CAZ 56

Barbat, 52 ani, potator cronic, se prezinta in urgenta

acuzand dureri abdominale epigastrice cu iradiere in
hipocondrul drept si stang, greata varsaturi, sindrom
febril 37,8 grade C, simptome debutate in ultimele 24
de ore.

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