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4) Diagnostic etiologic
5) Diagnostic diferential
6) Principii de tratament
1) Definitie si incidenta
• Definitie = inflamatie acuta a pancreasului din
cauze variate
• Incidenta = 5 – 50 /100.000 locuitori
2) Diagnostic pozitiv
• Clinic
– DURERE (90%)
• Tipica = epig./hcd/bara – irad. post/tot abd., “cocos de pusca”
– VARSATURI (50%)
– ILEUS (30%)
Independent de
gravitatea PA
– SOC (10%), Mt. > 40%
– DISPNEE (15%), Mt. > 30%
– OLIGO/ANURIE (10-15%), Mt. 30-50%
– PA necrotica, “severa”
• La fel ca PA edematoasa tipic/atipic +
• SIRS – SOC, SDRA, IRenala
• Complicatii infectioase
• Alte complicatii (digestive, coagulare, neuropsihice,
cutanate)
3) Diagnostic de gravitate
• Clinic
– PA grava – prin SIRS (citokine)
• Cand? Imediat
• Circulator: soc
• Respirator: SDRA – dispnee (si pleurezie)
• Renal: IRenala fct (75%) / organica ? (25%)
Scor > 3 = PA
severa
3) Diagnostic de gravitate
*Ranson et al. Prognostic signs and the role of operative management in acute pancreatitis. Gynecol Obstetr 1974; 139: 69 – 81.
3) Diagnostic de gravitate
Scorul Glasgow modificat
*Blamey SL, Imrie CW, O'Neill J, Gilmour WH, Carter DC. Prognostic factors in acute pancreatitis. Gut. 1984 Dec;25(12):1340-6
3) Diagnostic de gravitate
• Imagistic
– CT +/- contrast > 48h (pt. constituire leziuni)
– Scor Baltasar
3) Diagnostic de gravitate
*Baltazar. Acute pancreatitis: Value of CT in establishing prognosis. Radiology 1990; 174: 331 – 336.
3) Diagnostic de gravitate
3) Diagnostic de gravitate
• In concluzie:
– PA edematoasa benigna (70 – 80%)
• Sectia “medicala”
PANCREATITA ACUTA
Tratament
6) Principii de tratament
• Monitorizare TA, AV, SO2, CVP prin CVC, diureza, …
• A jeun
• Nutritie
– Parenterala
– Enterala: mai bine, scade translocatia bacteriana (scade % de complicatii
infectioase, scade durata de spitalizare)
– Reluare alimentatie la 7 zile de durere absenta + lipaza < 3 x N, disparitie
voma, reluare tranzit; cu regim sarac in lipide
– Abces
• Radiologie interventionala
• Endoscopic
• Chirurgical
6) Principii de tratament
• Tratament etiologic
– PA alcoolica
• stop consum alcool, sevraj (benzodiazepine preventia DT)
– PA biliara severa
• + angiocolita (calcul inclavat), bilirubina >5 mg/dl - ERCP cu extractie de
calculi in 48h
• Colecistectomie inainte de externare, dupa remisiunea PA
– PA autoimuna:
• Corticoterapie ?