Important knowledge

⚡️مريض ال acute pancreatitis ميصير تدخلة ردهه مفروض يدخل HDU = High Dependency Unit ك scientifically speaking

⚡️Acute pancreatitis ▪︎6w -2M = after trauma ( usually blant ) ▪︎1w = after ERCP

⚡️Mittelschmerz presented with abdominal pain & vaginal spoting ( very important do differentiate it from acute appendicitis) & last for several hours only (vs for days in appendicitis )

⚡️if u suspect ectopic pregnency and the pregnency test was negative send for US (not exclude)

⚡️شلون نفرقها عن ال appendicitis؟ ▪︎perforated DU >> generalized peritonitis (bord like rigidity) ▪︎appendicitis >> localized peritonitis ( rarly generalized )

⚡️perforated peptic ulcer if presented as right illiac fossa pain is called valentino sign ( يحبها د عبد الستار )

⚡️US in appendicitis is only for exclude other ddx ( because inflamed appendix rarely seen by US & we see non specific signs as fluid ) & the only diagnostic imaging modality for appendicitis is CT with contrast

نيمونك لل Ranson's criteria

⚡️Upper GIT bleeding د.عثمان ---------------------- ♦️Anatomical ddx : 🔹️nose ▪︎ Posterior epistaxis (يبلع الدم ويرجع يزوعة) 🔹️mouth ▪︎ulcer 🔹️esophagus ▪︎esophagial Vareses ▪︎mallory wiess tears 🔹️stomach ▪︎Ulcer (PU) ▪︎Malignancy ▪︎others (read lecture) 🔹️small intestine ▪︎duodenal ulcer ▪︎diverticulosis ▪︎others ♦️Mx ▪︎90% stop spontaneously ▪︎9% stop by endoscopy ▪︎1% need surgery 🔹️approach ▪︎ABC + 2 wide needle cannula ▪︎blood preparation (cross match ) ▪︎stop bleeding ▪︎replacement ♧anemia > give whole blood ♧platelate > give platelate ♧hypotension > give fliud ▪︎Antibiotic (3ed generation cephalo)

واجب علي عادل (مهم) +appendicitis

We usually perform the CT scan After 6-10 days of Acute pancreatitis to detect the complications while the US will be performed as an initial for diagnosis…

In case of suspicion of Acute pancreatitis we will send for lipase enzyme not Amylase… Amylase enzyme will return to normal within 24-48 hrs [ the Exception is the formation of pseudo cyst in which will remain elevated beyond this period…

Most useful test for detection of chronic pancreatitis is Endoscopic Ultrasound while to test the pancreatic function is Feacel pancreatic Elastase

Chronic pancreatitis causes…

Acute pancreatitis causes…

⚡️75% of patient diagnosed clinically as peptic ulcer they have GERD rather than PU

⚡️Notes in Mx of pancreatitis ----------------------- ▪︎Morphin (opiod ) is contraindicated in pancreatitis ( increase ton of sphincter of oddi ) aslo contraindication in cholysistitis for same reason [ also in uretric stone because increase ton of uretric muscle> ⬆️pain] ▪︎It is important to ask about stool لان جماعة البنكريتايتس يصير عدهم Paralytic illius ويصير عدهم constipation وكذلك نشوف ear fliud level بال CT او ال x ray ▪︎Antibiotics indicated only in severe pancreatitis (because it is chemical inflamation)

⚡️deep signs of abdominal palpation د.علي عادل ------------------------- ▪︎ Murphy sign ( mid claviculer line * transpyloric line (subcostal) نكدر نسويها بطريقتين اما بالايد اليمين باطراف الاصابع او بالايد اليسار بال thump ▪︎rebound tenderness ▪︎Rovssing sign --------------------------- Superfacial signs : ▪︎Superfacial tenderness ▪︎percussion tenderness (حسب جراحة الاطفال فهوه يعادل ال rebound tenderness!)

⚡️causes of S.O.B in pancreatitis (very important comlication) ----------------- ▪︎RDS [ due to release of immunological mediators ] ▪︎plural effusion [due to irritation of under surface of diaphragm]

⚡️Abdominal examination ( د.علي عادل) ------------------------------------------ ▪︎exposure from 5th intercostal space to knee ▪︎4 extreabdominal area included in abdominal examination ♧ genetelia & hernial orifices ♧ PR examination ♧ virtue lymph node (trousers sign ) ♧ femoral vessels