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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