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By ULY CLINIC

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Acute Pancreatitis

 

Introduction

 

Pancreatitis is an inflammatory process in which pancreatic enzymes auto digest the pancreatic gland leading to functional and morphologic loss of the gland.

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Acute pancreatitis  is due to sudden inflammation of the pancreas due to pancreatic enzymes auto digestion. Common risk factors which trigger the acute episode are presence of gallstones and alcohol intake. 

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 Diagnostic Criteria  

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  • Severe, unremitting epigastric pain, radiating to the back 

  • Nausea and vomiting

  • Signs of shock may be present

  • Ileus is also common

  • Local complications: inflammatory mass, obstructive jaundice, gastric outlet obstruction

  • Systemic complication: sepsis, acute respiratory distress syndrome, acute renal failure PLUS 

  • Raised Serum levels for  lipase and  amylase  greater than 3 times the upper limit of normal ULN and, 

  • Radiological evidence of inflamed and/or necrotizing pancreatitis.   

 

Pharmacological Treatment

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  • Principles of management include supportive therapies. 

  • Intravascular volume expansion (colloids/crystalloid)

  • Opiates analgesia usually required (follow WHO analgesic ladder)

  • Enteral feeding, (only in absence of illeus) start within 72 hours

  • Correction of electrolytes and metabolic deficit accordingly

  • Give Ceftriaxone (IV) 1 g 12 hourly AND Metronidazole (IV) 500mg 8 hourly for 7 days 

  • ERCP + Sphincterotomy may be needed.

 

Refer unstable cases to next level of care with adequate expertise and facility.

 

Chronic Pancreatitis

 

Introduction

 

Chronic pancreatitis is long-term (chronic) inflammation of the pancreas that leads to permanent loss of function and morphology of the gland. 

 

Diagnostic Criteria

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  • Chronic upper abdominal pain associated with nausea, vomiting and loss of appetite.

  • Malabsorption diarrhoea

  • Weight loss

  • Diabetes PLUS

  • Radiological evidence pancreatic calcification and atrophy. 

 

Pharmacological Treatment

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Supportive therapies with 

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  • Tramadol (PO) 50mg 12 hourly as need for chronic pain relief.

 PLUS

  • Pancreatin (PO) 1–3 tablet once daily to supplement digestive enzyme and improve food absorption.

PLUS

  • Metformin (PO) 500mg 12 hourly 

OR

  • Insulin 0.5mg/kg/day in two divided doses (SC) for control of hyperglycaemia.  

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Updated on, 2.11.2020

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References

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1. STG

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