Pancreatitis (acute)

Diagnosis:

pain: - Very very severe.

- In upper abdomen and radiating to back.

- Pain is increased by movement and respiration.

- Pain is relieved by sitting and waist flexion.

Fever (37.5° - 39°) is common.

Nausea and vomiting.

Shock may be present in severe cases.

By examination:

Rigidity and guarding.

Rebound tenderness may be present.

Cullen sign → bluish coloration around umbilicus is seen after 2 hours from acute attack.

Grey-turner sign → as Cullen but in flanks.

Investigations:

Serum amylase and lipase.

Urine amylase.

U.S and C.T scan.

NB. → Serum amylase is elevated only in first day and falls due to clearance. So serum lipase is more specific. U.S and C.T is the best.

NB. → Acute pancreatitis is usually idiopathic but in 50% of cases the cause may be ascending gall stone biliary disease – alcoholism.

Treatment:

1-     Emergency treatment (the most important).

2-     Symptomatic treatment (colic – vomiting - ….).

3-     If hyperglycemia → insulin by blood glucose.

4-     Surgical interference.

5-     Instructions.

Emergenic treatment:

 Hospitalization – nasogastric suction – ryle – to reduce pain – correction of shock, dehydration, hypokalaemia by K amp. , hypoxia by O2 and hypocalcemia by calcium gluconate 10% solution (10 – 20 ml I.V – can be repeated every 4 hours).

Symptomatic treatment:

Vomiting      - plasil amp. Primperan amp.

-         Motinorm tab. 1x3.

-         Motilium tab. 1x3.

Pain – diclophenac sodium as olfen = oflam = voltaren 50 tab. 1x3 or amp. Or

 Pethidine.

NB. Morphine is avoided as it may cause spasm of sphincter of oddi.

Surgical interference:

-         Pancreatic abscess.

-         Pseudocyst.

-         Damaged part of pancreas (surgical resection).

Instructions:

-         Bed rest.

-         Oral feeding is started when -Normal serum amylase and lipase.

                                                -No pain or tenderness.