Pancreatitis

Pancreatitis




This term includes two diseases that differ in symptoms, course, pathogenesis, treatment and prognosis.
Acute pancreatitis - a serious disease of pancreatic parenchyma, where it comes to uncontrolled activation of pancreatic enzymes and consequently to damages of the gland and the surrounding tissues. Untreated can lead to death. The most common causes of disease are biliary obstruction, alcohol abuse or trauma. For less common reasons for sickness can include regurgitation of duodenal contents into the digestive tract, mumps, diagnostic tests, metabolic disorders and the lack of obvious cause (idiopathic pancreatitis). Damaged cells release proteolytic enzymes that cause inflammation (pancreatitis slight edema) - in some cases: abscess and tissue necrosis (extending along the lumbar muscles). There is a whole range of systemic complications, including shock and death.


Symptoms



The lumbar pain, sometimes radiating to the abdomen and chest disorders of the gastrointestinal tract (vomiting, nausea), fever, yellowing of the eyes, painful abdominal palpation, symptoms of shock (low blood pressure, increased pulse rate, tachypnea, dyspnea, anuria, disseminated intravascular coagulation, impaired consciousness, Cullen sign (ecchymosis around the umbilicus).

Diagnosis involves blood tests (leukocytosis, hyperbilirubinemia, elevation of liver transaminases, amylase threefold increase in blood - mostly pancreatic isoenzyme, high lipase activity - the best diagnostic test, increased CRP - high values indicate pancreatic necrosis), ultrasound (inflammatory infiltration, seizure borders, enlarged prostate, fluid), CT with contrast (visibility of the inflammatory foci and necrotic), ERCP (diagnostic and treatment - allows for removal of gallstones from the bile ducts), X-ray of the abdomen (a symptom of the loop on guard - distension of one loop of the small intestine) .

The procedure involves conservative treatment - pethidine (analgesic, relaxant), absolute fasting (with the possible feeding by naso-intestinal tube, especially PV), control of water and electrolyte (potassium, sodium, calcium), proton pump inhibitors, aprotinin, prophylactic antibiotic therapy, oxygen therapy. In case of complications, surgery should be performed (infection of necrotic pancreatic parenchyma can cause multiple organ failure and collapse, the abscess may be punctured to the intestines or peritoneal cavity).

Chronic pancreatitis - chronic inflammation of pancreatic parenchyma, which leads to fibrosis and glandular atrophy. As a result, it comes to impaired excretory function of the pancreas. The most common cause is alcoholism, others are less frequent (e.g. hypercalcemia, chronic renal failure, poisoning phenacetin). It is divided into calcifying inflammation (deposits in the parenchyma and bile ducts) and obstructive (problems within the pancreatic duct).


Symptoms



Recurrent abdominal pain, vomiting, weight loss, fatty diarrhea, episodic jaundice. The disease can lead to a lot of complications (abscesses, peritonitis, renal, and endocrine organ outside).
The examination of choice is computed tomography (calcifications, deposits, cysts, enlargement of the pancreatic head), it is helpful to use ultrasound, ERCP, EUS, MRCP.

Treatment includes diet (calorie, protein, many small meals throughout the day), a ban on drinking alcohol (absolute), use of pancreatic enzymes, supplementation of fat soluble vitamins, analgesic treatment. When the cause is narrowing of the pancreatic duct or the presence of deposits, it should be performed endoscopic procedures to remove the changes. In some cases, surgery is indicated (unsuccessful endoscopic treatment, fistula, symptomatic cysts, severe pain, suspicion of neoplastic processes, the need for foundation drainage or resection).

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Risks of Having an Intraoperative Cholangiogram

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Some risks of having an intraoperative cholangiogram. Infection and bleeding. Inflammation of the pancreas (pancreatitis). Damage to the common bile duct. Allergic reaction to the contrast dye.

Impacted Minor Papilla Stone

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Clinical video case: a 37 years old came with recurrent episodes of pancreatitis. CT-Images showed multiple parenchymal calcifications at head & uncinate process with a calcification on medial wall...

Laparoscopic View: Acute Edematous Pancreatitis

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Acute pancreatitis is the leading cause of gastrointestinal-related hospitalization in the United States, and its frequency continues to rise in the United States and worldwide. The severity of the disease...

SSAT 2023 - Robotic Pancreaticoduodenectomy for...

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Video lecture on pancreaticoduodenectomy delivered during SSAT 2023.

Pancreatic Gastrostomy

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Video case: EUS-guided drainage of the pancreatic duct is a safe, feasible alternative to endoscopic retrograde drainage when the papilla cannot be reached endoscopically or catheterized. 

EUS with Biopsy of the Pancreatic Cyst Using...

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This video presents a case of a 59 years old female who suffered from recurrente acute pancreatitis since 2012.   

ERCP + Pancreatic Sphincterotomy and Stone Extraction

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This video presents a case of 67 years old male who suffered from epigastric pain and weight loss in January 2019. Ct SCAN & MRI showed chronic pancreatitis with calcifications. 1 session of ESWL...

Laparoscopic Trans-Gastric Necrosectomy

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Laparoscopic trans-gastric necrosectomy for a infected WON with gastric fistulization. It is a novel, minimally invasive technique for the management of pancreatic necrosis that allows for debridement...

Endoscopic Ultrasound Guided FNB for Hilar Lymph...

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A large liver hilar lymph node FNB was taken through pancreatic parenchyma because the lymph node could not be accessed by another site, there is a low risk of pancreatitis induced by this approach.

Surgical Management of Pancreatitis

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Presented by Syed A. Ahmad at the "SAGES/AAST/ASCRS/SSAT Acute Care Symposium: Are you a Good Acute Care Surgeon? Improving outcomes and Reducing Hospital Mortality" session during the SAGES...

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