08-07-2017, 10:07 PM
M.C.C. is Alcohol Abuse. 2nd M.C.C is Gallstone and 3rd M.C.C is Endoscopic Retograde Cholangipancreatography (E.R.C.P.).
Criteria that adversely affect the survival of Pts w/ Acute Pancreatitis were developed by Ranson and Imrie are divide into 2 groups:
Findings at admission or diagnosis (F.a.A.o.Dx.) , and Finding in the initial 48 hours. (F.i.i 48 h)
F.a.A.o.Dx = Over 55 years old, Leukocytosis above 16,000/uL; Hyperglycemia above 200 mg/dL; Serum Lactate Dehydrogenase above 400 IU/L
F.a.A.o.Dx = and Serum Aspartate Aminotransferase above 250 IU/L. Amylase levels are not correlated w/the severity of the disease.
Although triglycerides, bilirubin and trypsin are ↑ in some case of Acute Pancreatitis, these factors DO NOT influence survival.
↑Serum Amylase Level (around thousands) confirm the Dx. Type I and V hyperlipoproteinemias predispone to A.P.
X-ray Sign = SENTINENTAL - LOOP (Air-Filled Loop of Small Bowel in the L.U.Q.). Epigastric pain radiating to the back.
Severe cases destroy large parts of both the endocrine and exocrine pancreas.
Destruction of the exocrine pancreas can release many enzymatically or physiologically active substance that can cause local or distant effects
In severe cases pulmonary complications include Pleural effusion secondary to chemical irritation of the diaphragm and also ARDS.
A.R.D.S.
*** Adult respiratory distress syndrome can occur in Acute Pancreatitis Tx include Positive end expiratory pressure (PEEP)
*** Bilateral infiltrates + Air Bronchograms + Minimal Pleural Effusions. We can see DIFFUSE ALVEOLAR DAMAGE (Sepsis, Burn Pt)
*** Pt. with this problem have REDUCED LUNG COMPLIANCE, LOW PCO2.
*** In diffuse alverolar damage we will see hyaline membranes within the alveolar cavities
*** Cirteria for Dx:
*** 1) PCWP less than 18 mmHg. (normal value) favors Dx of A.R.D.S over Cardiogenic Pulmonary Edema
*** 2) PaO2 to FiO2 ratio of 200 mmHg or Less, regardless of the level of PEEP.
*** 3) Diffuse, bilateral infiltrates on Chest X-ray.
*** Can we see in Acute Pancreatitis because the reduction of the CIRCULATING PHOSPHOLIPASE.
*** In neonates can be produce by lacking of surfactant. To prevent this we give little glucocorticoids to the mother.
Criteria that adversely affect the survival of Pts w/ Acute Pancreatitis were developed by Ranson and Imrie are divide into 2 groups:
Findings at admission or diagnosis (F.a.A.o.Dx.) , and Finding in the initial 48 hours. (F.i.i 48 h)
F.a.A.o.Dx = Over 55 years old, Leukocytosis above 16,000/uL; Hyperglycemia above 200 mg/dL; Serum Lactate Dehydrogenase above 400 IU/L
F.a.A.o.Dx = and Serum Aspartate Aminotransferase above 250 IU/L. Amylase levels are not correlated w/the severity of the disease.
Although triglycerides, bilirubin and trypsin are ↑ in some case of Acute Pancreatitis, these factors DO NOT influence survival.
↑Serum Amylase Level (around thousands) confirm the Dx. Type I and V hyperlipoproteinemias predispone to A.P.
X-ray Sign = SENTINENTAL - LOOP (Air-Filled Loop of Small Bowel in the L.U.Q.). Epigastric pain radiating to the back.
Severe cases destroy large parts of both the endocrine and exocrine pancreas.
Destruction of the exocrine pancreas can release many enzymatically or physiologically active substance that can cause local or distant effects
In severe cases pulmonary complications include Pleural effusion secondary to chemical irritation of the diaphragm and also ARDS.
A.R.D.S.
*** Adult respiratory distress syndrome can occur in Acute Pancreatitis Tx include Positive end expiratory pressure (PEEP)
*** Bilateral infiltrates + Air Bronchograms + Minimal Pleural Effusions. We can see DIFFUSE ALVEOLAR DAMAGE (Sepsis, Burn Pt)
*** Pt. with this problem have REDUCED LUNG COMPLIANCE, LOW PCO2.
*** In diffuse alverolar damage we will see hyaline membranes within the alveolar cavities
*** Cirteria for Dx:
*** 1) PCWP less than 18 mmHg. (normal value) favors Dx of A.R.D.S over Cardiogenic Pulmonary Edema
*** 2) PaO2 to FiO2 ratio of 200 mmHg or Less, regardless of the level of PEEP.
*** 3) Diffuse, bilateral infiltrates on Chest X-ray.
*** Can we see in Acute Pancreatitis because the reduction of the CIRCULATING PHOSPHOLIPASE.
*** In neonates can be produce by lacking of surfactant. To prevent this we give little glucocorticoids to the mother.