Pancreatitis & Viral Hepatitis - GULF MEDICAL UNIVERSITY PDF

Pancreatitis Dr Muhammad Al-Shorbagy Professor of Pharmacology & Toxicology www.gmu.ac.ae COLLEGE OF PHARMACY By the end of this session, the student will be able to: Understand the pathophysiological changes in pancre...

Pancreatitis Dr Muhammad Al-Shorbagy Professor of Pharmacology & Toxicology www.gmu.ac.ae COLLEGE OF PHARMACY By the end of this session, the student will be able to: Understand the pathophysiological changes in pancreatitis Explain the difference between the presentation of acute versus chronic pancreatitis Understand the pharmacological treatment of acute and chronic pancreatitis 2 Introduction 3 Pancreatitis It is the inflammation of pancreatic parenchyma Types: 1. Acute: Reversible emergency condition Activated pancreatic enzymes leak into the substance of the pancreas and initiate the auto-digestion of the gland. Associated with raised pancreatic enzymes levels in the blood and urine. 2. Chronic: Permanent and irreversible damage to the pancreas Evidence of chronic inflammation, fibrosis and destruction of exocrine and endocrine tissues. 4 Pancreatitis Causes: BAD HITS Biliary tract diseases (gall stones causing obstruction) Alcohol intake Drugs (steroids, diuretics, valproic acid) Hypertriglyceridemia/Hypercalcemia Idiopathic Traumatic (operative trauma) Scorpion sting 5 Acute pancreatitis 6 Acute pancreatitis 7 Acute pancreatitis - symptoms Upper abdominal pain, sudden onset, sharp, severe & continuous Generalized abdominal pain Nausea, vomiting, & anorexia Fever and weakness Grey Turner’s sign Cullen’s sign Fox’s sign Panniculitis (subcutaneous red nodular fat necrosis) Panniculitis 8 Acute pancreatitis - investigations Blood tests - Serum amylase: elevated for 3-5 days - Serum lipase: more pancreatic specific, elevated for 7 days - CBC - CRP Imaging tests - Chest X-ray - Abdominal ultrasound - CT scan - MRI ERCP Endoscopic retrograde cholangiopancreatography 9 Acute pancreatitis - treatment Treatment goals Supportive care Decrease the inflammation Limit the risk for superinfection Identify and treat complications Treat cause (if possible) 10 Acute pancreatitis - treatment A. Anti-emetics: given I.V. B. Opioid analgesics: pethidine (I.M.) C. Patient is kept NPO (nil per OS) until pain free (2-3 days) D. Omeprazole or ranitidine I.V. E. Antisecretory drugs (somatostatin – octreotide) ⤋ pancreatic enzymes level F. Respiratory support (O2 mask) G. Aggressive fluid rehydration (I.V. fluids) H. Antibiotic therapy (Carbapenem – Fluroquinolones) Only if needle aspiration of necrotic material confirms infection 11 Chronic pancreatitis - symptoms Pain in upper abdomen Diarrhea Fatty stools, which are loose, pale, and don’t flush away easily Nausea and vomiting Shortness of breath Unexplained weight loss Excessive thirst and fatigue Diagnosis: as in acute cases Pharmacological treatment: ü Analgesics ü Artificial digestive enzymes (if enzyme levels are too low to digest food normally) ü Insulin (if complicated with diabetes) ü Steroids (if it is autoimmune pancreatitis) 12  Viral Hepatitis Portal Hypertension Dr Muhammad Al-Shorbagy Professor of Pharmacology & Toxicology November 10, 2024 www.gmu.ac.ae COLLEGE OF PHARMACY By the end of this session, the student will be able to: Understand the common features and classification of viral hepatitis types Explain the management and pharmacological mechanisms of various antiviral treatments in various viral hepatitis types Describe types of portal hypertension and their symptomatic manifestations Explain the pharmacological management of portal hypertension 14 Viral hepatitis – historical view 500 B.C. Written accounts of jaundice in Babylonia 400 B.C. Hippocrates describes “epidemic jaundice” 1941 Post-vaccination jaundice in >28K U.S. soldiers 1947 Hepatitis A and hepatitis B designation 1963 Hepatitis B Surface Antigen identified 1973 Hepatitis A identified by electron microscopy Mid-1970’s Hepatitis D recognized Mid-1970’s Non-A, Non-B hepatitis described Mid-1980’s Epidemics of “non-hepatitis A” enteric hepatitis 1989 Hepatitis C cloned and serological tests developed 1990 Hepatitis E cloned and characterized 15 Viral hepatitis – common features Early Prodromal Phase Occurs 2-3 weeks before jaundice Includes arthalgias, arthritis, rash, angioneurotic edema, fever Preicteric Phase GI symptoms (nausea, vomiting, abdominal pain, anorexia, changes in taste and smell, weight loss) Includes generalized malaise, myalgias, headache, fever Icteric Phase Fever declines Constitutional symptoms improve Convalescent phase Full recovery usually within 6 months 16 Viral hepatitis – differential features Features Hepatitis A Hepatitis B Hepatitis C Hepatitis D Hepatitis E Mean Incubation 30 75 50 35 40 period (days) Fecal-oral ✔ ✘ ✘ ✘ ✔ transmission Parenteral rare ✔ ✔ ✔ ✘ transmission Sexual ✘ ✔, common ✔, uncommon ✔, uncommon ✘ transmission Fulminant ~1%, 30% in