pancreatitis
pancreatitis
aetiology or contributing factors:
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others (<10%):
trauma - penetrating or blunt
pregnancy - any trimester, post-partum
post-ERCP
hypercalcaemia
penetrating peptic ulcer
drugs, toxins - oestrogen, phenformin, steroids, rifampicin, tetracyclines, isoniazid, thiazides,
frusemide / furosemide / Lasix, salicylates, indomethacin,
warfarin,
paracetamol (acetaminophen), ethacrynic acid
obstruction - neoplasms, diverticula, roundworms, benign
viral infection - mumps, hep A,B,C, IM, Coxsackie Gp B, Rubella, CMV, EBV, Varicella, Echo, Adenovirus
bacterial infection - typhoid, paratyphoid, scarlet fever, strept. food poisoning, dysentery, TB, mycoplasma, MAIS, legionella, leptospirosis, campylobacter
other infection - ascariasis, clonorchiasis
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cystic fibrosis
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clinical features:
mid-epigastric or LUQ pain:
usually constant, boring, often radiates to back as well as flanks, chest or lower abdomen
variable intensity
worse supine & relieved by sitting with trunk & knees flexed
nausea & vomiting are common
abdominal bloating due to GIT hypomotility frequent
examination:
epigastric tenderness
may have low grade fevers, tachycardia, and hypotension
10% have resp. symptoms due to atelectasis, pleural effusion (usually left sided) & rarely, ARDS
peritonitis is a late finding
rarely, haemorrhagic pancreatitis occurs which may cause Cullen sign & Grey Turner sign as bruising tracks to flanks & around umbilicus.
hypotension may result from fluid third-spacing, increased vascular permeability, vasodilatation, cardiac depression & vomiting.
investigation:
prognostic markers:
management:
90% recover with supportive care of “resting” the pancreas:
nil oral or clear fluids (some advocate NG tube but no evidence to support benefit)
IV fluid resuscitation to ensure urine output 100ml/h
unstable patients may require invasive monitoring
parenteral narcotics & antiemetics
if severe, IV imipenem decreases sepsis rate but not mortality
in biliary pancreatitis:
urgent decompression is indicated if there is persistent biliary obstruction
transient obstruction only, then elective cholecystectomy once inflammation subsides
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acute fluid collections are rarely symptomatic & frequently resolve spontaneously
laparatomy is indicated for haemorrhage control & abscess drainage
disposition:
home if:
mild alcoholic pancreatitis with no evidence of systemic complications and,
able to tolerate oral fluids, and,
pain is well controlled
follow up in 24-48hrs
otherwise, admit under general surgery unit.
ALL patients with pancreatitis due to biliary causes should be admitted.
high risk patients should be admitted to a hospital with ICU capabilities
pancreatitis.txt · Last modified: 2020/04/29 15:21 by gary1