acute pancreatitis

1. Complications of acute
pancreatitis

2. Local
1. Fluid collection (ascites/ pleural effusion)
2. Pancreatic pseudo cyst
3. Pancreatic necrosis
4. Infected pancreatic abscess
5. Hemorrhage and pseudo aneurysm

3. Regional
1. Venous thrombosis
2. Paralytic ileus
3. Intestinal obstruction
4. Intestinal ischemia/ necrosis
5. Cholestasis

4. Systemic
1. Systemic inflammatory response syndrome
2. Multiple organ dysfunction syndrome
3. ARDS/ pulmonary failure.
4. Renal failure
5. Cardiovascular complication
6. Hypocalcemia
7. hyperglycemia

5. 7. Disseminated intravascular coagulopathy
8. Protein energy malnutrition
9. Encephalopathy

6. Local fluid collection
• Small collection – reactionary.
• Massive ascites and pleural effusion due to
internal panceatic fistula.
• Treatment :
1. ERCP to detect site of leakage followed by
stenting
2. Distal pancreatic resection or internal drainage
in Roux en Y jejunostomy.

7. Pseudo cyst
• Peripancreatic fluid collection contained by
fibrous granulation tissue contrast to cystic
neoplasm having epithelialized wall.
• D’ Egidio classification:
Type I Acute post necrotic cyst
Type II Post necrotic cyst
Type III Retention cyst

8. Complications of pseudocyst
1. Infection
2. Hemorrhage
3. Mass effect
4. Leaks

9. Management
• Type I percutaneous drainage
• Type II and III internal drainage

10. Pancreatic necrosis
• May be sterile or infected.
• Treated by debridement (necrosectomy).

11. Pancreatic abscess
• Arise from infection of pancreatic collection.
• Ideally should not contain necrotic debris.
• Must be differentiated from infected
necrosum radiologically.

12. Clinical features of pancreatic abscess
1. Fever
2. Tachycardia
3. Abdominal pain
4. leucocytosis

13. Management
1. Percutaneous drainage radiolgically
2. Endoscopic drainage with placement of
double j stent

14. SIRS &MODS
• SIRS : Tachypnea, tachychardia, leucocytosis
and hyperthermia.
• Sepsis could be there.
• May progress to MODS
• Treatment is supportive care.