Pancreatitis : Complications

Complications
- Pseudocyst
  - Fluid, enzyme, debris, and exudates surrounded by wall
  - Abdominal pain, palpable mass, nausea/vomiting, anorexia
  - Detected with imaging
  - Resolves spontaneously or may perforate and cause peritonitis
  - Surgical or endoscopic drainage
- Pancreatic abscess
  - Infected pseudocyst
  - Results from extensive necrosis
  - May rupture or perforate
  - Upper abdominal pain, mass, high fever, leukocytosis
  - Requires prompt surgical drainage
- Systemic complications
  - The pulmonary complications are likely due to the passage of exudate containing pancreatic enzymes from the peritoneal cavity through transdiaphragmatic lymph channels
    - Pleural effusion
    - Atelectasis
    - Pneumonia
    - ARDS (acute respiratory distress syndrome)
    - Hypotension
    - Thrombi, pulmonary embolism, DIC
    - Hypocalcemia: tetany
      - Due in part to the combining of calcium and fatty acids during fat necrosis.
      - The exact mechanisms of how or why hypocalcemia occurs are not well understood
Diagnostic studies
- Laboratory tests
  - Serum amylase level
    - Usually elevated early and remains elevated for 24 to 72 hours.
  - Serum lipase level
    - Also elevated in acute pancreatitis
    - Is an important test because other disorders (e.g., mumps, cerebral trauma, renal transplantation) may increase serum amylase levels
  - Liver enzyme levels
  - Triglyceride levels
  - Glucose level
  - Bilirubin level
  - Serum calcium level
- Abdominal ultrasonography
- X-ray
- Contrast-enhanced CT scan
  - Identify pancreatic problems
- Endoscopic retrograde cholangiopancreatography (ERCP)
- Endoscopic ultrasonography (EUS)
- Magnetic resonance cholangiopancreatography (MRCP)
- Angiography
- Chest x-ray
  - May show pulmonary changes, including atelectasis and pleural effusions

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