Acute Pancreatitis: Overview and Introduction

Definition

• Acute pancreatitis is the inflammation of the pancreas caused by enzyme-mediated autodigestion.
• 80% of cases are mild; 20% can become serious and life-threatening.
• Inflammation can range from mild edema to peripancreatic necrosis.

Causes

• Major Causes:
  • Gallstones
  • Ethanol (alcohol)
• Other Causes (Acronym: GET SMASHED):
  • G: Gallstones
  • E: Ethanol
  • T: Trauma
  • S: Steroids
  • M: Mumps virus
  • A: Autoimmune diseases
  • S: Scorpion venom
  • H: Hypercalcemia, Hyperlipidemia
  • E: ERCP procedure
  • D: Drugs

Anatomy of the Pancreas

• Located behind the stomach, partly retroperitoneal.
• Makes contact with the duodenum (first part of the small intestine).
• Pancreatic ducts connect to bile ducts from the liver and gallbladder.
• Two main functions:
  • Exocrine: Secretes digestive enzymes into the small intestine.
  • Endocrine: Secretes hormones like insulin and glucagon into the blood.

Pathophysiology

• Inflammation leads to damage of the pancreas.
• Damaged pancreatic acinar cells release digestive enzymes, causing further damage.
• Key Enzymes:
  • Proteases: Causes cellular and vascular damage.
  • Amylase: Increases in blood, useful for diagnosis (not specific).
  • Lipase: Increases in blood, can cause fatty necrosis.

Clinical Presentation

• Symptoms include:
  • Vomiting
  • Severe epigastric central pain, possibly radiating to the back.
  • Relief in tripoding position.
  • Tachycardia
  • Jaundice
  • Fever

Diagnostic Investigations

• Serum Tests:
  • Amylase and lipase levels (lipase more specific).
• Imaging:
  • Ultrasound of pancreas.
• Additional Tests:
  • Arterial blood gas.

Management

• Do not feed orally.
• Use nasogastric tube.
• Administer fluids, anti-emetics, and analgesics like morphine.
• Monitor urine output with catheterization.
• Daily serology: Full blood count, amylase levels, electrolytes.
• Hourly monitoring: Blood pressure, heart rate, urinary output.

Complications

• Chronic pancreatitis.
• Pancreatic pseudocyst.
• Acute lung injury due to proximity to diaphragm.
• Pancreatic fistula with pleural effusion (pancreatic effusion).
• Acute renal failure.
• Infected pancreatic necrosis (responsible for 80% of deaths).
• Fatty necrosis.