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GERARD P. PERLAS MD
FPCP,FPSG,FPSDE
MCU FDTMF HOSPITAL
ETIOLOGY
Alcohol
Biliary
Active enzymes
proteolysis
edema
hemorrhage
Vascular injury
Bradykinin, Histamine
vasodilatation
inc. vascular permeability
edema
Clinical Features
Acute onset of Upper abdominal
pain lesser by knee-chest position,
w/ radiation to the back
vomiting
Physical examination
Distressed,
anxious
Tachycardia
Fever
Shock may be present
Jaundice
Abdominal tenderness, rigidity
Cullens sign
Grey Turners sign
Laboratory Tests:
Amylase
85-100%
sensitivity
3 fold rise is diagnostic
Goes down in 48-72 hrs.
perforation
Biliary tract dse
Ruptured viscus
Peritonitis
Ruptured ectopic pregnancy
Pancreatic psudocyst
Diabetic ketoacidosis
Serum Lipase
More
Laboratory Tests
Leukocytosis
Hyperglycemia
Hypocalcemia
Hyperbilirubinemia
Hypoalbuminemia
High
LDH
hypoxemia
Radiologic Studies
Plain abdominal Xrays
localized
Upper GI series
Displacement
of the stomach by a
retroperitoneal mass
Widening of the duodenal C-loop
Ultrasound of Pancreas
Enlarged
pancreas
Pseudocyst
To rule out mass lesion Pancreatic
CA
CT scan
Most
sensitive test
Pancreatic necrosis
Differential Diagnoses
perforated
criteria
Acute Physiology and chronic health
evaluation (APACHE) score > 12
Obesity
BP < 90 mmHg or
CAR > 130 beats/min
PO2 < 60 mmHg
Oliguria
> creatinine
Metabolic Indicators
Serum
And/or Local
Complications
Necrosis
Abscess
Pseudocyst
Fluid
resuscitation
Meperidine 50 100 mg iv q 3-4 hrs
Prognosis is Excellent
Fluid resuscutation
O2 inhalation for hypoxemia
Inotropics for Shock
Correct electrolytes
Antibiotics Imipenem
CT Scan
Parenteral Nutrition
10% Mortality rate
Surgery
Pancreatic
Abscess
Pseudocyst