In 20% of patients it presents a great distension of the upper part of the abdomen due to the paralysis of the stomach (gastric ileus) or a pancreatic inflammatory large mass displacing the stomach forward. Sudden abdominal tenderness, usually very painful abdominal pain in the upper part of the abdomen (epigastrium) occasions so intense that is checked is beyond rigidity of muscles by pain to what is called, abdomen in table. Acute pancreatitis should take as a box of deferencial diagnosis to all box of sudden abdominal pain among which we have: drilling of a gastric ulcer or duodenal, a heart attack mesenterico, intestinal obstruction with strangulation, biliary ruptured aneurysm desiccant, colic, ectopic pregnancy, appendicitis and diverticulitis. Complementary tests: amylase and lipase that is allan increased in the 1st day and normalized in the next 7 days. Leukocytes soar between 12,000 to 20,000/ul, the hematocrit is there in the 50 to 55% as a consequence of the great loss of inflammatory fluid to the third space.
Figures for calcium low 1st day for the loss of albumin in the inflammatory liquid or chemical burn. The simple abdomen radiography shows presence of gallstones in the interior of the pancreatic duct or gallbladder as bowel ileus in the upper left quadrant, in the chest X-ray revealed atelectasis or pleural effusion. Pancreatitis with necrosis and hemorrhage has a mortality of 10 50% and there is a progressive decrease in hematocrit, presence of liquid hemorrhagic ascites, decreased calcium in serum and the most striking, the appearance of the sign of Grey Turner (extravazacion towards the flanks) or Cullen (extravazacion towards the navel). The criteria of Ranson which gives us the pattern for the treatment and prognosis of severe pancreatitis are available: 1.-age of 55 years 2. serum glucose greater than 200 mg/dl 3.-serum LDH greater than 350 IU/L 4.-AST formerly called SGOT increased to 200 IU/L 5.-more than 16,000 leukocytes uL remaining signs are completing at 48 h following the patient admission: 6.-descent of the greater than 10% Hto 7.-increase of greater than 5 mg/dl 8 BUN-serum calcium higher than 8 mg/dl 9.-PO2 manor of the 60 mmHg 10.-basis deficit greater than 4 mEq/L 11-kidnapping estimated more than 6 litres of liquids. When there is a mild pancreatitis on CT images shows a slight swelling of the pancreas, his proostico is excellent, but if very temefacto, the prognosis is severe with a slow recovery and risk becoming chronic pancratitis. Suede box is very serious hospitalization is convenient to the patient with a box of sharp abdominal pain that it be completed with laboratory tests and start aggressive treatment in replacement of liquids by the great extravazacion inflammatory or hemorrhagic and avoid serious complications, so I repeat, do not try to automedicar or ambulatory resolution.
| January 20th, 2014 | Posted in General |