Morning ReportMarch 25, 2011

Morning ReportMarch 25, 2011 www.phwiki.com

Morning ReportMarch 25, 2011

Colin,, Contributing Writer has reference to this Academic Journal, PHwiki organized this Journal Morning ReportMarch 25, 2011

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PancreatitisCausesAdultGallstonesAlcoholChildrenBlunt traumaIdiopathic (25%)Drug-relatedInfectionsMumps, Enterovirus, EBV, HepA, Coxsackievirus BGallstones less commonStill look as long as them

PancreatitisDrug-relatedIdiosyncraticDirect toxic effectTimingDepends on drugFew weeks to many monthsNot very straight as long as wardDrugsValproic AcidAzathioprineCorticosteroidsSulfasalazineCimetidineEstrogens ThiazidesOf note6MP in addition to pentamidine have also been known to cause pancreatitisPancreatitisOther causesHypercalcemiaHyperlipidemia Vasculitic diseasesSLE, HSP in addition to KawasakiSepsisShockMultiorgan failureCFPancreatitisPathogenesisActivation of enzymesAutodigestionTissue InjuryProinflammatory in addition to cytokine responsesARDS, DIC, multiorgan failureBecause there is no capsule, the inflammation can spread easily to other structures

PancreatitisPresentationAbdominal painLocationMid-epigastricR or LUQQualityConstantBoringRadiation to backAlso flank, chest or lower abdomenAggravatorsLying supineN/V+/- JaundicePancreatitisFHIf present look as long as hereditary systemic or metabolic disordersAsk aboutDiarrhea, vasculitis, joint pain, rashes in addition to pulmonary diseasesPEVary depending on severityMild feverTachycardia30-40% hypotensionAbdominal tenderness with absence of peritoneal irritationPancreatitisLate SignsGrey Turner signLarge ecchymoses in flanksCullen signEcchymoses in umbilical areaRepresent blood dissecting from the pancreas along fascial planes

PancreatitisAmylaseSpecificity 70%Rises within 6-24 hoursPeaks at 48hNormalizes 5-7dSensitivity decreases after 24-48hLipaseRises within 4-8hPeaks at 24hNormalizes 8-14dLipase also exists in other tissuesThe degree of elevation is not a marker of severityPancreatitisOther labsCBCChemistryLFTsCoagsSystemic-wide effectsPancreatitisImagingUSGallstonesDilation of the biliary treeConfirm diagnosis of pancreatititisEnlarged edematous pancreasRule out obstructive anomaliesCTComplicated casesHemorrhage, pseudocyst, abscess or vascular abnormalitiesConsidering surgeryDeteriorating course

PancreatitisMimickersBowel per as long as ationIschemic bowelRuptured ectopic pregnancyAll may mimic pancreatitis in addition to cause an elevation in amylasePancreatitisTreatmentAdmissionUnpredictable coursePossible complicationsSupportiveFluidsFollow UOPPain medicationMeperidine Less likely to cause spasm of the sphincter of OddiNutritionGIConsult if gallstonesSurgeryIf focal findings are present on US or worsening conditionPancreatitisTreatmentNutritionOral feedingTime course dependsMild casesEarly feeding in addition to advancement is encouragedPain improvement in addition to decreased narcotic requirement24-48hNJElemental or semi-elementalIncreased protein in addition to decreased fatPreferred to TPN if toleratedIntestinal barrierEliminates complications of parenteral therapyTPNIf nutritional goals not met in 2 days

PancreatitisComplicationsShockHyperglycemiaDecreased insulin in addition to increased glucagonHypocalcemiaSequestration into necrotic areasHypoalbuminemiaHypomagnesemiaHyperglucagaonemiaInactivation of PTHPancreatitisComplicationsPseudocysts2-3 weeks after acute episodeLong-termChronic pancreatitisRecurrent pancreatitisDMDigestive disordersMalabsorptive disordersPancreatitisComplicationsPredictibility of complex courseElevations of GlucoseLDHBUNDecreases of HctCaAlbPartial pressure of OxygenRanson’s criteriaOther criteria exist as well

PancreatitisPrognosisMost patientsMild, self-limited15-20% Severe in addition to complicatedMortality rate5% if mild initial presentationVery high if hemorrhagic or multisystem

Colin, Game Revolution Contributing Writer www.phwiki.com

Colin, Contributing Writer

Colin, is from United States and they belong to Game Revolution and they are from  Berkeley, United States got related to this Particular Journal. and Colin, deal with the subjects like Hobbies; Video/Computer Games

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