PANCREAS Flashcards
(21 cards)
Cl/f acute pancreatitis
Upper abdo pain
Radiates to back
Relieved on bending forward
Vomitting
Tachypnea
High fever
Grey sign
Cullen sign
Fox sign
Oliguria
Features of shock
Jaundice
Guarding
Rigidity
Tenderness
Rebound tenderness
Paralytic ileus
Pleural effusion
Metabolic Changes acute pancreatitis
Hypovolemia
Hypocalcemia
Hypoalbuminemia
Hypochloremic met. Alkalosis
Hyperglycemia
Hyperbilirubinemia
HyperTGLemia
Methemalbuminemia
Investigations for acute pancreatitis
S. Amylase >1000 somogyi units
ACR >6
S.Lipase
S.lactescence - most specific for alcohol panc
S.Trypsin
Trypsinogen activating factor
LFT
blood urea, creatinine
Blood glucose
Hypocalcemia (worst prognosis)
Hemogram
Arterial po2 pco2
X-ray
Spirac CECT (gold std.)
Radio features of acute panc
X-RAY
sentinel loop - dilated proximal small bowel
Colon cut off sign
Renal halo sign
Duodenal air fluid level
Psoas shadow obliteration
Localised ggo
SPIRAL CT
edema
Fluid collection
Necrosis
Altered fat
Bowel distension
Mesenteric edema
APACHE II for acute pancreatitis
TAMPERS CHange With Glass
Temp (rectal)
Age
MAP
ph (arterial)
Exhaled pco2
Resp rate
S. Sodium
S. Creatinine
Hct
WBC count
GCS
Scoring systems for acute pancreatitis
Apache II
Ranson’s prognostic criteria
Glasgow Imrie prognostic criteria
Conservative mx acute pancreatitis
PANCREAS
Pain mx - pethidine
Plasma - in h’ge
Abx
Anticholinergics - reduce sphincter pressure
Nasogastric aspiration
Nasojejunal tube
Nutritional support TPN
Calcium gluconate for hypocalcemia
Central line
Rehydration - 250 - 400ml/h
Ranitidine for stress ulcers
Resp support
Endotracheal intubation
Electrolyte
Antacids
SWAN GANZ catheter
Somatostatin - OCTREOTIDE for dec secretion
BEGERS lavage
Done after initial sx
CONTINUOUS CLOSED PERITONEAL LAVAGE of pancreatic bed & lesser sac w 10-12 l of NS uisng multiple tubes until returning fluid is clear
Complications acute pancreatitis
Shock & hypovolemia
ARF
Pleural effusion
ARDS & resp failure
Hypocalcemia
Chronic pancreatitis
Pancreatic ascites
Colonic stricture
DIC
Abdo compartment
Acute pancreatic pseudocyst
Pancreatic necrosis/ WON
pancreatic pseudoaneurysm
BAID Test
In pseudocyst of pancreas
Stomach stretched towards abdo wall, so ryles tube passed is felt p/a
Barium meal finding of pseudocyst
WIDENED VERTEBRO-GASTRIC ANGLE
Operative procedure for pseudocyst
JURASZ procedure
Aka
Cystogastrostomy
TIGAR-O classification
Risk factor classification for chronic pancreatitis
Toxic - drug, alcohol, dietary, tobacco
Idiopathic
Genetic mutation - CFTR, SPINK 1 gene
Autoimmune - primary, Sjogren, crohns
Recurrent & severe acute attacks
Obstructive - annular pancreas , divisum, ductal stone, stenotic papilla, etc
TIGAR-O Classification
Risk factor classification for chronic pancreatitis
Toxic - alcohol, drug, tobacco, dietary
Idiopathic
Genetic - CFTR, SPINK - 1
Autoimmune
Recurrent & severe acute attacks
Obstructive - annular panc, divisum, ductal stones, stenotic papilla…
Theories for pathogenesis of chronic pancreatitis
- Oxidative stress theory
- Toxic metabolic theory
- Necrosis - fibrosis theory
- Genetic defect theory
- Sentinel acute pancreatitic event theory
Pathology chronic pancreatitis
Atrophy of acini
Hyperplasia of ductal epithelium
Strictures in duct
Ductal dilatation
Ductular metaplasia
Interlobular fibrosis
Calcifications
Initially, exocrine insuff.
Later, endocrine insuff.
Cl/f Chronic pancreatitis
Epigastric pain - radiates to back
Type A, Type B
Exo deficiency
Endo deficiency
Mild jaundice
Mass p/a
MALLET GUYS SIGN
MALLET GUYS SIGN
On right knee chest position, bowel shifts to right and tenderness can be evoked on palpation in left hypochondrium
Investigations chronic pancreatitis
CT abdomen
ERCP - CHAIN OF LAKE app.
MRCP
EUS (ROSEMONT CRITERIA)
Secretin - CCK Test (gold std)
Pancreolauryl test
X ray
LFT
Endoscopic techniques for chronic pancreatitis
Pancreatic ductal sphincterotomy
Main ductal stone extraction using dormia basket
Main ductal stenting
Stricture dilatation
ESWL of main ductal stone
Surgeries for chronic pancreatitis
Partington rochelle
Puestow’s
Longitudinal pancreaticojejunostomy w freys procedure
Beger’s procedure
Total pancreatectomy
Child’s operation
Duval procedure
Triple anastomosis
