Caz 57

Femeie, 44 ani, cu obezitate gr. 3, se prezinta in

urgenta acuzand dureri abdominale preponderent in
etajul abdominal superior, debutate in urma cu 4 ore
dupa ce a mancat crenvusti.

PANCREATITA ACUTA dg+++++

ANAMNEZA ==MOMENTUL ALIMENTAR (MESE COPIOASE)
BOGATE IN PROTEINE LIPIDE
VARSTATURI ! Durerea epigastrica!!
Ex paraclinice
LIPAZA 8X VN ENZIMELE HEPATICE ASAT ALAT 3XVN BT 3X
HEMOLEUCOGRAMA(ANEMIE?)PCR necroza TULB
helectrolicitce NACL K up/down Ureea serica III DESH.IR
Glicemie OOOiii VSH necroza
Bilirubina OOOoooo
ECOGRAFIE-Rx-DG DIF pt ulcer perforat /ocluzie ERCP
RMN urmatoarele zile pt evolutie tratament
DG diferntiar----PERFORATIA DE ORGAN ulcer gastro duodenal
Colecistita acuta greu de diferentiat ajutor LIPAZA crescuta
OCLUZIA INTESTINALA nivele hidro aerice
INFARCTUL ENTERO-MEZENTERIC diareea sanguinolenta
DURERI COLICATIVE-INTENSE colica renala LIPAZA
INFARCT MIOCARDIC ASAT>ALAT
SINDROAME RETROPERITONEALE ACUTE(ANEVRISM DISECANT
DE AORTA_
CETOACIDOZA DIABETICA (NU CRESTE LIPAZA)
CANCER DE CAP DE PANCREAS
PANCREATITA CRONICA FORMA ALGICA
TRATAMENT--- calmarea durerii XILINA 1% IV
ANTISPASTICE papaverina 100x2/4 ori pe zi
Reducerea secretiei pancreatice ATROPINA PEV suspendare
aport alimentar /aspiratie gastrica sonda / lichide reci sonda
inhiba tonus vagal/
REEchilibrare Hidro electroltica
Hipovolemia NAcl izotona Kcl
Trat antiinfectios amoxiklav 1000mgx2/zi
Alimentatia hipercalorica parenterala –50kcal/kg/zi
Tratament chirurgical—drenaj celiostoma
Trat chirurgical al pseudochistului chistograstroanastomoza
endoscopica