICAL LECTURES/Pancreatitis Ultrasound. X-Ray. AHMED SALAM MD STUDENT Investigation: Ultrasound. X-Ray. CT-Scan. MRCP. Endoscopic Ultrasound. WWW.GREATASSIMPLEMEDICINE.COM

Management: G.S.M MEDICAL LECTURES/Pancreatitis Alcohol Misuse. AHMED SALAM MD STUDENT Management: Alcohol Misuse. Pain Relief: NSAID. Malabsorption. WWW.GREATASSIMPLEMEDICINE.COM

Congenital abnormalities of pancreas: G.S.M MEDICAL LECTURES/Pancreatitis AHMED SALAM MD STUDENT Congenital abnormalities of pancreas: Pancreas divisum. Annular pancreas. Cystic fibrosis. WWW.GREATASSIMPLEMEDICINE.COM

Zollinger-Ellison syndrome: G.S.M MEDICAL LECTURES/Pancreatitis AHMED SALAM MD STUDENT Zollinger-Ellison syndrome: is a rare condition in which one or more tumors form in pancreas or the upper part of the small intestine (duodenum). These tumors, called gastrinomas , secrete large amounts of the hormone gastrin , which causes the stomach to produce too much acid. The excess acid then leads to peptic ulcers, as well as to diarrhea and other symptoms. WWW.GREATASSIMPLEMEDICINE.COM

Chronic Pancreatitis “Fibrosis” G.S.M MEDICAL LECTURES/Pancreatitis AHMED SALAM MD STUDENT Chronic Pancreatitis “Fibrosis” WWW.GREATASSIMPLEMEDICINE.COM