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

Cold Versus Flu

For Everyone AUG. 8, 2024 ESPAÑOL PURPOSE Influenza (flu) and the common cold are both contagious respiratory illnesses, but they are caused by different viruses.

Ebola Disease Basics

For Everyone JUNE 2, 2026 ESPAÑOL KEY POINTS Ebola disease is caused by an infection with an orthoebolavirus. Orthoebolaviruses are found primarily in sub-Saharan Africa.