PANCREAS

PANCREAS

 large gland behind the stomach and close to the duodenum

 secretes digestive enzymes into the small intestine through a tube called
the pancreatic duct
 releases the hormones insulin and glucagon into the bloodstream

PANCREATITIS

 Inflammation of the pancreas.

 Characterized by release of pancreatic enzymes into the tissue of the pancreas itself leading to hemorrhage and
necrosis.

TWO TYPES:

Acute Pancreatitis
 About 80,000 cases occur in the United States each year
 more often in men than women

Chronic Pancreatitis

CAUSES:

The most common causes of pancreatitis, are as follows :

 Western countries - chronic alcoholism and gallstones accounting for more than 85% of all cases
 Eastern countries – gallstones
 Children – trauma
 Adolescents and young adults - mumps

I - idiopathic
G - gallstone
E – ethanol (alcohol)
T - trauma
S - steroids
M - mumps
A - autoimmune disease
S – scorpion sting
H – hypercalcemia, hyperlipidemia/hypertriglyceridemia and hypothermia
E - ERCP
D - drugs

SIGNS AND SYMPTOMS

1. Abrupt onset of severe epigastric and LUQ pain radiating to the back
2. Nausea, vomiting diarrhea and loss of appetite; Fever/chills
3. Decreased bowel sounds with abdominal distention and rigidity
4. Tachycardia; hypotension ; cold and clammy skin
5. Positive turner’s and cullen’s sign
PATHOPHYSIOLOGY
 DIAGNOSTIC TEST

Abdominal Ultrasound

-The sound waves bounce off the pancreas, gallbladder, liver, and other organs, and their echoes make electrical
impulses that create a picture—called a sonogram—on a video monitor. If gallstones are causing inflammation, the
sound waves will also bounce off them, showing their location.

CT Scan

-The test may show gallstones and the extent of damage to the pancreas.

• Intrapancreatic
• Peripancreatic / extrapancreatic
• Locoregional

Magnetic Resonance Imaging (MRI)

-After being lightly sedated, the patient lies in a cylinder-like tube for the test. The technician injects dye into the
patient’s veins that helps show the pancreas, gallbladder, and pancreatic and bile ducts.

Endoscopic Retrograde Cholangiopancreatography (ERCP)

- A procedure that can be used to remove stones from the bile duct if your pancreatitis is due to gallstones or
other problems with the bile or pancreatic ducts

FIRST LINE OF TREATMENT

Pain control
 Meperedine 150 mg PO q3 – 4 hours
Bowel rest
 NPO
 IV Fluids for dehydration
Nutritional support
 TPN
Antibiotics
 Ampicillin
 Imipenem-cilastatin (Primaxin)
 Cefuroxime (Zinacef)
 Ceftazidime (Ceptaz) plus
 Amikacin (Amikin) plus
 Metronidazole (Flagyl)

To decrease pancreatic secretion

 Nasogastric suction
 Histamine H2-receptor blocker
 Atropine (Urised)
 Glucagon
 Somatostatin (Zecnil)
 Calcitonin (Calcimar)

SURGERY

 infected pancreatic necrosis

 diagnostic uncertainty
 complications

 Minimally invasive management

 Conventional management
 Closed management
 Open management