Acute Pancreatitis in HD

the next topic we're going to be talking about today is pranker titis this is my favorite I love it why cuz you've got to know this code whether you're a medical student uh PA whatever health professional feel you you got to know pancreatitis because the pancreas is the B delicate tissue right the pancreas has the head right over here has the tail and the body can you imagine that that's is pretty easy it's got a head a body and a tail it's like a cat I just drew the system to kind of illustrate so that you have a visualization picture and this will be your duum the B tree the G bladder the liver but we are more concerned about a pancreas understanding the basic physiology of the pancreas we actually allow you to understand how it works right pancreas does a lot of good stuff right like what it makes bicarbonate because we need to keep the pH inside the duum alkaline why because we're dumping a lot of acid come from the stomach if I'm dumping acid into somewhere and the enzymes that is needed for nice beautiful digestion of my food in my small botle right it has to be they only work on alkaline pH wouldn't make sense like the gateway to come inside make sure we have enough bicarb to neutralize the acids already been dumb from the stomach that also what it produces what so let's talk about the pancreas for a little bit before we talk about cuz it does a beautiful job we don't really appreciate the pancreas in I the people even care about the pancreas I mean it's a nice guy right he's got alpha cells bitter cells and Delta cells the bitter cells make what insulin the alpha cell makes what glucagon and the Delta cells make what somato statin which is an inhibitory hormone insulin what to regulate glucose to St glucose as glycogen glucagon want to break glucose down gly glucon glycogen down into glucose right aside from that this same juicy guy it makes what clot tripon no gen right amas it makes lipase it makes all these beautiful enzymes that need for what break down your fat break down carbohydrate break down your proteins right so you cannot ignore him it also makes what B carbonate I mean come on dude you got to have some respect for the pancreas however sometimes the pancreas get injured it gets into an injury it's working too hard something hits it bam it becomes inflamed that's what brings us to this chapter called acute pancreatitis so now that we know what the pancr does wouldn't it be nice to see what happens to it when it's not in a good mood so what is aute pancreatitis let's break it down pancreatitis I told you in medicine break every word break it into the pieces the pancreas is inflamed inflammation of the pancreas but something's got to be doing the inflammation right so if I take this beautiful panc and I squeeze it and I squeeze it and I squeeze it what is good thing happen it's going to leak out all its content because like yo I'm not I'm not just trying to cause any trouble here don't you think it's inflamed she's going to spill out all this contents all the juicy stuff like the biocarbonate a little bit of insulin a little bit of GC right thought saw a couple am in the Life bu there kind of wonder why you know what lives we order for the pancreatitis right however as a student you're going to get pay you're not getting away with it I did you're going to get pimped okay you need to know what causes pancreatitis it's a classic question on the floor on the board so how about this let's get on the bandwagon and see what pneumonic we're going to be using we're going to smash the pancreas I'm going to do that and that's the way when he gets smashed that's how it gets inflamed so what are the causes of Baner titis since we just defined it right we always do definition first let's talk about causes it's going to get smashed I promise you what is the most common things that cause bran titis G Stones you got to love it that's why you go back to the bilary college chapter we made right I made that for you so that when we get to pranker titis it's not record science you know why the same stone that came and obstructed the cystic duct is going to get a chance to take a ride and go here and obstruct you know what let me use color cuz I think I love colors okay let's follow this Stone this same bad boy is going to go from here and come and obstruct and what happens here is the nice pancreas try to secrete all his juices to trow to come out and Bam the stone is standing in front of the door right in this finger of Odie right does that make sense now see how the stone is obstructing the duct it's not going to like so everything gets backed up you get into traffic and every start cursing them out we got to move who is right in front come on move everything start to get inflamed CU it backs up super much the pressure start to get inflammation right G Stones you got to know that cold who's number two culprit it's the most common drink in America right go every street every corner you got a bar everybody's what drinking drinking they're drinking alcohol that's the number two cause so chronic alcoholics they're going to come in and we're going to talk about what they're going to come and complain about what is the next thing how about this you know you and your friends you guys are hanging out you know the party you know all of a sudden somebody's curing out somebody else he gets pissed up bam giv me your punch in the belly what is that trauma right does that make sense so now the so far we're about to get smashed but so far we only get you know we've got the get poot steroids go to go can cause prattis I know but Ms the same virus right that causes Ms par partis aritis right it's a bad boy being sh to cause prantis autoimmune antibodies can come and Bam they can start binding to your pancreas right patients with connective tissues diseases uh lupus all that bad stuff that cause grain and all that good stuff now they're not good but they can form antibodies to the what to the uh pancreas even diabetes right diabetes you form autoimmune antibodies to the allies of langa hands can cause us some kind of pancreatitis right this is my favorite it's kind of one of my my buddies they went on camping I don't know what they were doing inside the woods but something bit them and it was this little animal little head and got a body and got a sting oh what you think that it's a scorpion scorpion stinks they cause pancreatitis the toxin it can cause inflammation of the pancreas now this one I like the H part you know why I like the H cuz it's one of those things you never really think about but I'm going to give you a case a 79 year old male comes to the ER it's com of pain me epigastric pain okay pain is going to the back it radiates to the back we try to work up what my cousin we knew might heartitis but the problem is he doesn't have any Stones cuz when we did it right up a quarter sound there was no stor in that he doesn't drink however somebody said how about we check this cholesterol level and all of a sudden he h he has triglycerides of 2,000 jeez I just give us the answer he has hyper Tri glyceria a lot of triglycerides they cause pancreatitis now the E see hidden in there yeah e doesn't mean anything but the D all are notorious drugs are your step twos especially you better know this fosi can cause pker ties thide is a thoan can cause pancreatitis seizure medications valproic acid can cause pancre HIV medications didanosine notoriously no pentamidine even metronide is always on the list right so diuretics antibiotics HIV meds immunosuppressants like I said in at the beginning and also what seizure medications they cause prantis that's where the drugs come in so if your patients already on this kind of drugs and they complaining of and you discover eventually they have pancreatitis and they don't fit any of this criteria look at into the medicine if you stop that medicine and we talk about manim your pancreatitis you make them feel better now that we talk about the causes how are this patients going to present right history it's going to be epigastric pain M epigastric pain radiating to the back they're going to be like Doc I'm in pain it's going to my back it's crazy right severe radiat to the back they're going to be nausea vomiting weakness they might have a little bit of fever and sometimes it might be in shock you want to watch out these two signs I've never seen it hopefully I see it one day I think most likely you're going to see this with hemorrhagic pancreatitis from trauma traumatic uh injury the gray Turner sign those are that's that's the first one you need to know and that's what you look at their back and you see this emotic looking patch that's called the gray Turner sand right and they go back why do they have great turn sign huh the chimos is blood because the pancreas is what it's part of a retrop Partin structure right so if it gets inflamed they can get a little piece of blood eotic at the back the second sign which you need to know is the calling sign these two signs are often tested on your board the Colin sign will be per umbilical right this is your belly button and right in there you might be able to see an eotic uh discoloration per umbilical right so those are the two sign great Turners calling sign don't forget that that may be evident on the exam but you don't always see it sometimes it's not there but how do we really make the diagnosis right you know M epigastric pain right radiate into the back their nausea they vomiting obviously you got a history the guys is an alcoholic you are the labs that's how we do things in medicine I want to get an amales and a lipas because if this guys are elevated it's telling me they might have they have pancreatitis however what is the most specific enzyme to pancreati it's lipas don't never let them fool you and I'm going to explain exactly why that's true remember at the beginning of the lecture I was telling you about how the pancreas produces amales and lipase what you need to know is that amales is in your mouth it's called tiling it's produced in the mouth amales is found inside your esophagus it's also produced in their pancreas so somebody with Hyper amisia which means a lot of amalis in their blood it doesn't not specific to the pancreas because if be com from their mouth they can have a GI perforation CA bav syndrome and it's just spilling into their blood and you think oh the Amal is but the only place you get the lipase is in the pancreas is the master producer of the lipas enzyme because lipase is anything as Ace is an enzyme lipids it breaks down triglycerides right it breaks down fatty acid so when they ask you on the test and they ask you on the boards or on the W you better tell them lias are you digging this guys good number two they're going to have hypocalcemia calcium loves inflammation it's notoriously being known throughout history calcium loves inflammation because what will happen is the the pancreas is going to get inflamed and calcium is going to come start sprinkle over it cause calcification of the pancreas so all what have happen the calcium is coming out of your blood and it's dumping it's like little grains of salt right you sprinkle extra salt extra salt but now it's calcium salt so you become hypocalcemic this is not good because hypocalcemia can cause you to have weakness right that will explain why they're weak D I'm tired I have epigastric pain rting into my back I have nausea and vomiting why they nausea and vomiting because irritating the wall of their bowel right the bow doesn't want to do his job it doesn't want to keep digesting food cuz if you if you tell me to do a job right now right and you tell me oh okay I want you to take this bag from here to here but on my way you keep like smacking me in the back of my head bam bam I think I'm going to drop the back right that's the way it is I'm going to cause nausea vomiting the GI tract vomit all the food out so the bowel can rest and we will talk about why the management of rest is important for pancreatitis now another thing you will see on chest x-ray is a sentinel Loop sign so now we ordered the labs you can get a chest x-ray oh I'm sorry an abdominal x-ray apologize abdominal x-ray you can see a sentinel Loop sign which is specific specific for the acute pancreatitis or a colon cut off sign I don't have images to show you but I employ to go on Google type this in there and you'll be able to see what I'm talking about now what Imaging is best to see a c pancreatitis a c scan right so you want to get a CAT scan of their belly so you can see the inflam pancreas you might see some fluid around it right and that would tell you the patient has pancreatitis that is the best test now the good thing about CTS you can't show if it's an absis around the pancreas right because bacteria is probably sitting around eating a couple of stuff right if it's Hemorrhage which is blood right if it's just inflammation necrosis or pseudois this things that could beon complications which we're going to talk about at the end of this lecture now we can also use ultrasound why do we want to do ultrasound you know why because I always go to Ultrasound first because ultrasound just shows me a lot perfect example if I do an ultrasound of that gallbladder and I see a stone in here and eventually I find a stone inside the duct I don't need a CT scan to tell me what the problem is we need to take out that Stone because that is where the problem because gall stones is the number one cause of what pancreatitis now we need to treat this patient okay this is common sense but common sense I just discovered lately it's not common the patient has what they complaint of severe epigastric pain going to the back what do you want to give them first I'll give them some pain medicines so we give them some anesia they say don't give them morphine because what it ca spasm of the sphin of ODI you also want to remember that should give them something else you can't give them any po food right because I mean po drugs if somebody's nausey and vomitting if you give them a pill they're going to vomit it out so you give them a pain medication I VI eyes because they been having a lot of nauseum vomiting and your fluid depleted you want to give them ivu fluids normal sailing they've been vomiting a lot they might have hypokalemia right you want to replace that so you replace the electrolytes that have been lost by ordering Labs so when you order your BMP which is your basic metabolic pan we have sodium potassium bicarb that good stuff in there whatever they depleted in give it back to them if they deficient is potassium give them potassium chloride right they number of selling they give them uh fluids back but the most important thing you want to do is bowel rest right the bowel is inflamed all this pancreas is inflaming everything around it the bow is not ready for paralysis so you don't want to put anything in their mouth you tell them Miss Jones you're not going to be eating until this episode is over right so bow rest pay meds ior floods give them their electrolytes back it's very important another thing you can do if they have a lot of food inside their belly you want to suck that food out you know why cuz if you don't give them NG to suction that's called naso gastric tube suction you put it through their nose it goes to the back of their mouth goes to the GI tract the idea of doing a suction is because if they have food stuck in their stomach right and this still food has to go to the pyloris and go back into the duum again this pancreas got to get now you're making it work hard you want to rest the pancreas you give it a time out right give the pancreas a time out cuz this food is going to come again and want to stimulate b car production lipus production no it's already inflamed when you're sick you don't want to move leave them alone so you want to give patients Ang your suction you put it through your nose you suck the food out and they should be feeling much better you want to give them some oxygen if they hypoxic right if they if they malnutritional give them food like nutrition replace you can give them tpn if they're severely malnutritional IED because we can't put food in their mouth on to Bow rest you give them flutin you give them pain medications that's the only way going to feel better now you need to give them antibiotics right because this is B has a lot of bacteria in there so you want to make sure you cover them with a good dose of antibiotics now because pancreatitis is really bad there could be severe complication from it patients are usually recover after all this that we've done for them in the hospital but the thing is you have to know that there could be complications one of the biggest complications of acute the cute one pancreatitis is pancreatic pseudocyst let's talk about that what exactly is a pancreatic pseudo cyst complication and usually since complications are not the nicest things they have to be in red nothing comes easy let's talk about a pancreatic pseudo cist so let's break it it's a cist it's Pudo which means it's not true it's kind of fake pan in the pancreas so it's going to be something like that right right and if you look at it inside this the reason why they call a pseudo cyst like it's not a true cyst is because it doesn't have a true epithelial lining it does not normal cyst they should have a nice beautiful epithelial lining it's just this nice scarring the inflammation was so much there was a pocket like Lake of pull of fluids and this fluid usually caus it has a lot of inflammatory fluids in it am lipas you know okines basically tissue and debris kind of yucky stuff all the stuff the the pancreas normally makes right they all not kind of encircled in this nice cute looking uh cyst and usually patients usually have this after they've had a a pancreatitis episode which is one of the most complication uh of pancreatitis now what you need to know is because there's amalis inside the IST when you order lapse on this patient this amaly can leak out if this thing ruptures and they you might think they have hyperemia but like I told you it's always a lipas so if you have an isolated amales that's elevated in a patient after the pancreatitis think of a pseudocyst and how do we going to pick this out so it's just that would be the continuation of the pancreas you do ultrasound I be but before actually we order ultrasound you want to know why they're going to complain they're going to come back complain with the same R you know I mean severe epigastric pain kind of going to their back you order the labs it comes with high M MLS only you start to realize okay maybe they might have a assist then you do a ultrasound in the ultrasound you'll be able to see the cyst and usually what we normally do this cyst actually normally resolv spontaneously there CU not much we can do about it if it's more than 6 weeks this have this cyst we have to take it it out all right we drain it we stick a little needle in there and we drain it out and this patient usually feel better or if the cyst is greater than 5 cm or it's greater than six weeks they have had is definitely you have to drain it or take it out now like I said there's other complications like fistular formation because the inflammation can allow the bowel to form a Fisher because inflammation can easily cause fist formation inside your bowel uh we already talked about hypocalcemia the problem is they can also develop sepsis CU bacteria CPS in there they can develop peritonitis and go into sepsis so that is pancreatitis in short do you need to know this yes I will know it cold so we talked about what pancreatitis which is inflammation of the pancreas it's caused about get smashed to pneumonic most common gall stones alcohol right in trauma those are the top of things forget about the Scorpion things nothing really nobody ever seen that as much as I do I haven't seen one but you want to know how we treat it patient I when patient's present right up a quarum PR read into the back right nausea vomiting feel a little weak hypocalcemic when you order your Labs you're going to see elevator at lipase that's most specific that's all you need to know right we tell them you can't eat you give them fluts bow rest you give them pain medicines you make sure you don't have complications and that's it that is the end of our lecture thank you

Channel: Dr. Adeleke Adesina, DO

Views: 206,203

Keywords: pancreas, pancreatitis, lipase, amylase, gastrointestinal, GI, ftp, future teaching physicians, ftpinc, medicine, pancreas lecture, causes of pancreatitis, managment of pancreatitits

Id: KvYRfJLdbM0

Length: 25min 44sec (1544 seconds)

Published: Sat Sep 24 2011