Pancreatitis crónica
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Transcript of Pancreatitis crónica
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PancreatitisPancreatitis
CrónicaCrónica
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PANCREATITIS CRONICAPANCREATITIS CRONICA
EpidemiologíaEpidemiología•La verdadera incidencia y prevalencia de la pancreatitis crónica no es bien conocida aunque su frecuencia ha aumentado en las últimas décadas.
•Se estima que la incidencia de la pancreatitis crónica se sitúa en torno a 6,7 casos para hombres y 3,5 para mujeres cada 100.000 habitantes en el mundo, causado principalmente por el consumo continuado de alcohol.
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Pancreatitis CrónicaPancreatitis Crónica
Enfermedad Inflamatoria
• Crónica
• Irreversible
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PANCREATITIS CRONICAPANCREATITIS CRONICA
ETIOLOGIAETIOLOGIA• Alcohólica (70%)Alcohólica (70%)• No alcohólicaNo alcohólica
- Tropical - Tropical (nutricional)(nutricional)
- Hereditaria- Hereditaria- Metabólica - Metabólica (hipercalcemia)(hipercalcemia)
- Autoinmune- Autoinmune- Idiopática- Idiopática
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Chronic Pancreatitis and Pancreatic Exocrine Insufficiency: Tigar-O Classification System
Toxic-metabolic Alcoholic Tobacco smoking Hypercalcemia Hyperlipidemia Chronic renal failure Medications—phenacetin abuse Toxins—organotin compounds (e.g.,
DBTC) Idiopathic
Early onset Late onset Tropical
Genetic Hereditary pancreatitis Cationic trypsinogen PRSS1 PRSS2 CFTR mutations SPINK1 mutations
Autoimmune Isolated autoimmune chronic
pancreatitis Autoimmune chronic pancreatitis
associated with Sjögren's syndrome Inflammatory bowel disease Primary biliary cirrhosis
Recurrent and Severe Acute Pancreatitis
Postnecrotic (severe acute pancreatitis) Recurrent acute pancreatitis Vascular diseases/ischemia Postirradiation
Obstructive Pancreas divisum Sphincter of Oddi disorders
(controversial) Duct obstruction (e.g., tumor) Preampullary duodenal wall cysts Posttraumatic pancreatic duct scars
Abbreviations: DBTC, dibutylin dichloride; TIGAR-O, toxic-metabolic, idiopathic, genetic, autoimmune, recurrent and severe acute pancreatitis, obstructive.
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Pancreatitis autoinmuneCaracterísticas clínicas
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Pancreatitis CrónicaPancreatitis Crónica
I- Daño anatómicoI- Daño anatómico
II- Daño funcionalII- Daño funcional
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Pancreatitis CrónicaPancreatitis Crónica
- Células ascinares
- Conductos pancreáticos
I- Daño anatómicoI- Daño anatómico
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• Conductos pancreáticos:• presencia de cálculos• tortuosidad• dilatación
• Parénquima:• zonas de fibrosis
DOLORCRONICO
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Pancreatitis CrónicaPancreatitis Crónica
II.- Daño funcionalII.- Daño funcional
• Insuficiencia pancreática exócrina
•Insuficiencia pancreática endócrina
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PANCREATITIS CRONICAPANCREATITIS CRONICA
Cuadro ClínicoCuadro ClínicoDolor
INSUFICIENCIA PANCREATICA EXOCRINA
INSUFICIENCIA PANCREATICA ENDOCRINA
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PANCREATITIS CRONICAPANCREATITIS CRONICA
Cuadro ClínicoCuadro ClínicoDolor
DIARREA CRONICA S A I D
INSUFICIENCIA PANCREATICA EXOCRINA
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PANCREATITIS CRONICAPANCREATITIS CRONICA
Cuadro ClínicoCuadro ClínicoDolor
INSUFICIENCIA PANCREATICA EXOCRINA
INSUFICIENCIA PANCREATICA ENDOCRINA
DIABETES
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PANCREATITIS CRONICAPANCREATITIS CRONICA
Cuadro ClínicoCuadro Clínico• Dolor
• Pérdida de peso
• DIARREA CRONICA
• DIABETES MELLITUS
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PANCREATITIS CRONICAPANCREATITIS CRONICA
DiagnósticoDiagnóstico• T A C
•US Endoscópico
• CPRE
- sensibilidad – 90%
- especificidad – 100%
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DiagnósticoDiagnóstico
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DiagnósticoDiagnóstico
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A. Chronic pancreatitis and pancreatic calculi: CT scan. In this contrast-enhanced CT scan of the abdomen, there is evidence of an atrophic pancreas with multiple calcifications and stones in the parenchyma and dilated pancreatic duct (arrow).
B. In this contrast-enhanced CT scan of the abdomen, there is evidence of an atrophic pancreas with multiple calcifications (arrows). Note the markedly dilated pancreatic duct seen in this section through the body and tail (open arrows).
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C. Chronic pancreatitis on MRCP: dilated duct with filling defects. Gadolinium-enhanced MRI/MRCP reveals a dilated pancreatic duct (arrow) in chronic pancreatitis with multiple filling defects suggestive of pancreatic duct calculi.
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Algoritmo diagnósticoAlgoritmo diagnóstico
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PANCREATITIS CRONICAPANCREATITIS CRONICA
TratamientoTratamiento• Abstinencia de alcohol
•Al no conocer la etiología, el tratamiento es sintomático
•La abstinencia total de alcohol no previene la progresión de la enfermedad, pero disminuye dramáticamente las complicaciones y mejora el pronóstico.
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PANCREATITIS CRONICAPANCREATITIS CRONICA
TratamientoTratamiento• MANEJAR DOLOR
•Analgésicos y/o antiespasmódicos
•El dolor incontrolable, es la indicación más frecuente de intervenciones invasivas
•Descompresión o resección
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PANCREATITIS CRONICAPANCREATITIS CRONICA
TratamientoTratamiento• Dieta• Enzimas pancreáticas
• Bloquear la acidez gástrica
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PANCREATITIS CRONICAPANCREATITIS CRONICA
PronósticoPronóstico• Ésta es una enfermedad grave que puede conducir a la incapacidad o a la muerte. El riesgo puede reducirse evitando el consumo de alcohol.
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PANCREATITIS CRONICAPANCREATITIS CRONICA
ReferenciasReferencias• Principios de Medicina Interna. Harrison. Mc Graw Hill. 2012