Acute Pancreatitis Dr. khaled sheha - PowerPoint PPT Presentation

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Acute Pancreatitis Dr. khaled sheha

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Acute Pancreatitis Dr. khaled sheha – PowerPoint PPT presentation

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Title: Acute Pancreatitis Dr. khaled sheha


1
Acute PancreatitisDr. khaled sheha
2
  • ?????? ????????? ?????
  • ?? ????? ???????? ???? ?? ????????? ?? ?????
    ?????? ?? ??????? ??????? ?? ??????? ???????? ???
  • ???? ?????? ?? ??????? ????????? ????????
    ????????? ??????????
  • ???? ???
  • ?????? ???? ( ???? )
  • ?????? ???? ( ???? )

3
  • ????? ?????? ????????? ?????

4
Gall stone
5
Alchohol
6
  • 1- ??????? ????????
  • ???? 75 ?? ???????
  • ???????
  • 3? 7 ?? ???? ??????? ???? ????? ?????? ???????
    ???? ???
  • ?????? ????????? ???? ??????? gt ??? ?????? ??
    ??????
  • ???? ?????? ?? ?????? ????? ?????? ????????? ????
    ??????? ???? ???? ??????? ??? ?????? lt ?? ??????
  • ???? ???????? ???????? ??????? lt ?? 5 ?? ??? ????
    ?????? ???????? ????? ??? ???????
  • ????? ??????? ???? ?????
  • ??? ?????? ?? ??????? ??????? ???? ???? ??????
    ???????

7
  • 2- ????????
  • ?????? ???? ?????? ???? ?????
  • ???? ??? ??? ?????? ???? ?????? ??? ??? ????
    ????? ????? ?? ???? ?????? ??? ??? ????
  • ??????
  • 1- ?????? ???? ??? ???? ?????? ??????? ???????
    ??????????
  • 2- ?????? ???? ??? ?????? ????? ????
  • 3- ?????? ???? ?????? ????? ???????? ???????? ???
    ???? ??? ?????? ???????
  • 4- ????? ?????? ?????? ??????????? ???????
    ???????
  • 5- ???? ?? ????? ????????? ?????? ??????? ??
    ??????? ???????

8
  • ??? ???? ????
  • ????? ???? ???? gt 1000 ???? ????? ??????
    ?????????
  • ????? ?????? ?? 500 _ 1000 ?? ???? ????? ???????
  • ???? ???????? ???????? V . II. I
  • ?? ???? ???????? ?? ??????? ???? ???? ??? ???
    ???? ????
  • ?????
  • ??? ??????
  • ????????
  • ??????? (( ???????? _ ???????? _ ??????B _
    ?????????? ))
  • ?????
  • ??? ???? ?????
  • ????????? ?????????

9
  • ??? ??????? ????
  • ?? ??? ???? ??? ??? ??????? ???? ???? ??? ??????
    ???????
  • ???? ????? ?????? ?? ??? ???? ????? ?????
  • ?????? ???? ????????? ???????? ?????????
  • ????? ????????? ???????????? ??? ?????
    ?????????
  • ?????????
  • ????????? (( ???? . ??????? . ?????? ??? A . B .
    C,CMV, Herps. Ep ))
  • ????????? (( ?? , ?????? , ????? , ?????????? ,
    ???????? ))
  • ?????? (( ???????? ????? , ???? ????? ))
  • ???????? (( ????????? , ??????? ???????

10
  • ???????
  • ??????? ????????? ?? ???? AP
  • ???? ?????? ???????? ?????? NO.IDEA
  • N NSAIDs ( ???????? , ????????? )
  • O Other ( ???????? )
  • I ????? IBD (( ??????????? , ASA5 ))
  • Immunosuppressats (( ??? ??????? ,
    6??????????? ,
  • ???????????
  • D Diuretice (( ????????? , ?????? ))
  • E Estrogens
  • A Antibiotic (( ???????????? , ????????? ,
    ????????? ,??????????????
  • Aids (( Didanosine. Pentamidine))
  • ACE ???? AP ?????? ???? ??????
    ?????????

11
  • ?????? ????????? ???????
  • ???? ?????? ?? ?????? ??? ?? 35 ???
  • ????? ?? ??? ???? ????? ?? ??????? ????? AP
  • ????? ??? ??? ?? ????? AP
  • ???? ?? ???? ????? ??? ???? ???? ????? ?????
  • ???? ?????? ?? ????? ??????
  • ??????? ????????
  • ???????? ??????? (( SLE , ?????? ???????? ??????
    ))
  • ?????? ?? ???????? ???????????? ?? ?????? ???
    ?????????

12
  • ???? ?????
  • ?????? ?????????
  • ??? ????? ???????
  • ?????? (( ???? ??????? ???????? ))
  • ?????? ???? ????
  • ?????? ????????? ??? ERCP

13
(No Transcript)
14
  • ?
  • ??????? ? ????????

15
  • ??????? ????????
  • ????? ??????
  • ???? ?? ???? ????? ?????? ????????? ?????
  • ???? ?????? ?????? ????? ?? ?????? ?????? ???????
    ?????? ??????
  • ???? ???? ????? ?????? ??? ????? ????? ???? ?????
  • ????? ???? ????? ?????
  • ??? ???????? ?????? ?????????
  • ?? ???? ????? ?? ?? 5_10 ?? ???????
  • ??????? ???????? ???? ??? 90 ?? ??????
  • ?? ???? ???? ????? ???? ????? ???? ?? 1_3 ????
  • ?? ???? ??? ?????? ( ?????? ??? , ?????? , ????
    ?????)
  • ?? ???? ???? ??? ( ??? ??? , ???? , .... )
  • ??? ???? , ????? , ???? , ????

16
  • ????????
  • ?? ????? ????? ??????? ???? ?????? ????????
  • ?? ??? ???? ???????? (( ???? ?????? , ????
    ????????? ))
  • ???? ????? ???? ??? ?????? ?????? ??????? (( ????
    ????
  • ???? ?????? ???? ???? ?????? ???????
  • ?? ??? ??? ????? ?????????? ( ??? ????? )
  • ?? ????? ( ????? )
  • ??????? ??? ?????
  • ??? ???? ????? ??? ?????
  • ?????? ???? ???? ??????
  • ?????? ?????

17
  • ???? ??? ????? ??????????

18
Ranson critiria
??? ?????? ??? 48 ????
????? gt 55 ?????? ???????? Ht gt 10???
??? ???? gt 200 ????? BUN ???? ?? 5 ??? ??????
WBC gt 16000 ??????? lt 8 ???
LDH gt 350 ???? / ?? Pao2lt 60 ??? .?
AST gt 250 ???? / ?? ??? ?????? gt 4 ????? / ?
?????? ????? gt ?? 6 ?
??? ?????? 0 _ 1 _ 2 ( ??????? lt 5 )
??? ?????? 3_ 4 _ 5 (??????? lt 10 )
??? ?????? gt ?? 6 ( ??????? gt 60 )
19
?????? ApachII
  • ???? ?? ?????? ?????? ?? ??????? ????? ??????
  • ????? ????????? ????? ??? ????? ???? ????
    ????????? ????????
  • ??? ???????? 1- ??????? 2- ???? ?????? 3- ????
    ?????
  • 4- ??????? 5- ????? ????? 6- PH
    ????????
  • 7- ??????? ????? 8- ????????????
    9- ??????????
  • 10- ?????? ????? 11- ????????
    ?????
  • 12- ????? ?????? ??????
  • ??? ?????? lt 8???? 48 ???? ( ???? ?????? ???? )
  • ??? ?????? gt 8?????? ???? ?????

20
?????? ?????
  • ?? ?????? ?????? ????? ?? ???? ??? AP ?????? ??
    AP ??????
  • CRP ?? ???????? ????? ?????
  • ??????? ???? ????? 94
  • gt 210 ??? 48 ???? ???? ??? AP ??????
    ??????
  • ????????? 6 ( IL6 ) ?? ???????? ????? ?????
  • ??????? ?????? ?? AP ????? ????
  • ???????? ??????? ????? ?????? ?????
  • ???? ????? ?? ?????? AP ??????
  • ????? ????????????? ?????? ?????? TAP
  • ???? ????? ????????? , ????? , ????? ???? 48
    ????
  • ???? ?? ???? AP ?????? ?? ??????

21
  • ?????? ??????? ?????? ???????
  • gt3 ?????? ??????
  • gt 8 ?????? ApacheII
  • ???? ??????? ( ?????? ?????? )
  • ???? ( ????? ????????? lt 90 ??? .? )
  • ???? ????? Pao2 lt 60 ??? .?
  • ???? ???? Cr gt 2 ???
  • ??? ???? gt 500 ?? ???? 24 ????

22
????? ?????? ?????????
23
  • ???????
  • ????????
  • 40 ?? ?????? ????? ????? ????????? 60 ?????
    ????????
  • ???????? ????? ?????????? ???? ?????? Ap
  • ???? ???? ??? ???? ???????? ?????
  • ????? ?????? gt 3????? ?????? Ap
  • ????? ???? 6?12 ???? ????? ??????? ???? 3?4 ????
  • AP ?? ???????????
  • 1? 2? 3 ????? ?????? 2? ?????? ?????3? ??? ???
    ???? 4? ????? ???? ???? 5? ?????? ???? ????

24
  • ????? ?????? ?????? ?????
  • 1- ????? ?????????
  • AP ????? Ap ??? ?????? ????? ?????????
    ???????
  • 2- ???? ????? ????? ??????
  • ?????? ??????? ?????? ??????? ?????? (
    ??? , ???? ,????? ?????..) ??? ????? ????? ??
    ?????? ?????? ??????? ??????? ???????? ??????
    ( ???? ??? ???? ?????? ?????? ,?????? ???? ????
    )
  • 3- ????? ????? ????????
  • 4- ??????? (?????? ?????? )
  • 5- ???? ???? ????
  • 6- ???? ?? ???? ???? ????
  • 7- ?????? ???????
  • 8- ????? ??????
  • 9- ???? ?????
  • 10- Macroamelazema
  • 11- ?????? aids

25
  • ???????
  • ????? ?????? ???? 24 ???? ??????
  • ???? ??????? ????? ???? ?? ???????? ( gt ?????
    ?????? ????????? )
  • ?????? ???????? ???????? ??????? ???? ??????? gt
    ?????? ( ??? ?? ???? ??????? ?? ????????? ?????
    ???? ?? ?????? ???????? )
  • ????? ??????? ?? ??? ???? Ap
  • ???? ?????? ??????
  • ????? ????? ?????? ???? lt 3 ?????
  • ??????? ???????? ??????
  • ????? ????? A ? ????? ????? A2 ? ????????
    ??????????
  • ??? ???? ???? ???? ?? ???????? ???????? ?? ?????
    Ap
  • ???????????? ????? ?????? ???? ?? ????? Ap
    ?????? ??? ERCB

26
  • ?????? ??? ?????
  • CRP - ???????? ????????? ??????? ????
    ????? ?????? ???? ????? 6 ( ?? ????? ????????
    ?????? )
  • ???????? ???? ????????
  • WBC ?????? ????? ????? ?? ???????? ??????
  • ??? ???? ?????? ????? ??????? ?? ??????? ??????
    ?? ??????????
  • ?? ????? ??? ALT AST - ALP - ????????? (
    ???? ?????? ????????? ??????)

27
  • ??????? ???????
  • 1- ???? ????? ???????
  • ???? ????? ????? ?????? ( ?????? , ?????? )
  • ???? ???? ???? ?? ??????? ??????? (?????? ???????
    )
  • ?? ????? ??????? ??????? ( ?????? ????????
    ??????? ???? ????? ??????? ??? ?????? )
  • ?????? ?? ??? AP ????? ??? ??????
  • ???? ????? ????????
  • ?????? ??? ?????? ???? ??????? ????
  • ?????? ????
  • ???????? ?????

28
  • ?????? U/S
  • ???? ????? ????? ?????????? ??? ??? ???? ?????
  • ???? ???????? ??? ?????????
  • ?? ????? ???? ????? ?? ???? ??????? ?? ?????
    ???????
  • CT SCAN
  • ???? ??????? ??????? ?????? ?????? ( ?????? ?????
    . ??????
  • ????? ???? ?????? ?????????
  • ???? ???????? ??? ??? ??? ????? ????? ?? ?????
    ??????????
  • ?? ?? ???? ????? ????? ??? ??? ?? 48 ??? 72 ?? ??
    ????? ????????

29
U/S IN AP
30
CT and acut pancrititis
31
  • ??? ?????? ????????? ????? CT
  • ???? ?????? ?????????
  • ???? ???? ?? ????? ?????????
  • ?????? ??? ?????????
  • ???? ????? ???? ??? ?????????
  • ???? ????? ?? ?????? ?? ????
  • ERCP
  • ?? ?????? ?????? ?????? ????????? ??? ?? ???
    ????? ?????? ?? ?????? ??????? ?? ??? AP ??????

32
  • ERCP

33
  • ???????? ?????? ?????????
  • 1. ??????? ???????
  • ????? ??? ???? ?????? ?? ????????
  • ????? ?????? ?????? ???????? ?? ???? ??? ??????
  • 85 ????? ?????? ??????? 15 ?????? .
  • 2. ???????
  • ???? ???? ???? ???? ????? ???????? ??????
  • ???? ???? ????? ????? ?????????? ?? ????? ???????
    ???????

34
(No Transcript)
35
  • ?????????? ????????
  • 1. ?????? ????? ????? ???????? ?????? ??????? .
  • 2. ???? ???? ??? ????? ??? ??????? ???????
    ?????? ???????? ????? .
  • 3. ???? ????? ????? ??????? ????? ??????? ARDS
  • ??? ???????? ??????? ???????? ???????
  • 4. ????? ?????? ???? ?????
  • ????? ?????
  • ?? ????? ?????? ???????? ????? ???? ???? ?????
    ???????? ?????? ?? ?????? ?????? ?? ?????? ?????
    ?????? ???????? .
  • ????? ?? ????? .
  • 5. ??? ???? ??? ?????? ???? ?????? ?????? ?????
    ??? ?????.
  • 6. ?????? ?????
  • 7. ?????? ??????? ?? Purtscherc
  • ?? ?????? ???? ??? AP ???? ??? ??? ????? ????
    ?????? ??????? ?????? ?????? .

36
  • ??? ????? AP
  • AP ??????
  • ????? ???????? ??????? ( ????? ??????? ???????
    ???? ?????? ????? ???? ???? ?? ??? ???? ?????
    ???? ?? ???? ????
  • ?? ???? ?????? ?????? ??????? ???????
  • AP ??????
  • ??? ?????? ??? ?????? ?? ??????? ??????? .
  • ????? ???????? ????? ????????? .
  • ?? ??? ???? ??? ???????? ???????? ???????? ????
    ??????? ??????? .
  • ??????? ?? ?????? ????????? ??? ( Imipenem?
    ?????? ?????? ??? ????? ????????????
    ????????????? ???????????? .
  • ????????? ??????? ??????? ?? ???? ??????? ???????
    ??? ???? ????????? ???????? ??????.

37
  • ???? ????? ????????? ?????? ????????
  • ?????? ???????? ?????? ???????? ?? ?????? ???????
    ????? 20000 ?? ???? ????? ???? ????? ???? ???????
    .
  • ???? ????? ????? ???? CT ?? ????? ????? ?? ?????
    ??? ???????? ???????? ???? ?????? ??????? .
  • ??? ???? ????? ??? ????? ??? ????? ???? ??????
    ??????? .
  • ???? ??????? ???? ???? ???????? ( ????????
    Echoli? ?????????? ??????? ).
  • ???? ????? ????? ???? ??????? ???????
  • . ??? ?????? ?? ????? ?????????? ?????? .
  • ???? ??????? ???? ????????? ???? ???? ??? ??
    ?????? ??????? ??????
  • ???? ?????? ????? ???? ???? ????? ????????
  • ??????? ???????
  • ??? ?? ?????? ?????? ?????? ( ????? ????? ) ????
    ?????? ??????? ???????? ?????? ?? ????? ??????
    ???????? .

38
????? ???? AP
????
???? ? ?????
CT ?? ???? ?????
????? ???
???? gt 30
???? lt 30
????? ?????? ????
??????
????
??? ???? ???? CT
?????? ???? 3 ??????
????
???? ????????
????? ?????
????? ????????
????? ?????
39
(No Transcript)
40
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