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Acute interstitial oedematous pancreatitis (IOP)
Where there is diffuse or localised enlargement of the pancreas due to interstitial oedema together with peripancreatic inflammation and fluid. This type usually presents with a mild attack.
Organ complications in acute pancreatitis
1. Gastric outlet dysfunction
2.Splenic/portal vein thrombosis
3.Intestinal necrosis
Drug causing acute pancreatitis
Anti-tiberculous
ARVS
Antibiotics
Thiazide diuretics
Rx of gallsrone pancreatitis
Elective cholecystectomy 1-4 weeks after the acute attack is strongly recommended to pre-empt a possible second attack. Earlier intervention is sometimes required in the small group of patients with progressive jaundice with or without
associated cholangitis.
SIRS is defined by the presence of 2 or more of the following criteria
• Heart rate > 90 beats per minute
•Core temperature <36°C or >38°C
• White blood cell count < 4000 or >12000/mm³
•Respirations >20/min or PCO2 <32mmHg
Enzyme that coverts trypsinogen to active form and its function
Brush border enzyme enterokinase when pancreatic juice enters the duodenum.
Trypsin converts pro-enzymes in pancreatic juice into active enzymes as well as further trypsinogen into trypsin in an
autocatalytic chain reaction
activates phospholipase A2 which forms lysolecithin from lecithin, a normal
constituent of bile
Indications for pylorus preserving pancreatico-duodenectomy
If resection of the head is required
Main causes of acute pancreatitis
Alcohol
Gallstones
Idiopathic
Misc
Trauma causing acute pancreatitis
Blunt
Post-op
Important bloods to do in pancreatits
FBC
U and E
Blood gas
Liver function
INR
Ca and lipid profile
A pancreatic pseudocyst (IOP)
Encapsulated collection of fluid with a well-defined inflammatory wall, outside the pancreas with little or no necrosis.
Usually >4 weeks from the onset of IOP and associated with duct disruption.
Glucagon
Glucagon mobilises glucose, fatty
acids and amino acids into the bloodstream
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