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Ðề tài: Acute panceatisis

  1. #1
    phucla1987
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    Default Acute panceatisis

    Chủ Đề: Default Acute panceatisis

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    ►Ngày Gửi: 05-12-09 ►Đánh Giá: Sao

    What is the Pancreas:
    The pancreas is a vital gland that produces various enzymes and hormones.
    The name pancreas (Greek pan: all, kreas: flesh or meat) was used because the organ contains neither cartilage nor bone.




    Physiology
    Exocrine pancreatic secretion contains multiple of enzymes( trypsinogen, chymotrypsinogen, procarbocypolypeptidase, amylase, cholesterol esterase, phospholipase) to digest proteins, carbohydrates and fats.
    Endocrine pancreatic secretes insulin, glucagon and somatostatin directly into blood.

    Definition of acute panceatitis
    Acute pancreatitis is inflammation of the pancreas and peripancreatic tissue from activation of potent pancreatic enzymes within the pancreas, particularly trypsin.

    Pathology of acute pancreatitis:
    The pathologic changes of acute pancreatitis include parenchymal and peripancreatic fat necrosis and an associated inflammatory reaction.

    Etiologies of acute pancreatitis:
    Abuse of ethanol
    Biliary tract stones
    Drugs
    Endoscopic retrograde cholangiopancreatography
    Hypercalcemia
    Hypertriglyceridemia
    Idiopathic
    Infections
    Ischemia
    Parasites
    Postoperative
    Scorpion sting
    Trauma


    Symptoms of Pancreatitis:
    Abdominal pain, nausea, and vomiting (but pain does not decrease after vomitting) are the dominant symptoms of pancreatitis.
    Bowel sounds are usually diminished or absent.
    Mayo-Robson's point (+)
    Mallet Guy- Ton That Tung's point (+)
    Cullen's sign (+) (a faint blue discoloration around the umbilicus)



    Turner's sign (+) (blue-red-purple or green-brown discoloration of the flanks)



    Diagnosis
    Dual-phase (pancreatic protocol) CT scanning is useful in the initial evaluation of severe acute pancreatitis. The Ranson criteria may provide prognostic information.


    Ranson Criteria for Severity Assessment in Acute Pancreatitisa
    Alcoholic pancreatitis
    On admission
    Age >55 yr
    WBC count >16,000/mcL
    Blood glucose >200 mg/dL
    LDH >350 International Units/L
    AST >250 units/L
    During the first 48 hr of admission
    Fall in hematocrit >10%
    Serum calcium <8 mg/dL
    Base deficit >4.0 mEq/L
    Increase in blood urea >5 mg/dL
    Fluid sequestration >6 L
    Arterial PO2 <60 mm Hg



    Nonalcoholic pancreatitis
    On admission
    Age >70 yr
    WBC count >18,000/mcL
    Blood glucose >220 mg/dL
    LDH >400 International Units/L
    AST >440 units/L
    During the first 48 hr of admission
    Fall in hematocrit >10%
    Serum calcium <8 mg/dL
    Base deficit >5.0 mEq/L
    Increase in blood urea >2 mg/dL
    Fluid sequestration >6 L
    Arterial PO2 <60 mm Hg

    Complications of Acute Pancreatitis

    Local
    Necrosis
    Sterile
    Infected
    Organized
    Pancreatic fluid collections
    Pancreatic abscess
    Pancreatic pseudocyst
    Pain
    Rupture
    Hemorrhage
    Infection
    Obstruction of gastrointestinal tract (stomach, duodenum, colon)
    Pancreatic ascites
    Disruption of main pancreatic duct
    Leaking pseudocyst
    Involvement of contiguous organs by necrotizing pancreatitis
    Massive intraperitoneal hemorrhage
    Thrombosis of blood vessels (splenic vein, portal vein)
    Bowel infarction
    Obstructive jaundice
    Systemic
    Pulmonary
    Pleural effusion
    Atelectasis
    Mediastinal abscess
    Pneumonitis
    Adult respiratory distress syndrome
    Cardiovascular
    Hypotension
    Hypovolemia
    Sudden death
    Nonspecific ST-T changes in electrocardiogram simulating myocardial infarction
    Pericardial effusion
    Hematologic
    Disseminated intravascular coagulation
    Gastrointestinal hemorrhage
    Peptic ulcer disease
    Erosive gastritis
    Hemorrhagic pancreatic necrosis with erosion into major blood vessels
    Portal vein thrombosis, variceal hemorrhage
    Renal
    Oliguria
    Azotemia
    Renal artery and/or renal vein thrombosis
    Acute tubular necrosis
    Metabolic
    Hyperglycemia
    Hypertriglyceridemia
    Hypocalcemia
    Encephalopathy
    Sudden blindness (Purtscher's retinopathy)
    Central nervous system
    Psychosis
    Fat emboli
    Fat necrosis
    Subcutaneous tissues (erythematous nodules)
    Bone
    Miscellaneous (mediastinum, pleura, nervous system)

  2. #2
    skinnystorm-duyquang
    Guest

    Default


    become easy or not??? I don't know...

    The Washington Manual Gastroenterology 2008

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