0:00

Okay, so now we've come to midline upper

0:02

abdominal pain, and the major player in

0:05

midline upper abdominal pain is the pancreas.

0:08

As I've said, the kidneys are hardworking.

0:10

The gallbladder is stupid.

0:12

I can tell you the pancreas is mean.

0:15

The pancreas, the pancreatic juice

0:16

basically can digest your interior of

0:19

your body, so it is not to be played with.

0:21

To know the anatomy of the

0:22

pancreas is really important.

0:24

You can see that the pancreatic duct drains with

0:27

a common bile duct into the duodenal papilla.

0:29

The vessels are very intricately

0:32

oriented around the pancreas.

0:33

It is a retroperitoneal organ

0:35

in the anterior pararenal space.

0:37

It's very loosely covered in a fascial layer.

0:41

It tends to allow its juices to

0:44

radiate throughout the entire abdomen.

0:46

The drama of pancreatitis is something that

0:49

cannot be seen in many other entities in the body.

0:52

So we always like to say in acute pancreatitis, or

0:55

pancreatitis, treat the patient, not the images.

0:57

Because sometimes the images are so dramatic.

1:00

But let's go into a few things.

1:02

What are some causes of pancreatitis?

1:04

Uh, we just saw the gallstone pancreatitis.

1:06

That's a very common cause of pancreatitis

1:08

and definitely something we fear so

1:09

frequently, if a patient comes in with.

1:12

Midline abdominal pain.

1:13

The first study that would be needed for that patient

1:16

would actually be a right upper quadrant ultrasound to

1:18

determine if they have gallstones, if they have choledocholithiasis,

1:21

if that's the cause for their pancreatitis.

1:25

Now, you know, maybe if they had the vodka actually

1:27

stapled to their hand, we wouldn't do that.

1:29

But I have to say, we probably would

1:30

look for gallstones even in the case of

1:32

a patient who's suspected for alcohol,

1:34

just because we wouldn't want to miss that.

1:36

There are a lot of drugs that can cause pancreatitis.

1:39

You can get pancreatitis from trauma.

1:41

It is quite devastating.

1:43

I had to write a whole talk on it, and I can tell

1:45

you I will not ride one of those Lime scooters

1:47

'cause they are right at the level of the pancreas.

1:50

You can definitely get pancreatitis from fatty foods.

1:53

We had a gentleman who had gone to

1:55

GNC to get the high lipid supplement and

1:58

unfortunately got pancreatitis and died.

1:59

So be really careful with any of those high lipid

2:02

supplements you may be taking with your weightlifting.

2:04

Those can be very bad for your pancreas.

2:06

And of course, you know the scorpion bite, which

2:08

we all love in the differential in medicine.

2:10

Of course, a scorpion is not

2:12

even available to you in America.

2:13

But still, always fun to put on the list.

2:15

And I have to tell you, whenever I ask medical students

2:17

what are causes for pancreatitis, I tell you someone.

2:20

Always put scorpion number one, but there are

2:22

a lot of opportunities to get pancreatitis.

2:24

I would highly suggest steering clear of pancreatitis.

2:28

Well, here we have the ERCP from our patient who

2:30

indulged into much clam chowder, and we can see

2:33

these filling defects within the common bile duct.

2:35

They're very extreme.

2:36

You can imagine that these need to be

2:37

swept out of the duct in order to clear the

2:40

common bile duct and allow for bile to flow.

2:42

This is the endoscope here, which

2:44

is a cannulation portion here.

2:45

So this is indeed a very dramatic

2:48

case of choledocholithiasis.

2:50

But beware, if you come to Boston, be very careful

2:53

with your consumption of the clam chowder because

2:55

this is a real problem for us and it is a problem for.

2:59

Pancreatitis is if you have choledocholithiasis, and

3:02

we as radiologists need to exclude that by

3:04

either ultrasound or if we see it on CT scan.