tailieunhanh - Emergency critical care and decision making: Part 2

(BQ) Continued part 1, part 2 of the document Emergency critical care and decision making has contents: Acute leukemia, platelet disorders and hemostatic emergencies, sickle cell disease, transfusion therapy, principles of antimicrobial therapy, electrolyte disorders, acute kidney injury and renal replacement therapy, and other contents. Invite you to refer. | 26 Pancreatitis Susan Y. Quan and Walter G. Park BACKGROUND The pancreas is approximately 6 to 10 inches long is located directly behind the stomach and has distinct endocrine and exocrine functions. The endocrine portion of the pancreas is composed of islets of Langerhans cells that constitute about 2 of the organ. These cells produce and secrete hormones including insulin glucagon and somatostatin. The exocrine portion of the pancreas is composed of acinar cells 80 of the organ and ductal cells 18 of the organ . Acinar cells produce digestive enzymes that are sequestered until physiologic impulses stimulate their release into the pancreatic ductal system where they are transported to the small intestine. The digestive enzymes are enzymatically inert until activated in the small intestine by various peptides. Disruption of this physiologic process by any of a variety of etiologies is the basis for our current understanding of acute and chronic pancreatitis. This chapter primarily focuses on acute pancreatitis which is more commonly seen in emergency care. Pertinent aspects of chronic pancreatitis are also addressed. ACUTE PANCREATITIS The incidence of acute pancreatitis is estimated to be as high as 38 per 100 000 patients and accounts for more than 220 000 hospital admissions in the United States Most cases are clinically mild and self-limited a minority of cases are severe and are associated with critical illness prolonged hospitalization infection organ failure and death. Acute pancreatitis occurs from premature activation of digestive enzymes within the pancreatic parenchyma leading to an autodigestive and inflammatory process. Evolution into a life-threatening systemic process begins when acinar cell injury leads to expression of endothelial adhesion molecules that further potentiates the inflammatory response. Local microcirculatory failure and ischemia-reperfusion injury ensue with some patients developing systemic complications such as systemic