By Prof. Dr. med. P. G. Lankisch, Prof. Dr. med. M. Büchler, Prof. Dr. med. J. Mössner, Prof. Dr. S. Müller-Lissner (auth.)
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Abstinence from alcohol may alleviate the pain. A decrease in pain and the course of exocrine and endocrine insufficiency do not run in parallel. Social consequences Within 10 years 25 % of the patients retire, in half of these cases retirement is due to pancreatitis. Prognosis Very few patients die from chronic pancreatitis itself. The main causes of death are cardiovascular diseases and malignant tumours. 38 Incidence, course and prognosis % of patients lOa 50 Functional impairment req uiring pancreatic enzyme supplementation or insul in O__+-__________________~ lr~ ea ~t~ m ~e ~n ~t________~----- o Yea rs 10 Mortality 20% over 10 years 39 Chronic pancreatitis Diagnosis: overview Functional examinations The morphological alterations and the functional impairment do not run in parallel.
40 Diagnosis: overview Morphological examinations • Ultrasound • Endoscopic retrograde cholangiopancreaticography (ERCP) • Computed tomography • Plain abdominal X-ray Function tests • Indirect pancreatic function tests • Direct pancreatic function tests • Faecal fat analysis • Oral glucose tolerance test 41 Chronic pancreatitis Symptoms Pain The pain mosdy takes an undulating or intermittent course and can impair the quality of life decisively. The main localization is the middle and left upper abdomen, frequendy with radiation to the back.
Heparin When required • Correction of acid-base balance • Catecholamines for hypotension despite volume replacement • Insulin in the event of hyperglycaemia > 250 mg% • 02 by nasal intubation in the event of p02 < 70 mm Hg • Controlled ventilation in the event of p02 < 50 mm Hg • Haemodialysis in the event of acute renal failure • Fresh plasma in the event of coagulation disorders • Parenteral feeding Antibiotics in the event of necrotising pancreatitis • If possible, according to antibiotic sensitivity tests (fine needle aspiration, blood culture) • Otherwise, empirical therapy: - ureidopenicillin + metronidazole - cefuroxime - 3rd generation cephalosporin + metronidazole • Carbapeneme (imipenem, meropenem) 1 2 2 gl24 h as infusion e.
A Primer of Pancreatitis by Prof. Dr. med. P. G. Lankisch, Prof. Dr. med. M. Büchler, Prof. Dr. med. J. Mössner, Prof. Dr. S. Müller-Lissner (auth.)