Staging Laparoscopy with Laparoscopic Ultrasonography ...

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Etiology of Acute Pancreatitis• Gallstones: most common cause. 50-70 yrs of age. 1:2,male:female• Alcohol: younger (30-35 yrs of age). 3:1, male:female• Drugs: sulfonamides, furosemide, thiazides, valproic acid,estrogens <strong>with</strong> hyperlipidemia, azathioprim (6-MP), L-asparaginase, pentamidine, didanosine.• Trauma: surgery, blunt trauma to the upper abdomen, ERCP,S.O. manometry.• Metabolic: hypertriglyceridemia, ? hypercalcemia.• Obstruction: gallstones, sludge/crystals, tumors,ascaris/clonorchis, choledochocele, annular pancreas, duodenalcrohn’s, afferent loop obstruction, perhaps periampullarydiverticula, pancreas divisum, ? S.O. spasm
Etiology of Acute Pancreatitis• Pregnancy: Usually in 3rd trimester or postpartum.Coexisting cholelithiasis in 90%.• Infection: Mumps, CMV, ?MAI and MTB, varicella,EBV.• ESRD: High mortality. Incidence increases <strong>with</strong> yrs ofHD.• Scorpions: Excessive cholinergic stimulation. Seenmostly in the West Indies. Salivation, sweating, dyspnea,arrythmias.• Idiopathic: 8-25% of cases. May be due to S.O.dyskinesia or microlithiasis.• Miscellaneous: SLE, penetrating DU, CF.
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PancreatitisCharles M. Vollmer, Jr.
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Pancreatitis
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Classification of PancreatitisAcute
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Mechanisms ofAcute Pancreatitis•
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Etiology• Alcohol• Gallstones
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What Now?What is the differential?W
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Clinical FeaturesSigns and Symptoms
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Mortality and Ranson’s CriteriaRa
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Change in Plans8 hours later….The
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Basic TenentsFluidsEnd organ suppor
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What’s the diagnosis?
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Indications for BiliarySphincteroto
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Why is he still febrile?
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HD # 15• WBC 25,000 and rising•
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Infection• Pneumonia• Line Seps
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Pancreatic NecrosisDiffuse or focal
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Sterile Necrosis:Operative Indicati
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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.
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Staging Laparoscopy with Laparoscopic Ultrasonography ...

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