Presenter R3 吳聖婷 Supervisor Attending 王建得 Patients profile Name 莊 O C Age 13Y9M Sex Male Chart No CCCCC Admission date 1061211 Chief Complanit ID: 1033013
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1. Acute pancreatitis in pediatricsPresenter: R3 吳聖婷Supervisor: Attending 王建得
2. Patient’s profileName: 莊OCAge: 13Y9MSex: Male Chart No.:CCCCCAdmission date: 106/12/11
3. Chief Complanit X 4 hours
4. Clinical Coarse X 10 days -> LMD: symptomatic control medication 12/1 12/11 0am 12/11 3am (竹山秀傳 ER) our PERLab:↑amylase(402) , ↑ lipase(622) Tx: Ranitidine and buscopan Lab:leukocytosis( WBC: 15060),↑ amylase(438) and ↑ lipase(588)Abdominal sonograpgy: 1.Mild hepatomegaly, 2.Intestine ileus, 3.Ascites.
5. OthersBirth history: G3P2A1, C/S, BBW: ~ 3000gmFamily history: Parents: both thalassemia minorolder sister died shortly after birth due to severe thalassemia.
6. Lab
7. Impression1. Acute pancreatitis2. Thalassemia
8. Image
9. TreatmentPain control with PethidineNPO until no vomitingFluid supplement
10. Acute pancreatitis in pediatrics
11. Etiologies25% unknown<5% idiopathicRef: Nelson Textbook of Pediatrics 20th
12. HistopathologyInterstitial edemaLocalized and confluent necrosisBlood vessel disruption leading to hemorrhage,Inflammatory response in the peritoneum
13. Criteria2 of 3 of the following: abdominal painserum amylase +/- lipase > 3x ULNimaging findingsRef: Nelson Textbook of Pediatrics 20th
14. Clinical ManifestationsMild Acute PancreatitisSevere abdominal pain(87%), persistent vomiting(64%), possibly fever.The pain increase in intensity for 24-48 hrThe prognosis : excellent
15. Severe Acute Pancreatitis (rare)Severe nausea, vomiting, abdominal pain.Shock, high fever, jaundice, ascites, hypocalcemia, PLECullen sign or Grey Turner sign: necrotic, inflammatoryMortality rate: ~ 20%The percentage of necrosis on CT scan : the severity of the disease.
16. LABLipase: rises by 4-8 hr, peaks at 24-48 hr, remains elevated 8-14 days Amylase : elevated for 4 daysOthers: HCT↑, WBC↑, glucose↑, rGT↑, Bilirubin↑, glucosuria, coagulopathy, Ca↓
17. Abdominal X-rayssentinel loop, dilation of the transverse colon (cutoff sign)Ileuspancreatic calcification (if recurrent)blurring of the left psoas margina pseudocystDiffuse abdominal haziness (ascites)peripancreatic extraluminal gas bubbles.
18. UltrasonographyPrimary screening toolAbsence of ionizing radiationThe ability to image without sedation
19. Abdominal CTPancreatic enlargementHypoechoic, sonolucent edematous pancreasPancreatic massesFluid collectionsAbscesses≧20% children initially normal
20. Severity
21. TreatmentRelieve pain and restore metabolic homeostasisFluid, electrolyte balanceIf Vomiting: NG, NPOEarly refeeding(within 2-3 days of onset): the complication rate↓ and length of stay↓.Recovery : within 4-5 days.Antibiotics: infected necrosis, prophylacticAcute pancreatic pseudocysts <5 cm: OBS 4-6 weeks. >5 : may require surgical intervention.
22. ConclusionLab: CBC/DC, GOT/GPT, rGT, amylase/lipase, BUN/Cr, CRP, LDH, electrolyte(Na,K,Cl,Ca), ABG, glucose, TG/cholesterolImage: Abdominal X-ray, Abdominal sonography, abdominal CTTreatment: Pain control(Acetaminophen, Tramadol, Demerol)Fluid suppulment, nutrition supportAntibiotic if necrotic pancreatitisNG tube if vomiting,
23. Chronic pancreatitisGenetic mutations Congenital anomalies of the pancreatic or biliary ductal system.
24. ReferanceNelson Textbook of Pediatrics 20thMedscape