“Pancreatitis aguda de origen biliar”

Abstract

Acute pancreatitis is characterized by inflammation and partial destruction of the pancreas, is accompanied by a systemic inflammatory reaction that can cause complications or damage to distant organs. Serious complications usually occur within the first 48 hours after admission, which is why it is important to have simple tools that allow accurate and early prediction of the severity of this pathology, several have been proposed scales, however, the complexity of some and the time required by others make it necessary to look for more accessible options. The present case is about an 87-year-old female patient with a personal pathological history of arterial hypertension. Patient comes to present abdominal pain accompanied by nausea and vomiting, 24 hours later presents jaundice. At the icteric physical examination, febrile, dehydrated, diaphoretic, hypotensive, diminished vesicular murmur, crepitan rattles. Painful abdomen to deep palpation in right hypochondrium, positive Murphy. The patient is diagnosed with sepsis of biliary origin, cholangitis, pneumonia acquired in the community. Patient on his fifth day of hospitalization presents a deterioration of clinical condition, referring abdominal pain, hypotension, jaundice and dyspnea. The characteristic of abdominal pain that it presents is suggestive of pancreatitis, in addition to presenting an amylase and lipase 4 times being diagnosed of acute pancreatitis of biliary origin, sepsis of biliary origin, cholangitis, bilateral pleural effusion. After six days of performing ERCP, the bile duct was examined, responding favorably to this procedure, but the continuous infectious process after 18 days of hospitalization dies due to cardiorespiratory arrest after septic shock, the importance of this case lies in the awareness of the management of a critical patient where decision making takes radical importance. In the present case, it was revealed, step by step, how to establish a septic process and the consequent multiorgan failure that it causes. Additionally, it is important to take into account certain observations that the case under study has left us.