pancreatitis 2015.ppt
TRANSCRIPT
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UNIVERSIDAD NACIONAL DEL CALLAOFACULTAD DE CIENCIAS DE LA SALUD
Docente: Mg. Pilar Moreno Obregón
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PANCREATITIS AGUDA
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ANATOMIA
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FUNCIONES DEL PANCREAS
• Función Secretora EXOCRINA:– Enzimas Digestivas
• Función Secretora ENDOCRINA– Insulina– Glucagón– Somatostatina
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PANCREATITIS AGUGA
• Inflamación del pancreas
• Frecuente en nuestro medio
• Puede llevar a la muerte
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ETIOLOGIA DE PANCREATITIS• Litiasis vesicular - Coledocolitiasis
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ETIOLOGIA DE LA PANCREATITIS• Alcohol: Segunda causa
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ETIOLOGIA DE LA PANCREATITIS
• Litiasis y el alcohol = 80% de las causas
• Otras causas– Farmacológicas– Hipertrigliceridemia– Alteraciones anatómicas– Traumáticas
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OTRAS CAUSAS
• Se desconoce la causa hasta en el 20 %
• Microlitiasis y barro biliar
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SIGNOS Y SINTOMAS
• Dolor Abdominal• Náuseas• Vómitos• Ictericia
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DIAGNOSTICO
• CLINICO: Dolor Abdominal
• LABORATORIAL:– Amilasa: Más de 3 veces el valor normal– Lipasa: Más de 3 veces el valor normal– Diferencia: EL TIEMPO
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TIPOS DE PANCREATITIS AGUDA
• LEVE
• SEVERA
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PANCREATITIS AGUDA LEVE
• HIDRATACION
• ANALGESIA
• OXIGENACION
• DESCOMPRESION GASTRICA
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Cloruro Sodio 0.9%: 250-300 cc/h
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Petidina es la indicación universal
50-100 mg e.v. cada
3-4 horas
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02 x CANULA BINASAL SUELE SER SUFICIENTE
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SONDA NASOGASTRICA
Mantenerla sólo mientras haya
drenaje.
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DETECCION SEVERIDAD
• Complicaciones Locales
• Complicaciones Sistémicas
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LA TAC
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Páncreas NORMAL
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Páncreas NORMAL
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COMPLICACIONES LOCALES
• Absceso Pancreático
• Necrosis Pancreática
• Pseudoquiste Pancreático
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NECROSIS
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Pseudoquiste pancreático
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COMPLICACIONES SISTEMICAS
1. Circulatorias
2. Respiratorias
3. Renales
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ALTERACION CIRCULATORIA
PAS < 90 mmHg
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ALTERACIONES RENALES
Creatinina sérica > 1.5 mg
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PO2 < 60 mmHg
EN LA PRACTICASatO2 < 95%
COMPLICACIONES RESPIRATORIAS
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Sangre roja o negra, la SNG en más de 500 cc
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TRANSFERENCIA A UCI
La aparición de cualquiera de estos hallazgos por más de 48 horas y que no responde a rescate inicial es razón suficiente para transferir al paciente a una UCI.
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MANEJO NUTRICIONAL
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LA NUTRICION
• 30 kcal/kg peso.
• 1 cc de volumen x cada kcal.
• Empezamos con el 30% y en 3-4 días estamos en el 100%.
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EN EL ADULTO MAYOR
• Hay MAYOR RIESGO
• Criterios de RANSON– Edad > 55 años– Leucocitos > 16000– TGO > 250– LDH > 350– Glucosa > 200
MAS DE 3 PUNTOS:
RIESGO DE SEVERIDAD
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CIRUGIA ES SIEMPRE EL ULTIMO RECURSO
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