DIAGNOSIS OF ACUTE
PANCREATITIS
1.Elevated serum amylase and lipase levels.
2.Serum lipase rises 4 to 8 hours from the onset of symptoms and normalizes within 7 to
14 days after treatment.
3.Serum amylase may be normal (in 10% of cases) for cases of acute or chronic
pancreatitis (depleted acinar cell mass) and hypertriglyceridemia.
Cbc : leukocytosis , anemia, hypocalcemia , hyperglycemia , elvate LDH and AST,
hypoxemia, Elevated urinary trypsinogen activation peptide
• Ultrasonography :
US is important in the evaluation ofthe gallbladder and the biliary tract to detect
possible gallstones and biliary obstruction.
• CT:is the best diagnostic test for the diagnosis of
acute pancreatitis. Contrast-enhanced CT is excellent for diagnosis of pancreatic
necrosis.
• detecting and assessing the severity of pancreatitis.
Treatment
• The aim of treatment is to treat and try to prevent the systemic
manifestations of the first phase and detect the occurrence of
local infection.
• Start with :
• NPO (no food)
• • IV hydration at very high volume (ringer solution)
• • Analgesia for mild pain NSAID for severe opoid
• • PPIs decrease pancreatic stimulation from acid entering the
duodenum
• If there is more than 30% necrosis on CT use antibiotic
imipenem
• Octerotid use to decrease secretion of pancreas
Treatment of Local Complications
• 1)For pancreatic pseducyst
• It is the most common complication of acute pancreatitis
• It look like cyst but without fibrotic wall .
• Diagnosis by CT
• If <6 cm observe
• If >6 cm a--- then antibiotic and drainge
• 2) surgical resction of necrotic material
INDICATIONS STERILE NECROSIS :
Surgery indicate in
1 – massive pancreases necrosis >50%
2- with progression of organ failure
infected necrosis :
When developed pseudocyst
Necrosectomy/ debridment
• Necrosectomy done by open route A longitudinal
midline incision allows the assessment of the
entire abdominal After the abdominal cavity is
opened, the gastrocolic and the duodenocolic
ligaments are divided close to the greater
curvature of the stomach, and the pancreas is
exposed.
1. Open packing
• The cavity is lined with a nonadherent
dressing and packed. The patient is re-
turned to the operating room every 48 hrs
for further debridement and repacking
until no further necrosis is evident. After
several reoperations, debridement may
sometimes be performed in sedation in the
ICU until healthy granulations appear.
Then, the abdomen can be closed over
drains, with or without lavage of the
2Planned, staged
relaparotomies with repeated
lavage
• Following the primary necrosectomy, planned
reoperations for repeated necrosectomies on an
every other day basis are performed until all
devitalized tissue has been removed,
granulation tissue has started to form, and the
surgeon is
convinced that the necrotizing process is
controlled.
3. Continuous lavage of the
lesser sac and retroperitoneum
• For closed postoperative local lavage, two or
more double-lumen Salem sump tubes (20-24
French) and single-lumen silicone rubber tubes
(28 to 32 French)
are inserted from each side, directed to the left
and right, and placed with the tip at the tail of the
pancreas, behind the descending colon, the
head of the gland, and
the ascending colon. The smaller lumen of the
Salem drains is used for the inflow
of the lavage and the larger lumen for the
outflow
4. Closed packing
• This technique follows the same principle as the continuous
postoperative lavage as it also ensures a continuing easy egress of
residual necrotic material postoperatively. After the necrotic tissue
has been removed and the cavity irrigated with saline, the residual
cavity is filled with multiple, large, gauzefilled Penrose drains as well
as closed-suction drains. This also packs the abscess cavity and by
this
controls minor bleedings. All drains must be brought out laterally to
ease drain-age. Drains can be removed successively after a
minimum of 7 days of continu-ous drainage. At the same time the
gauze packing must be gradually removed
which results in a slowly collapse of the cavity
