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Acute Pancreatitis

Acute pancreatitis is a sudden inflammation of the pancreas. The most common symptoms and signs include severe, dull epigastric pain, nausea, vomiting, diarrhea, anorexia and fever. Alcohol consumption and biliary stone disease cause most cases of acute pancreatitis.


Presentation

The most common presenting sign of acute pancreatitis is pain on the epigastric area involving the upper left quadrant of the abdomen. Abdominal pain is aggravated with intake of drinks and food especially those with high fat content. Patient usually appears prostrated because pain becomes worst when lying flat on the back. Referred pain is usually felt at the back by the edge of the lower left shoulder blades.

General appearance will convey an ill-looking person with heavy sweating. Patients may also complain of fever, nausea and vomiting in the early part of the disease. Other gastrointestinal symptoms like feeling of fullness, intractable hiccups, clay-colored stools, indigestion and sometimes jaundice are also associated with acute pancreatitis.

Fever
  • We report a 10-year-old child who presented with fever, persistent vomiting, and abdominal pain. A diagnosis of acute pancreatitis was made. This is a very infrequently reported complication of dengue hemorrhagic fever.[ncbi.nlm.nih.gov]
  • Hantaviruses cause potentially fatal two different systemic infectious diseases in humans named as hemorrhagic fever with renal syndrome (HFRS) and Hantavirus pulmonary syndrome.[ncbi.nlm.nih.gov]
  • PATIENT CONCERNS: A 22-month-old girl presented with intermittent epigastralgia for approximately 10 days and fever for three days. Fasting and total parenteral nutrition were administered after admission.[ncbi.nlm.nih.gov]
  • He presented with respiratory distress, shock and fever at the emergency.[ncbi.nlm.nih.gov]
  • The patient rapidly deteriorated, presenting with dyspnea, tachypnea, productive cough, abdominal pain, and onset of fever. C-reactive protein was at 270 mg/L, with a rise in serum lipase (670 UI/L, N: 13-60).[ncbi.nlm.nih.gov]
Severe Pain
  • If there is severe pain, at least one type of pain relief (e.g. paracetamol, non-steroidal anti-inflammatory drugs, opioids) is generally used.[cochrane.org]
  • What we mean by severe pain Other signs include: lying back makes the pain worse sitting forward and curling up eases the pain your tummy feels swollen and tender you have a high temperature of 38C or more you’re feeling sick or vomiting you have diarrhoea[beta.nhs.uk]
  • This may be done if vomiting and severe pain do not improve. The tube will stay in for 1 to 2 days to 1 to 2 weeks. Treating the condition that caused the problem can prevent repeated attacks.[nlm.nih.gov]
  • Common symptoms are severe pain in the upper abdomen, nausea, and vomiting. Treatment is usually a few days in the hospital for intravenous (IV) fluids, antibiotics, and medicines to relieve pain. Chronic pancreatitis does not heal or improve.[fpnotebook.com]
Anorexia
  • Abstract A 36 year old male presented to the emergency department with severe epigastric pain, nausea, vomiting without hematemesis, diarrhea and anorexia. He presented with respiratory distress, shock and fever at the emergency.[ncbi.nlm.nih.gov]
  • CASE PRESENTATION: A 28-year-old Caucasian woman was referred for anorexia lasting for 1 week. Her past medical history was notable for congenital hydrocephalus with consecutive ventriculo-peritoneal shunt, epilepsia and paraparesis.[ncbi.nlm.nih.gov]
  • The most common symptoms and signs include severe, dull epigastric pain, nausea, vomiting, diarrhea, anorexia and fever. Alcohol consumption and biliary stone disease cause most cases of acute pancreatitis.[symptoma.com]
  • Review Topic QID: 107797 M2 Select Answer to see Preferred Response PREFERRED RESPONSE 1 (M2.GI.4692) A 39-year-old male presents to the emergency department with acute abdominal pain and anorexia for two days.[medbullets.com]
  • [6] Less common [ edit ] Scorpion venom Chinese liver fluke [7] Ischemia from bypass surgery Heart valve surgery [8] Fat necrosis Pregnancy Infections other than mumps, including varicella zoster [9] Hyperparathyroidism Valproic acid Cystic fibrosis Anorexia[en.wikipedia.org]
Pleural Effusion
  • She had an extended hospital course because of severe disease, characterised by systemic inflammatory response syndrome, pleural effusion and ascites but was successfully managed conservatively with bowel rest, hydration and pain management.[ncbi.nlm.nih.gov]
  • The aim of this study was to compare BISAP (blood urea nitrogen 25 mg/dl, impaired mental status, systemic inflammatory response syndrome (SIRS), age 60 years, and pleural effusions) with the "traditional" multifactorial scoring systems: Ranson's, Acute[ncbi.nlm.nih.gov]
  • The aim of this study was to compare BISAP (blood urea nitrogen 25 mg/dl, impaired mental status, systemic inflammatory response syndrome (SIRS), age 60 years, and pleural effusions) with the “traditional” multifactorial scoring systems: Ranson's, Acute[doi.org]
  • SIRS, sepsis, DIC Pneumonia, respiratory failure, ARDS Shock Prerenal failure due to volume depletion Hypocalcemia Pleural effusion, pancreatic ascites Paralytic ileus References: [9] [19] [15] [26] We list the most important complications.[amboss.com]
  • A systemic cascade of mediators and cytokines leads to complications like acute respiratory distress syndrome (ARDS), bacteremia, pleural effusion, gastrointestinal hemorrhage, and renal failure.[symptoma.com]
Tachypnea
  • The patient rapidly deteriorated, presenting with dyspnea, tachypnea, productive cough, abdominal pain, and onset of fever. C-reactive protein was at 270 mg/L, with a rise in serum lipase (670 UI/L, N: 13-60).[ncbi.nlm.nih.gov]
  • The physical examination findings may be normal or reveal fever, hypotension, tachycardia, tachypnea, or diaphoresis.[aafp.org]
Severe Clinical Course
  • We found (a) that patients with image-proven pancreatitis suffer a more severe clinical course than those without; (b) that the sensitivity, positive predictive value, and accuracy in condition B are higher than in condition A at any cutoff level; (c)[ncbi.nlm.nih.gov]
Abdominal Pain
  • KEYWORDS: Type 2 diabetes mellitus; abdominal pain; amylase activity; diabetic ketoacidosis; hypertriglyceridemia; pancreatitis[ncbi.nlm.nih.gov]
  • Abdominal pain or tenderness and persistent vomiting (warning signs) are present in the majority of cases with severe dengue prior to clinical deterioration.[ncbi.nlm.nih.gov]
  • Abstract We describe 2 patients with diabetes mellitus, presenting with upper abdominal pain. Although imaging findings were consistent with acute pancreatitis (AP), serum amylase and lipase levels were within normal limits.[ncbi.nlm.nih.gov]
  • Three days later, the patient displayed sudden abdominal pain, distension, nausea, and vomiting without obvious inducements.[ncbi.nlm.nih.gov]
  • Abstract A 52-year-old man presented with sudden abdominal pain and intermittent vomiting.[ncbi.nlm.nih.gov]
Vomiting
  • Abdominal pain or tenderness and persistent vomiting (warning signs) are present in the majority of cases with severe dengue prior to clinical deterioration.[ncbi.nlm.nih.gov]
  • Three days later, the patient displayed sudden abdominal pain, distension, nausea, and vomiting without obvious inducements.[ncbi.nlm.nih.gov]
  • No differences for this outcome were found between opioid and non-opioid treatments, or for type of adverse event (nausea-vomiting and somnolence-sedation).[ncbi.nlm.nih.gov]
  • CASE PRESENTATION: A 20-year-old Bengali man presented to our hospital with a history of acute upper abdominal pain, vomiting, anuria, and disorientation.[ncbi.nlm.nih.gov]
  • Here, we present a case of a 61-year-old woman with a history of alcohol misuse who presented with epigastric pain, nausea and vomiting after binge drinking. Elevated serum lipase and imaging were suggestive of acute-on-chronic pancreatitis.[ncbi.nlm.nih.gov]
Nausea
  • Three days later, the patient displayed sudden abdominal pain, distension, nausea, and vomiting without obvious inducements.[ncbi.nlm.nih.gov]
  • No differences for this outcome were found between opioid and non-opioid treatments, or for type of adverse event (nausea-vomiting and somnolence-sedation).[ncbi.nlm.nih.gov]
  • Here, we present a case of a 61-year-old woman with a history of alcohol misuse who presented with epigastric pain, nausea and vomiting after binge drinking. Elevated serum lipase and imaging were suggestive of acute-on-chronic pancreatitis.[ncbi.nlm.nih.gov]
  • Abstract A 36 year old male presented to the emergency department with severe epigastric pain, nausea, vomiting without hematemesis, diarrhea and anorexia. He presented with respiratory distress, shock and fever at the emergency.[ncbi.nlm.nih.gov]
  • In mild AP, oral feedings can be started immediately if there is no nausea and vomiting. In severe AP, enteral nutrition is recommended to prevent infectious complications, whereas parenteral nutrition should be avoided.[ncbi.nlm.nih.gov]
Epigastric Pain
  • CASE REPORT We report the case of a 74-year-old man with a significant past medical history for coronary artery disease, sleep apnea, and gastroesophageal reflux disease who presented with epigastric pain radiating to the back.[ncbi.nlm.nih.gov]
  • METHOD AND RESULTS: A 44-year-old man was admitted due to severe epigastric pain. The patient was diagnosed with non-small cell lung cancer 9 months ago and received 6 cycles of chemotherapy with motesanib, paclitaxel, and carboplatin.[ncbi.nlm.nih.gov]
  • Here, we present a case of a 61-year-old woman with a history of alcohol misuse who presented with epigastric pain, nausea and vomiting after binge drinking. Elevated serum lipase and imaging were suggestive of acute-on-chronic pancreatitis.[ncbi.nlm.nih.gov]
  • However, sudden onset of severe epigastric pain occurred. An abdominal sonogram showed turbid ascites and peritonitis was impressed.[ncbi.nlm.nih.gov]
  • I report a case of a 33-year-old woman, admitted with severe epigastric pain and vomiting 2 hours after an elective OGD for evaluation of chronic gastrointestinal symptoms.[ncbi.nlm.nih.gov]
Severe Abdominal Pain
  • Acute Pancreatitis: What You Need to Know Pancreatitis, an inflammation of the pancreas, can arise suddenly; it may be accompanied by severe abdominal pain.[hopkinsmedicine.org]
  • Signs and symptoms include severe abdominal pain, nausea, vomiting, diarrhea, fever, and shock. Causes include alcohol consumption, presence of gallstones, trauma, and drugs.[icd10data.com]
  • Advice for healthcare professionals: patients treated with DDP-4 inhibitors should be informed of the characteristic symptoms of acute pancreatitis – persistent, severe abdominal pain (sometimes radiating to the back) – and encouraged to tell their healthcare[gov.uk]
  • Seek care right away if you have the symptoms of acute pancreatitis, especially severe abdominal pain, vomiting, and fever. Key points about acute pancreatitis Acute pancreatitis is a medical emergency.[cedars-sinai.edu]
  • Symptoms Almost everyone with acute pancreatitis has severe abdominal pain in the upper abdomen. The pain penetrates to the back in about 50% of people.[merckmanuals.com]
Pancreatic Pain
  • To assess the effectiveness and safety of opioids for treating acute pancreatitis pain.[ncbi.nlm.nih.gov]
  • Morphine compared to metamizole for acute pancreatitis pain Morphine compared to metamizole for acute pancreatitis pain Patient or population: participants with acute pancreatitis pain Settings: Intervention: Morphine Comparison: Metamizole Improvements[doi.org]
  • Objectives: To assess the effectiveness and safety of opioids for treating acute pancreatitis pain.[cochrane.org]
  • "Opioids for acute pancreatitis pain". The Cochrane Database of Systematic Reviews. 7 (7): CD009179. doi : 10.1002/14651858.CD009179.pub2. PMID 23888429. Helm JF, Venu RP, Geenen JE, Hogan WJ, Dodds WJ, Toouli J, Arndorfer RC (October 1988).[en.wikipedia.org]
Hypotension
  • Systemic inflammation may lead to hypotensive shock which may lead to mortality. The early diagnosis of the disease and early medical interventions may prevent serious complications in acute pancreatitis.[symptoma.com]
  • , tachycardia distributive shock Pancreatic necrosis : Uncorrected hypotension and third space loss decreased organ perfusion multiorgan dysfunction (mainly renal) and pancreatic necrosis Hypocalcemia : Lipase breaks down peripancreatic and mesenteric[amboss.com]
  • […] may radiate to the back Nausea and vomiting Patients often have a history of prior similar episodes Signs Vital sign abnormalities dependent on stage of disease Early on may be normal or with slight tachycardia in response to pain Later in disease, hypotension[rebelem.com]
  • Clinical findings Abdominal pain, nausea, vomiting, hypotension. Diagnosis Contrast-enhanced CT (method of choice), ultrasonography. Lab Increased amylase, increased lipase. Management Supportive bowel rest with parenteral nutrition.[medical-dictionary.thefreedictionary.com]
  • Severe cases present with hypotension and shock, and various surgical scales have been devised to assess the severity and prognosis of the condition.[diapedia.org]
Tachycardia
  • Capillary leakage : Release of inflammatory cytokines and vascular injury by pancreatic enzymes vasodilation and increased vascular permeability shift of fluid from the intravascular space into the interstitial space ( third space loss ) hypotension, tachycardia[amboss.com]
  • […] in response to pain Later in disease, hypotension, tachycardia and frank shock may develop Low grade fever common Epigastric tenderness with or without peritoneal signs Jaundice: indicates obstruction of common bile duct as etiology Hemorrhagic pancreatitis[rebelem.com]
  • Common symptoms of acute pancreatitis can include: sudden severe upper abdominal pain (often referred to as epigastric pain) severe pain that might also be felt in the back nausea and vomiting diarrhea fever and chills racing of the heart (also known as tachycardia[ddc.musc.edu]
  • […] food Nausea, emesis Retroperitoneal hemorrhage – indicates poorer prognosis Grey Turner sign – gray discoloration over flank Cullen sign – bruising in and around umbilicus Constitutional – fever Cardiopulmonary – respiratory distress, hypotension, and tachycardia[arupconsult.com]
  • Symptoms and signs [ edit ] Common [ edit ] severe epigastric pain (upper abdominal pain) radiating to the back in 50% of cases nausea vomiting loss of appetite fever chills (shivering) hemodynamic instability, including shock tachycardia (rapid heartbeat[en.wikipedia.org]
Grey Turner's Sign
  • We report a case of retroperitoneal NSTI in an immunocompetent young male, with clinical symptoms and signs mimicking acute pancreatitis (pseudo-Cullen's and pseudo-Grey-Turner's signs.[ncbi.nlm.nih.gov]
  • ., Cullen's and Grey-Turner's sign) have been described in clinical medicine. The aim of the present study was to evaluate if, and how often, skin signs were noted in autopsy-confirmed cases of necrotizing pancreatitis.[ncbi.nlm.nih.gov]
  • Turner's sign : flank ecchymosis with discoloration Fox's sign : ecchymosis over the inguinal ligament References: [1] [8] [9] Diagnostics Acute pancreatitis is diagnosed based on a typical clinical presentation, with abdominal pain radiating to the[amboss.com]
  • Turner sign – gray discoloration over flank Cullen sign – bruising in and around umbilicus Constitutional – fever Cardiopulmonary – respiratory distress, hypotension, and tachycardia Neurologic – encephalopathy Renal – diminished urine output Potential[arupconsult.com]
  • (Rare) signs of hemorrhage on the physical exam include: Cullen sign : periumbilical bruising Grey-Turner sign : flank bruising There continues to be debate over the precipitating factor leading to acute pancreatitis, with duct occlusion being an important[radiopaedia.org]
Back Pain
  • F-FDG PET/CT showed no definite malignancy but incidental finding of moderately severe acute pancreatitis, which was the cause of back pain.[ncbi.nlm.nih.gov]
  • The typical presentation of multiple myeloma is anemia, back pain, and an elevated sedimentation rate. Patients with multiple myeloma have hypercalcemia but it's rarely manifested as acute pancreatitis.[ncbi.nlm.nih.gov]
  • The patient was admitted with complaints of febrile sensation, back pain, and abdominal pain around the epigastric area. Levels of serum amylase and lipase were elevated to 663 U/L and 3,232 U/L.[ncbi.nlm.nih.gov]
  • Other symptoms include: A swollen, tender belly (abdomen) Back pain Nausea Vomiting Loss of appetite Fever Fast heartbeat If you suspect your child is experiencing pancreatitis, call your child’s primary care doctor or go to a nearby urgent care center[cincinnatichildrens.org]
  • Abdominal pain and back pain can have other causes. If you notice these symptoms see your doctor.[healthline.com]
Confusion
  • […] steady and sharp Gets worse when you move Feels better when you sit or lean forward Usually makes you vomit Other symptoms may include: Fever Bloating In severe cases, you may have signs of shock, including: Restlessness A fast heartbeat Lightheadedness Confusion[summitmedicalgroup.com]
  • Pancreatitis symptoms can be confusing. Abdominal pain and back pain can have other causes. If you notice these symptoms see your doctor.[healthline.com]
  • […] thrombosis portal vein thrombosis fistula formation with pancreatic ascites : leakage of pancreatic secretions into the peritoneal cavity abdominal compartment syndrome The role of imaging is manifold: to clarify the diagnosis when the clinical picture is confusing[radiopaedia.org]
  • […] thrombosis Gastrointestinal Gastrointestinal hemorrhage from stress ulceration; gastric varices (secondary to splenic vein thrombosis) Gastrointestinal obstruction Hepatobiliary Jaundice Portal vein thrombosis Neurologic Psychosis or encephalopathy (confusion[en.wikipedia.org]

Workup

The following diagnostic tests are used to evaluate acute pancreatitis:

  • Serum amylase: An increase in serum amylase level is always present with acute pancreatitis.
  • Urine amylase: In the same way, amylase excretion in the urine is also evident.
  • Serum lipase: An increase in serum lipase correlates well with the disease.
  • Complete blood count: Demonstrates the acuteness of the disease while the neutrophil to lymphocyte ratio is valuable a predictor of pancreatitis prognosis.
  • Serum electrolyte: Determines any instability in the electrolyte balance during the inflammatory process.
  • Imaging methods like CT-scan, ultrasound and MRI can demonstrate the inflaming pancreas in the acute phase of the disease.
Pancreatic Calcification
  • calcification, and pleural effusion (usually on the left). [27] It is noteworthy that the abdominal plain film can be completely normal in patients with acute pancreatitis.[emedicine.com]
Hypertriglyceridemia
  • Hypertriglyceridemia is one of the rare causes of the acute pancreatitis.[ncbi.nlm.nih.gov]
  • RATIONALE: Severe hypertriglyceridemia is the 3rd-leading cause of acute pancreatitis.[ncbi.nlm.nih.gov]
  • KEYWORDS: Type 2 diabetes mellitus; abdominal pain; amylase activity; diabetic ketoacidosis; hypertriglyceridemia; pancreatitis[ncbi.nlm.nih.gov]
  • In practice, the development of diabetic ketoacidosis induced by acute pancreatitis is rare and generally associated with hypertriglyceridemia.[ncbi.nlm.nih.gov]
  • BACKGROUND: Unlike western world, gallstones and hypertriglyceridemia (HTG) are among the first two etiologies of acute pancreatitis (AP) in China.[ncbi.nlm.nih.gov]
Base Deficit
  • CT scan Some sources determine prognosis based on Ranson's 11 criteria : Ranson's Criteria On Admission Within 24-48 hours Age 55 years HCT drops 10% BUN increase by 5 mg/dL after resuscitation Serum Ca 8mg/dL Arterial PaO 2 60mmHg 6 L fluid deficit Base[medbullets.com]
  • deficit – Fluid sequestration – PaO2 – AST aspartate aminotransferase; BUN blood urea nitrogen; PaO2 partial arterial oxygen tension; WBC white blood cell Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) II scale Equation includes[arupconsult.com]
  • deficit (negative base excess) 4 mEq/L Sequestration of fluids 6 L The criteria for point assignment is that a certain breakpoint be met at any time during that 48 hour period, so that in some situations it can be calculated shortly after admission.[en.wikipedia.org]
  • deficit 4 Fluid sequestration 6 L Mortality based on score 3 1% 3-4 15% 5-6 40% 6 100% Glasgow criteria or Imrie score On admission age 55 years WCC 16 glucose 11 AST 250 Within 48 hours decrease in HCT by 10% increase in urea by 1.8 Ca2 2, PaO2 60mmHg[lifeinthefastlane.com]
Lipase Increased
  • increased earlier and to a greater extent than total amylase, and the peak activities of lipase and pancreatic type amylase in the serum have shown significant correlation. 14 In addition, serum lipase remains elevated for a longer period of time than[doi.org]
Calcium Decreased
  • Between one and three months postpartum, her serum calcium decreased from 11.4 to 10.2 mg/dL while her 1,25(OH) 2 D level decreased from 83 to 24 pg/mL. Her 24-hour urine calcium was 277 mg. Six months postpartum, she became pregnant again.[ncbi.nlm.nih.gov]
Amylase Increased
  • Lab Increased amylase, increased lipase. Management Supportive bowel rest with parenteral nutrition. Prognotic instruments Ranson’s criteria, modified Glasgow criteria, APACHE II.[medical-dictionary.thefreedictionary.com]
Pancreatic Necrosis
  • No relationship was found between the aetiology and the presence of pancreatic necrosis, EXPN, location of pancreatic necrosis or presence of collections.[ncbi.nlm.nih.gov]
  • The incidence of pancreatic necrosis in group DM and group non-DM was, respectively, 64.7% and 53.0% (χ   3.506, P   .06).[ncbi.nlm.nih.gov]
  • (H&E, ob.x10) Acute pancreatitis (Acute hemorrhagic pancreatic necrosis) (detail) The acute pancreatitis ( acute hemorrhagic pancreatic necrosis ). Area of fat tissue necrosis due to lipase activation in the pancreatic interlobular space.[pathologyatlas.ro]
  • Pancreatic necrosis was defined as lack of enhancement of all or a portion of the gland.[ncbi.nlm.nih.gov]
Pleural Effusion
  • She had an extended hospital course because of severe disease, characterised by systemic inflammatory response syndrome, pleural effusion and ascites but was successfully managed conservatively with bowel rest, hydration and pain management.[ncbi.nlm.nih.gov]
  • The aim of this study was to compare BISAP (blood urea nitrogen 25 mg/dl, impaired mental status, systemic inflammatory response syndrome (SIRS), age 60 years, and pleural effusions) with the "traditional" multifactorial scoring systems: Ranson's, Acute[ncbi.nlm.nih.gov]
  • The aim of this study was to compare BISAP (blood urea nitrogen 25 mg/dl, impaired mental status, systemic inflammatory response syndrome (SIRS), age 60 years, and pleural effusions) with the “traditional” multifactorial scoring systems: Ranson's, Acute[doi.org]
  • SIRS, sepsis, DIC Pneumonia, respiratory failure, ARDS Shock Prerenal failure due to volume depletion Hypocalcemia Pleural effusion, pancreatic ascites Paralytic ileus References: [9] [19] [15] [26] We list the most important complications.[amboss.com]
  • A systemic cascade of mediators and cytokines leads to complications like acute respiratory distress syndrome (ARDS), bacteremia, pleural effusion, gastrointestinal hemorrhage, and renal failure.[symptoma.com]

Treatment

The medical approach in the treatment of acute pancreatitis revolves on pain management with intravenous analgesics and bowel rest. Parenteral feeding or fluid maintenance may ensue for weeks till full recovery. A nasogastric tube (NGT) may be inserted for a week or two to drain the contents of the stomach especially with paralytic ileus.

The introduction of intravenous antibiotics may prevent necrosis if given early in the course. Surgical intervention may be imployed in the removal of gallstones or any blockage in the bile ducts that incites the disease. A cohort study was performed demonstrating that an early cholecystectomy in the first 48 hours shortens the clinical course of pancreatitis [9]. Fluid drainage of the pancreas may be performed in some cases to relieve inflammation.

Prognosis

Out of 100 cases of acute pancreatitis 10 to 15 cases die. Mortality cases are more pronounced in biliary pancreatitis compared to alcoholic ones. Acute pancreatitis patients who complicate with organ failures has a mortality rate of 30% [6].

However, in cases of pancreatitis with necrosis presenting with no organ failure mortality rate is almost zero. Majority of deaths in the first week of illness is due to multi-organ failure. Recent studies have demonstrated that an increased neutrophil-lymphocyte ratio (NLR) in the first 48 hours of the disease increases the likelihood of a severe pancreatitis attack carrying a grimmer prognosis [7].

Complications

The following disease conditions may complicate from acute pancreatitis:

Etiology

The most common cause of acute pancreatitis is gallstone formation that is lodged in the bile duct. Alcoholism is also a common cause of acute pancreatitis that could clinically resolve within two days. The less common causes of acute pancreatitis include infections, infestations, genetic defects and tumors of the pancreas.

Patients with celiac disease have a very high prevalence of acute pancreatitis due to pancreatic insufficiency [1]. Abdominal trauma and some elicit medications may trigger the inflammation of the pancreas in some cases.

In rare occasions, acute pancreatitis may be initiated after its inadvertent manipulation with some diagnostic procedures like endoscopic retrograde cholangio-pancreatography (ERCP) [2].

Epidemiology

In the United States, approximately 40 cases of adult pancreatitis in 100,000 population per year is observed [3]. The incidence of acute pancreatitis worldwide is 5 to 80 per 100,000 population with the highest prevalence in Finland and the US [4]. Other European countries and Hong Kong has a predominance of gallstone pancreatitis compared to the alcoholic type observed in the US.

Alcohol related acute pancreatitis has a median age of onset at 39 years old while those cases related to the biliary tract has median age of 69 years old [5]. Patients suffering from AIDS may manifest pancreatitis early at a median age of 31 years old.

Males are more predisposed to acute pancreatitis than females due to alcohol related issues. The relative risk of African American for acute pancreatitis within the age group of 35 to 64 years is 10 times higher than any other age group risk in the United States.

Sex distribution
Age distribution

Pathophysiology

The pathophysiology of acute pancreatitis is grossly due to the imbalance of the gland’s homeostasis or normal functioning. Common inciting factors like alcohol use, gallstones, and certain drugs injure the exocrine acinar cells of the pancreas and impair the secretion of zymogen granules.

Once the process of acute pancreatitis is triggered, lysosomal and zymogen granule compartments fuse which advertently activate the trypsinogen to trypsin that initiates autodigestion. The intracellular trypsin activates the entire zymogen cascade of events aggravating the autodigestive process. The molecular fragments formed from the secretory vesicles of the exocrine membranes attract inflammatory cells that further damage the organ.

The increase in early mediators in bloodstream like plasma tumor necrosis factor–alpha (TNF-a), interleukin 6 (IL-6), and interleukin 8 (IL-8) suggests that an inflammatory response triggered by the macrophages and activated neutrophils is in effect in acute pancreatitis. These same mediators cause an increase in vascular permeability in the pancreas which may lead to necrosis, edema and hemorrhage.

A systemic cascade of mediators and cytokines leads to complications like acute respiratory distress syndrome (ARDS), bacteremia, pleural effusion, gastrointestinal hemorrhage, and renal failure. Systemic inflammation may lead to hypotensive shock which may lead to mortality.

Prevention

The early diagnosis of the disease and early medical interventions may prevent serious complications in acute pancreatitis. The early demonstration of gallstone in the biliary tree through imaging must be promptly performed to prevent pancreatitis. Pancreatic tumors and cysts must also be dealt with accordingly for the same purpose. Alcohol binge drinking must be avoided to prevent occurrence of the disease.

Summary

Acute pancreatitis is a clinical emergency defined as the sudden onset inflammation of the pancreas that may resolve in a few days. Inflammation of the pancreas may lead to auto-digestion of the organ.

The pancreas is a digestive organ found behind the stomach that secretes enzymes and aids in the digestion of carbohydrates, proteins and fats. It is also an endocrine organ that helps the regulation of plasma glucose by secreting the hormones insulin and glucagon. Acute pancreatitis may be managed medically without the need of surgery.

Patient Information

Acute pancreatitis is the sudden onset of inflammation of the pancreas. Proper education about the disease and how it is prevented to high risk individuals is of paramount importance. Patients who have just recovered from acute pancreatitis may tolerate low fat diet and clear liquids initially [10]. Avoidance of fatty foods and alcohol binges may lessen the risk of recurrence. Encourage them to inform their physicians about any abdominal trauma they may have incurred recently to avoid any risk in the future.

References

Article

  1. Sadr-Azodi O, Sanders DS, Murray JA, Ludvigsson JF. Patients with celiac disease have an increased risk for pancreatitis. Clin Gastroenterol Hepatol. 2012; 10(10):1136-1142.e3 
  2. Ito K, Fujita N, Kanno A, Matsubayashi H, Okaniwa S, Nakahara K, Suzuki K, Enohara R. Risk factors for post-ERCP pancreatitis in high risk patients who have undergone prophylactic pancreatic duct stenting: a multicenter retrospective study. Intern Med. 2011; 50(24):2927-32 
  3. Granger J, Remick D. Acute pancreatitis: models, markers, and mediators. Shock. Dec 2005;24 Suppl 1:45-51.
  4. Banks PA. Epidemiology, natural history, and predictors of disease outcome in acute and chronic pancreatitis. Gastrointest Endosc. Dec 2002;56(6 Suppl):S226-30.
  5. Morinville VD, Barmada MM, Lowe ME. Increasing incidence of acute pancreatitis at an American pediatric tertiary care center: is greater awareness among physicians responsible?. Pancreas. Jan 2010;39(1):5-8.
  6. Whitcomb DC. Clinical practice. Acute pancreatitis. N Engl J Med. May 18 2006;354(20):2142-50.
  7. Suppiah A, Malde D, Arab T, Hamed M, Allgar V, Smith AM, et al. The Prognostic Value of the Neutrophil-Lymphocyte Ratio (NLR) in Acute Pancreatitis: Identification of an Optimal NLR. J Gastrointest Surg. Feb 1 2013;
  8. Maraví-Poma E, Gener J, Alvarez-Lerma F, Olaechea P, Blanco A, Domínguez-Muñoz JE. Early antibiotic treatment (prophylaxis) of septic complications in severe acute necrotizing pancreatitis: a prospective, randomized, multicenter study comparing two regimens with imipenem-cilastatin. Intensive Care Med. Nov 2003;29(11):1974-80.
  9. Aboulian A, Chan T, Yaghoubian A, Kaji AH, Putnam B, Neville A, et al. Early cholecystectomy safely decreases hospital stay in patients with mild gallstone pancreatitis: a randomized prospective study. Ann Surg. Apr 2010;251(4):615-9.
  10. Jacobson BC, Vander Vliet MB, Hughes MD, Maurer R, McManus K, Banks PA. A prospective, randomized trial of clear liquids versus low-fat solid diet as the initial meal in mild acute pancreatitis. Clin Gastroenterol Hepatol. Aug 2007;5(8):946-51; quiz 886.

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Last updated: 2018-06-22 05:16