Pancreatitis

Pancreatitis

Acute Pancreatitis

  • Acute inflammatory process of pancreas
  • Spillage of pancreatic enzymes into surrounding pancreatic tissue causing autodigestion and severe pain
  • Varies from mild edema to severe necrosis

Etiology and Pathophysiology

  • Gallbladder disease (women)
  • Chronic alcohol intake (men)
  • Smoking
  • Hypertriglyceridemia
  • Less common causes
    • Trauma
    • Viral infections
    • Penetrating duodenal ulcers
    • Cysts
    • Abscesses
    • Cystic fibrosis
    • Kaposi sarcoma
    • Certain drugs
    • Metabolic disorders
    • Vascular diseases
    • Idiopathic causes
  • Caused by auto-digestion of pancreas
    • Injury to pancreatic cells
    • Activation of pancreatic enzymes
      • Autodigestive effects of pancreatic enzymes
        • Trypsin
          • Edema
          • Necrosis
          • Hemorrhage
        • Elastase
          • Hemorrhage
        • Phospholipase A and lipase
          • Fat necrosis
        • Kallikrein
          • Edema
          • Vascular permeability
          • Smooth muscle contraction
          • Shock
  • Alcohol consumption is another common cause
    • Exact mechanism unknown
    • Alcohol may increase production of pancreatic enzymes
    • 5% to 10% of alcohol abusers develop pancreatitis
  • Classification
    • Mild pancreatitis
      • Edematous or interstitial
    • Severe pancreatitis
      • Necrotizing
      • Endocrine and exocrine dysfunction
      • Necrosis, organ failure, sepsis
      • Rate of mortality: 25%
  • Clinical Manifestations
    • Abdominal pain predominant
      • Left upper quadrant or midepigastrium
      • Radiates to back
      • Sudden onset
      • Deep, piercing, continuous or steady
      • Aggravated by eating
      • Starts when recumbent
      • Not relieved with vomiting
    • Flushing
    • Cyanosis
    • Dyspnea
    • Nausea/vomiting
    • Low-grade fever
    • Leukocytosis
    • Hypotension, tachycardia
    • Jaundice
    • Abdominal tenderness with muscle guarding
    • Decreased or absent bowel sounds
    • Crackles in lungs
    • Abdominal skin discoloration
      • Grey Turner’s spots or sign
      • Cullen’s sign
    • Shock

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