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Pancreatitis

QuestionAnswer
Patho Autodigestion of pancreas by its own enzymes due to obstruction or injury, leading to inflammation & necrosis.
Causes Gallstones, chronic ETOH use, trauma, ERCP, drugs (thiazides), hypertriglyceridemia.
Early S/S Severe epigastric/LUQ pain radiating to back, worse supine, relieved by sitting forward/fetal position.
Late S/S Jaundice, clay-colored stools (obstructive), Cullen's sign, Turner's sign (retroperitoneal bleed).
Systemic Effects (SIRS) Third-spacing, ascites, hypovolemia, ARDS, pleural effusions, hypocalcemia, shock.
Hypocalcemia in Pancreatitis Free fatty acids from lipase action bind calcium, forming "soap." Causes tetany, +Chvostek/Trousseau.
Labs ↑Lipase (most specific), ↑Amylase, ↑Trypsin/Elastase. ↓Ca++, ↑Glucose. Thrombocytopenia late.
Imaging CT abdomen is gold standard. ERCP can diagnose & treat biliary obstruction.
Treatment NPO, NG suction, IV fluids, pain control (Dilaudid/Morphine, avoid Demerol), bowel rest.
Nutrition Start with enteral (jejunal) feeding if needed. Avoid TPN unless necessary. Advance to low-fat diet.
Complications Pseudocyst, pancreatic necrosis, infection, ARDS, DIC, multi-organ failure, chronic pancreatitis.
Cullen's Sign Periumbilical ecchymosis indicating retroperitoneal hemorrhage in severe pancreatitis.
Turner's Sign Flank ecchymosis indicating retroperitoneal hemorrhage in severe pancreatitis.
Pancreatic Enzymes Exocrine: Amylase (carbs), Lipase (fats), Trypsin/Elastase (proteins). Autodigestion causes damage.
Endocrine Function Produces Insulin (↓glucose), Glucagon (↑glucose), Somatostatin (regulates both).
Created by: Wasurenboh
 

 



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