Saturday, April 30, 2011

Treating pancreatitis

IT OCCURS SUDDENLY AND SUBSIDE IN FEW DAYS IF TREATS PROPERLY.
EACH YEAR ABOUT 210,000  PEOPLE IN THE US ARE ADMITTED TO THE HOSPITAL WITH ACUTE PANCREATITIS.

TREATMENT
The goals of communication of accent pancreatitis are to alleviate pancreatic inflammation and to correct the inexplicit cause. Treatment commonly requires hospitalisation for at small a few days."Treatment of accent pancreatitis"

BED REST
SUPPORTIVE INTRAVENOUS THERAPY  restore adequate blood volume as soon as possible e.g by physiological saline .A careful fluid balance chart should be kept ,with appropiate allowance made for insensible loss .Daily serum electrolyte estimations are made ,together with acid-base studies.Full water replacement is given by intravenous route .Calories are given as glucose .Na ,K ,and Cl are given in appropriate amounts .ca deficiency, if develops , is treated by Ca gluconate IV

NASOGASTRIC ASPIRATION   continuous suction removes gastric HCl from entering duodenum,that suppressing hormonal stimulation of exocrine secretions of pancrease .It also brings relief from persistent nausea and vomiting.

PAIN RELIEF  
Originally it was thought that analgesia should not be provided by morphine because it haw drive symptom of the musculus of Oddi and exacerbate the pain, so the drug of choice was meperidine. However, due to lack of effectualness and risk of toxicity of meperidine, more recent studies hit institute morphine the analgesic of choice. Meperidine haw ease be utilised by some practitioners in more secondary cases, or where morphine is contraindicated.

PROPHYLACTIC ANTIBIOTICS  given as a prophylactic against infection of necrotic retroperitoneal tissue ,and also against bronchopneumonia .A  broad spectrum antibiotic ,e.g. cefoperazone should  be given for 3-5 days.

EDOSCOPIC SPHINCTEROTOMY gallstone pancreatitis will be improved ,if a stone is obstructing the ampulla of vater .

Surgical options for pussy necrosis include:

  • Minimally intrusive management - necrosectomy through small incision in wound (left flank) or breadbasket
  • Conventional management - necrosectomy with ultimate drainage
  • Closed management - necrosectomy with closed continuous postoperative lavage
  • Open management - necrosectomy with planned staged reoperations at definite intervals (up to 20+ reoperations in some cases)


COMPLICATIONS include : Pancreatic Pseudocyst __  this is a localized collection of fluid in the lesser sac of peritoneum. Pancreatic Abscess , Stress induced gastric erosion with haemate mesis or melena .Acute renal failure  ,Toxic psychosis ,Multiple organ failure ,chronic pancreatitis .

PROGNOSIS  the overall mortality is between 10 % and 20 % .With severe haemmorrhagic pancreatitis the mortality rate reaches 50 % .The usual cause of mortality is multiple organ failure .


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