pancreatitis%20-%20acute
PANCREATITIS - ACUTE
Acute pancreatitis is inflammation of the pancreas that occurs suddenly.
Abdominal pain is the most prominent symptom of acute pancreatitis.
It is diagnosed by at least two of the following: characteristic abdominal pain, serum amylase or lipase levels ≥3 times the upper limit of normal and characteristic abdominal imaging findings.
Mild acute pancreatitis does not have any organ failure or local or systemic complication.
Moderately severe acute pancreatitis has the presence of local or systemic complication and/or transient organ failure in <48 hours.
Severe acute pancreatitis has organ failure persistent in >48 hours.

Definition

  • Acute pancreatitis is the sudden swelling and inflammation of the pancreas

Signs and Symptoms

Abdominal pain is the most prominent symptom of acute pancreatitis

  • Commonly felt in the midepigastric area or the right upper quadrant of the abdomen
  • Pain is often of rapid onset, reaching its maximal severity in 10-20 minutes and is persistent
    • Pain is steady and moderate-severe in intensity; it may be unbearable, boring and refractory to narcotics
  • Pain often radiates to the back; also, change in position has little effect on the pain
  • If pain lasts only a few hours and then is completely relieved, an alternative diagnosis should be sought
    • Serious disease rarely has a painless presentation

Other Symptoms

  • Nausea and vomiting

Risk Factors

  • Alcohol and gallstones are the most common causes of acute pancreatitis

Alcohol

  • Alcohol-related acute pancreatitis usually occurs 1-3 days following drinking
  • The mechanism of alcohol-related acute pancreatitis is unclear but may include the effects of alcohol on the sphincter of Oddi and on the gland’s level of enzyme secretion, as well as direct injury of pancreatic acinar cells

Gallstones

  • Gallstone-related pancreatitis occurs more often with stones <5 mm in diameter because small stones are more likely to pass through and obstruct the common bile duct
  • Biliary sludge in the gallbladder may also contain small stones

Hypercalcemia

  • Hypercalcemia may be due to hyperparathyroidism, sarcoidosis, Ca infusions, etc
  • Excess Ca may deposit in the pancreatic duct, or may activate trypsinogen within the pancreatic parenchyma

Hypertriglyceridemia

  • Free fatty acid release may damage pancreatic acinar cells or the capillary endothelium
  • Acute pancreatitis associated with hypertriglyceridemia is often seen in the following groups of patients:
    • Alcoholic patient presenting with hypertriglyceridemia on admission
    • Diabetic patient with poorly controlled disease and a history of hypertriglyceridemia
    • Patients without predisposing factors but have drug- or diet-induced hypertriglyceridemia

Other Causes of Acute Pancreatitis

  • Medications
    • Certain antibiotics, anti-inflammatory drugs, immunosuppressive agents and other drugs may cause acute pancreatitis
    • A complete medication history should be obtained from the patient
  • Infections
    • Infection with a number of viruses (eg mumps, hepatitis, varicella-zoster, herpes simplex, etc) and bacteria (eg tuberculosis, Legionella sp, Salmonella sp, etc) may be associated with acute pancreatitis
    • Parasites and fungi may also be associated with acute pancreatitis
  • Other conditions which may be associated with acute pancreatitis are the following:
    • Postoperative and post-endoscopic retrograde cholangiopancreatography (ERCP) state
    • Blunt and penetrating trauma to the pancreas
    • Pancreatic ischemia

Risk factors for severe pancreatitis include the following:

  • Age ≥60 years old
  • History of chronic alcohol use
  • Presence of comorbid illnesses eg chronic liver and kidney disease, heart failure, cancer
  • Obesity
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