1. PANCREATITIS.
UNIVERSIDAD DE GUADALAJARA
CENTRO UNIVERSITARIO DE CIENCIAS DE LA SALUD
Surgical Clinics.
Dr. Benjamín Robles Mariscal
Profesor: Dr. Héctor Virgen
Ayala
Luis Gerardo Caballero Romero.
EPG MCPA

2. • Non-bacterial disease, caused by interstitial release and activation of
pancreatic enzymes that perform the self digestion of the pancreas, the
process is accompanied by morphological and functional changes.

3. CAUSES
• Biliar Lithiasis 40%
choledocholithiasis 25%
• Alcoholic Pancreatitits in the USA causes more of the 40%
• Hypercalcemia
• Hyperlipidemia
• familiar pancreatitis
• protein deficiencies
• postoperative pancreatitis (iatrogenic)

4. • Drug pancreatitis
corticosteroids
steroidal contraceptives
azathioprine
thiazide diuretics
tetracyclines
• Obstructive pancreatitis
• idiopathic pancreatitis and for different reasons.

5. PATHOGENY
• Phospholipase A (Able to create necrotizing pancreatitis severe)
• Trypsin (not attack living tissue, but activates phospholipase A).
• Elastase (can digest blood vessels)
• Lipase

6. SYSTEMIC MANIFESTATIONS
• Acute respiratory distress syndrome (ARDS)
• Myocardial depression
• Renal insufficiency
• Gastric ulcer
Complement C5

7. ACUTE PANCREATITIS
• Sudden epigastric pain
• Nausea, vomiting
• High concentrations of amylase
• Edematous condition
Similar disease processes
• Bleeding form and treatment

8. • Edematous condition: interstitial fluid congestion, infiltrated by
inflammatory cells surrounding small areas of parenchymal necrosis.
• Bleeding form: Effusion of blood into the parenchyma and extensive
pancreatic necrosis

9. SIGNS AND SYMPTOMS
• Acute attacks after a hearty meal
• epigastric pain radiating to back
• Vomiting and retching.
• According to gravity
deep dehydration
tachycardia 1 to 2% Grey Turner's sign (bluish
hipertencion postural discoloration flanc)
Decreased myocardial function Cullen's sign (bluish Periumbilical)

10. LABORATORY STUDIES
• Hematocrit - Bleeding Pancreatitis
(by dehydration)
• Hematocrit - Bleeding Pancreatitis
(For bleeding into the abdomen)
• Moderate leukocytosis
• Normal liver function tests
• In the first 6 hours up to twice amylase 1000 IU / dl
• Lipase - alcoholic pancreatitis
• Amylase - calculous pancreatitis

11. IMAGING STUDIES
• Abnormalities were observed up to 66% of cases
More often an isolated dilated bowel segment (loop Sentinel).
• Sometimes it is remarkable glandular calcification.
• TC
• ERCP (Endoscopic Retrograde cholangiopancreatography)

12. RANSON CRITERIA IN TERMS OF SEVERITY
Criterios Iniciales Criterios de
Evolución en 24 Hrs
EDAD > 55 DISMINUCION DEL > 10%
HEMATOCRITO
CUENTA DE > 16,000 AUMENTO DEL BUN >8 mg/dl
LEUCOSITOS
GLUCOSA 200 mg/dl Ca EN SUERO < 8mg/dl
LDH EN SUERO >350 IU/L Po2 ARTERIAL < 60 mmHg
AST (GOT) > 250 IU/dl DEFICIT BASAL >4mg/L
CALCULO DE >600 mL
LIQUIDOS
AST ---ASPARTATO TRASNAMINASA

13. • Chronic pancreatitis

14. • Persistent abdominal pain
• Pancreatic calcification observed in radiographs.
• Pancreatic insufficiency, malabsorption and diabetes mellitus
• Common cause alcohol

15. SIGNS AND SYMPTOMS
• Asymptomatic in many cases.
• Malabsorption.
• DM
• Epigastric abdominal pain (deep, radiating to back, increases and decreases
from one day to another, episodic lasting days or weeks and then disappears
for months)

16. LABORATORY STUDIES
• Amylase (in acute exacerbations)
• Exocrine function tests of the pancreas
• DM (75% of calcific pancreatitis px and px 30% of pancreatitis
without calcification).
• Biliary obstruction
• Phlebothrombosis.

17. COMPLICATIONS
• Pancreatic pseudocyst.
• Biliary obstruction
• Duodenal obstruction.
• Malnutrition
• DM

18. TREATMENT
• Medical treatment:
Malabsorption and steatorrhea are treated with supportive measures.
You must leave the consumer to insist on Alcohol
Psychiatric treatment is beneficial.
• Surgical Treatment:
It consists of a treatment that facilitates pancreatic duct drainage, or
resection of the affected portion of pancreas.

19. SURGICAL TREATMENT:
• Drainage Procedure:
Dilatation of the ductal system
is used for alcoholic calcific pancreatitis.
Dilated duct (1 to 2 cm)
with sites of stenosis ("Chain of Lakes")
Tx: pancreaticojejunostomy (Pastow Procedure)

20. PANCREATECTOMY:
• Pancreaticoduodenectomy (Whipple procedure)
Pain Relief in 80% of patients.
• Total pancreatectomy
Contraindicated in patients who do not leave alcohol.

21. CELIAC PLEXUS BLOCK:
• Thoracoscopic splanchnicectomy:
Splanchnic resection of major and minor nerve.

22. • Pancreatic pseudocyst.

23. • Mass and epigastric pain
• Grade fever and leukocytosis
• High concentration of amylase
• Cyst demonstrated by ultrasound.

24. • Accumulation of fluid in capsules containing large amounts of enzymes.
• Pseudocyst indicates that there is no epithelial lining.
• Two mechanisms of pathogenesis:
Complication of pancreatitis. 2% (one cyst, 85%)
Alcoholics and trauma victims.

25. SIGNS AND SYMPTOMS
When a person is suspected draw, no signs of recovery after a week, or after a
temporary improvement, the symptoms reappear.
And tender palpable mass in the epigastrium, due to the swelling of the
pancreas and adjacent viscera (cellulitis).
Common sign: Pain.
50% of the px:
fever
Weight Loss.
hypersensitivity

26. COMPLICATIONS
Infections:
Are rare, high fever, chills, and leukocytosis.
It is possible percutaneous drain through a tube.
breakage:
occurs in less than 5% of cases.
Perforation into the peritoneal cavity, chemical peritonitis (abdominal rigidity board, severe
pain).
hemorrhage:
into the cavity of the cyst (false aneurysm)
anemia
Hemorrhagic shock.
Tx open cyst.
Flirt glass.
Drain cyst.

27. TREATMENT
• Symptomatic improvement and prevention of complications.
Treatment expectation (40% spontaneous resolution)
• Cysts larger than 5 cm active treatment. (Percutaneous
drainage or to the stomach).

28. • Resection:
definitive treatment for traumatic cysts in the tail of the pancreas.
• External drainage:
best treatment for patients in critical condition, although the incidence of
recurrent pseudocyst is four times higher after external drainage into the
intestine.
• Drainage Internal:
Preferred method.
Roux Anasotmosis And at one end of the jejunum (cistoyeyunostomia)
the rear wall of the stomach (cystogastrostomy)
or the duodenum (cistoduodenostomia).
• Nonsurgical drainage:
Percutaneous external drainage tube was permanently eradicated 66% of
infected cysts.

29. FORECAST:
• 10% recurrence
• More frequent relapse after tx with external drainage.

30. • Pancreatic abscess

31. PANCREATIC ABSCESS
• Complication of 5% of postoperative pancreatitis.
• Lethal without treatment.
• Secondary to bacterial contamination and exudate hemorrhagic
necrotic debris.

32. CLINICAL MANIFESTATIONS
• Acute pancreatitis does not yield, fever or recurrence of
symptoms after a period of recovery.
• Serum albumin concentration is less than 2.5 g / dl
• Alkaline phosphatase

33. TREATMENT AND PROGNOSIS
• Drain the accumulated pus.
Surgical debridement for necrotic debris in the retroperitoneal space that do not pass by
the probe.
Antibiotics (Escherichia coli, Staphylococcus, Klebsiella, Proteus).
• 20% mortality rate for incomplete drainage and inability to establish Dx.

34. BIBLIOGRAPHY:
Diagnosis and surgical treatment, Gerard M. Doherty
13th edition, McGrawHill Lange.
P. 495-507