Staging Laparoscopy with Laparoscopic Ultrasonography ...

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Mechanisms ofAcute Pancreatitis• Reflux theory: Bile reflux up the pancreatic ductactivates trypsinogen. Postulate interstitial (asopposed to intracellular) trypsin leads topancreatitis.• Co-localization theory: Missorting of digestiveenzymes and lysosomal enzymes <strong>with</strong>in the acinarcell. Lysosomal enzymes, e.g. cathepsin B,prematurely activates trypsinogen to trypsin thusactivating the cascade
Pathogenesis of Acute Pancreatitis4Blockade ofsecretion?protein pluggallstone sludge33aenterokinaseortrypsinTrypsinCellularDestructionPrematureactivationEarly release51 – antitrypsin2 - microglobulinlysosomesFusion oflysosomes andzymogensEarlyRelease2aPSTICathepsin B1GolgiComplexcvcvcv2ZymogengranulesNucleusRER
Page 1: PancreatitisCharles M. Vollmer, Jr.
Page 4 and 5: Pancreatitis
Page 6 and 7: Classification of PancreatitisAcute
Page 10 and 11: Etiology• Alcohol• Gallstones
Page 12 and 13: What Now?What is the differential?W
Page 15 and 16: Clinical FeaturesSigns and Symptoms
Page 17 and 18: Mortality and Ranson’s CriteriaRa
Page 19 and 20: Change in Plans8 hours later….The
Page 21 and 22: Basic TenentsFluidsEnd organ suppor
Page 23 and 24: What’s the diagnosis?
Page 25 and 26: Indications for BiliarySphincteroto
Page 27 and 28: Why is he still febrile?
Page 29 and 30: HD # 15• WBC 25,000 and rising•
Page 31 and 32: Infection• Pneumonia• Line Seps
Page 33 and 34: Pancreatic NecrosisDiffuse or focal
Page 35 and 36: Sterile Necrosis:Operative Indicati
Page 37: Clinical Signs of InfectedNecrosis
Page 44 and 45: Abscess
Page 46 and 47: Rational of SurgicalManagementRemov
Page 50 and 51: HD # 25Why is he still in the ICU?
Page 52 and 53: MSOF• Pulmonary• Renal• Cardi
Page 54: Pancreatic Pseudocyst
Page 57 and 58: Chronic Pancreatitis
Page 59 and 60:
Course of Chronic Pancreatitis10080
Page 61 and 62:
Pathophysiology of Chronic Pancreat
Page 63 and 64:
Indications for SurgicalTreatmentCh
Page 65:
ERCP
Page 69 and 70:
Chronic PancreatitisSurgical Manage
Page 71:
Chronic PancreatitisDuctal Drainage
Page 77:
Long-Term Outcome after Duct Draina
Page 80 and 81:
Traditional Pancreatic HeadResectio
Page 83:
Afferent Limb ReconstructionCommonH
Page 86 and 87:
DPPHR
Page 88 and 89:
Distal Pancreatic ResectionsNOT rec
Page 90:
PancreatitisCharles M. Vollmer, Jr.
Page 93:
Etiology of Acute Pancreatitis• P
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Staging Laparoscopy with Laparoscopic Ultrasonography ...

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