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Pancreatitis

 

Types:-

  1. Acute pancreatitis
  2. Acute relapsing pancreatitis 
  3. Chronic pancreatitis
  4. Chronic relapsing pancreatitis
  • In acute relapsing pancreatitis there is a necrosis of pancreatic tisssue, which may differ in degree& clinical condition is acute.
  • If patient is settled after attack there is no structural & functional deformity of gland i.e. pancreas return to normal.
  • In acute relapsing pancreatitis, there is repeated episode of acute pancreatitis.
  • In chronic & chronic relapsing pancreatitis there is low & progressive destruction of tissue.
  • The area of destruction is relaxed by fibrotic tissue. As time passes, this fibrous tissue extensively result in functional failure of pancreas.

Etiological Factors

  • Gall stones
  • Some infection, trauma to biliary system 
  • Cholecystitis
  • Alcohol
Clinical features

  • Both sexes are equally effected.
  • The episode of pancreatitis is mostly followed by heavy meal / alcohol.
  • Pain initially starts from epigastricradiating to back & intensity of pain is severe, it is unbearable.
  • Patient gets relief from pain when he is in sitting position / bended forward.
  • Nausea & vomiting is a constant reflex of gastric irritation.
  • Cullen's sign ( Ecchymosis) - It is described as discoloration of umbilicus(bluish) due to massive hemorrhage from pancreas.
  • Gray turner's sign- It is described as discoloration of flank region due to hemorrhage of pancreas.
  • Tenderness of abdominal muscles.
  • Rebound tenderness
  • Sign of peritonitis
  • Gardening & rigidity of anterior abdominal muscles.
  • Sign of shock due to massive internal hemorrhage.

Investigation

  • Serum Amylase level is higher (80-160 Somagyi units), the increase in amylase level isn't proportional to severity of pancreatitis. But some conclusions regarding it's value started from degree of increase. 
  • if serum amylase level is higher than 1000Somagyi units , it usually indicates pancreatitis with biliary tract diaseases.
  • Serum amylase level between 200-500 Somagyi units often indicates only pancreatitis.
  • If Serum amylase - Serum creatinine ratio is higher than 5 then it indicates pancreatitis.
  • X-ray
  • USG
  • ERCP
  • History of alcohol
Treatment

  • Antibiotics
  • Digestive enzymes
  • Biliary tract disease treatment
  • Advice to avoid alchol
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