CHRONIC PANCREATITIS diagnosis & tratment

4.1 DIAGNOSIS

Diagnosis is difficult and is aided by :

*  Determination  of  serum or urinary amylase but  may  not  be

   fruitful.

*  X-ray may show pancreatic calcification

*  Ultrasound of upper abdomen

A side to side pancreatic jejunostony is also a procedure for chronic pancreatic with obstruction of flow of pancreatic juice.

4.2 TREATMENT

Non-operative  management  is  tried  with  insulin  therapy  and

pancreatic digestive enzymes for diabetes and enzyme

There are a variety of operative procedure :

*  The  lateral pancreaticojejnostomy provides for the  entry  of

   pancreatic juice into the intestine.

*  Sphincterotomy may provide relief in soce cases.

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CHRONIC PANCREATITIS

CHRONIC PANCREATITIS

Typical patient is in thirties or early forties and may have-

*  History of alcoholism is present (70% in West)

*  Repeated attacks of acute pancreatitis in the past

Patient gives history of

*  Complains   of   repeated  attacks  of  pain  which   may   be

   intermittant or persistent and is located in the  epigastrium,

   but radiates to back and is often not relieved by analgesics.

There may be:

*  Anorexia

*  Weight loss

*  Nausea and vomitting may also occur

*  Diabetes and steatorrhoea

*  Pseudocysts are found on examination

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ACUTE PANCREATITIS Treatment

TREATMENT                           PRINCIPLES OF MANAGEMENT

                                          OF ACUTE PANCREATITIS

Food  is witheld and continous            * Nil by mouth and intra

aspiration of stomach  started              venous fluids

to minimise pancreatic                    * Nasogastric aspiration

secretions.                               * Broad-spectrum intra

*  Nil by mouth                             venous antibiotics

                                          * Intesnive care

*  Replacement of losses  of                - Fluid & electrolyte

   fluid and electrolyte  is                  management

   started intravenously                    - Treatment of hypo-

                                              calcaemia

*  Routine administration of                - Ventilatory support

   antibiotics and analgesic                - Rarely peritoneal

   are required                               lavage

                                          * Laparotomy and

*  Daily    monitoring    of                peritoneal toilet

   patient to asses

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Acute Pancreatitis Investigations 2

Deferential diagnosis

*  Biliary tract  disease

   and

*  Intestinal obstruction

*  Acute   and    chronic

   renal failure

 Prognosis

If  serum calcium values fall below 7.5mg/100 ml.,  it  generally

indicates a poor prognosis because of the extensive disease.

The other factors associated with poor progress are:

*  Age above 55 years

*  Blood glucose more than 200 mg

*  WBC more than 16000/mm

*  Fall in Haematocrit > 10% in 48 hours.

X-ray of abdomen shows:

*  "Sentinal loop" in upper jejunum

Oral  chlorocystography during an attack may show  biliary  tract

stones.

A CT Scan or ultrasound can also aid diagnosis

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Acute Pancreatitis Investigations 1

DIAGNOSIS                           INVESTIGATIONS IN SEVERE

                                          ACUTE PANCREATITIS

Estimation    of    serum                 * Haemoglobin estimation &

amylase  is  most   often                   white cell count

used    for    diagnosis.                 * Arterial blood gas

Serum  amylase over  1000                   estimations

units is diagnostic                       * Blood sugar

                                          * Serum electrolytes and

*  One  third  have  more                   urea

   than 500 units                         * Serum amylase

*  Another third patients                 * Liver function tests

   have  between 200  and                   (i.e. bilirubin,alkaline

   500 units                                phosphatase,lactate

                                            dehydrogenase (LDH),

Other  conditions in which                  tranaminases,serum

the serum amylase level is                  proteins)

elevated, include:                        * Serum calcium  and

                                            phosphate

*  Biliary tract  disease

   and

*  Intestinal obstruction

*  Acute   and    chronic

   renal failure

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