Question 1 of 10

    Acute Pancreatitis

    Illu pancrease[1]

    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.

    This disorder is induced by the following process: auto immune.

    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.

    Skin
    Grey Turner's Sign
    • Turner sign – grey 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]
    • Turner's sign : flank ecchymosis with discoloration Fox's sign : ecchymosis over the inguinal ligament References: [1] [5] [6] Diagnostics Acute pancreatitis is diagnosed based on a typical clinical presentation, with abdominal pain radiating to the[amboss.com]
    • (Rare) signs of haemorrhage 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]
    • There may be bruising around the umbilicus (Cullen’s sign) and in the loin region (Grey Turner’s sign), but these are rare manifestations (Alexander et al, 2000).[nursingtimes.net]
    • Turner’s sign) Differential Diagnosis: Abdominal Pathology Perforated viscus Peptic ulcer Biliary colic Cholecystitis Cholangitis Bowel obstruction Abdominal aortic aneurysm Ectopic pregnancy Cardiopulmonary Pathology Acute myocardial infarction ARDS[rebelem.com]
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  • cardiovascular
    Hypotension
    • Hemorrhage in acute pancreatitis is not usually large enough to cause hypotension.[medbullets.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]
    • […] vomiting Further symptoms Fever Abdominal tenderness , distention , and guarding Ileus with reduced bowel sounds and tympany on percussion Ascites , pleural effusion Possibly jaundice in patients with biliary pancreatitis Signs of shock : tachycardia , hypotension[amboss.com]
    • […] of acute pancreatitis is “I GET SMASHED” Idiopathic Gall stones Ethanol Trauma Steroids Mumps and other viruses (EBV, CMV, HIV) Autoimmune diseases (SLE, polyarteritis nodosa, pregnancy) Scorpion stings Hypercalcaemia, hyperlipidaemia, hypothermia, hypotension[lifeinthefastlane.com]
    • Clinical findings Abdominal pain, nausea, vomiting, hypotension.[medical-dictionary.thefreedictionary.com]
    Tachycardia
    • […] 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]
    • […] abdomen Nausea, emesis Retroperitoneal hemorrhage – indicates poorer prognosis Grey Turner sign – grey discoloration over flank Cullen sign – bruising in and around umbilicus Constitutional – fever Cardiopulmonary – respiratory distress, hypotension, and tachycardia[arupconsult.com]
    • […] gallstones Nausea , vomiting Further symptoms Fever Abdominal tenderness , distention , and guarding Ileus with reduced bowel sounds and tympany on percussion Ascites , pleural effusion Possibly jaundice in patients with biliary pancreatitis Signs of shock : tachycardia[amboss.com]
    • Symptoms and signs [ edit ] The most common symptoms and signs include: 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[en.wikipedia.org]
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  • musculoskeletal
    Back Pain
    • 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.[healthline.com]
    • He had also been taking ibuprofen as prescribed to treat low back pain for 1 week prior to this incident.[physio-pedia.com]
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  • gastrointestinal
    Vomiting
    • Watch for loss of appetite, lethargy, or vomiting.[petplace.com]
    • Other symptoms include nausea, vomiting, weight loss, and fatty stools.[wakegastro.com]
    • If your pain comes on gradually, or has been present for a long time, it is likely from another cause. 3 Tell your doctor about associated nausea and/or vomiting. [3] It is very common for acute pancreatitis to be accompanied by nausea and vomiting, and[wikihow.com]
    • 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]
    • Other symptoms may include nausea, vomiting, fever , and an increased pulse rate.[medicinenet.com]
    Abdominal Pain
    • Acute pancreatitis signs and symptoms include: Upper abdominal pain Abdominal pain that radiates to your back Abdominal pain that feels worse after eating Fever Rapid pulse Nausea Vomiting Tenderness when touching the abdomen Chronic pancreatitis signs[mayoclinic.org]
    • If you have acute abdominal pain, your doctor may order a CT scan.[wikihow.com]
    • Also watch for signs of abdominal pain, vomiting, loss of appetite or other abnormalities.[petplace.com]
    • Acute pancreatitis arises suddenly and may be accompanied by severe abdominal pain.[hopkinsmedicine.org]
    • The diagnosis, as agreed by international consensus, can be established by fulfilling two of the following three criteria: upper abdominal pain of sudden onset, elevation of either serum lipase or amylase activity to greater than three times the upper[ueg.eu]
    Nausea
    • If your pain comes on gradually, or has been present for a long time, it is likely from another cause. 3 Tell your doctor about associated nausea and/or vomiting. [3] It is very common for acute pancreatitis to be accompanied by nausea and vomiting, and[wikihow.com]
    • Therefore, alert your doctor if you have signs of pancreatitis, including severe upper abdominal pain, nausea and vomiting.[livestrong.com]
    • Symptoms include nausea, vomiting, weight loss, and oily stools.[fpnotebook.com]
    • Acute pancreatitis is inflammation of the pancreas that occurs suddenly, and produces severe, upper abdominal pain, nausea and vomiting.[uchospitals.edu]
    • Signs and symptoms include severe abdominal pain, nausea, vomiting, diarrhea, fever, and shock.[icd10data.com]
    Epigastric Pain
    • Acute pancreatitis usually presents with epigastric pain radiating to the back, nausea and vomiting, and epigastric tenderness on palpation.[amboss.com]
    • The diagnosis of acute pancreatitis is made by fulfilling two of the following three criteria 8 : acute onset of persistent, severe epigastric pain (i.e. pain consistent with acute pancreatitis) lipase/amylase elevation 3 times the upper limit of normal[radiopaedia.org]
    • The diagnosis of acute pancreatitis is based on a combination of both clinical (severe epigastric pain radiating to the back, relieved by sitting forward) and laboratory tests (elevated amylase and lipase- more specific- blood levels).[medicine.yale.edu]
    • Patients usually present with rapidly escalating right upper quadrant or epigastric pain, often radiating to the back, accompanied by nausea and vomiting.[clinicaladvisor.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[ddc.musc.edu]
    Severe Abdominal Pain
    • Acute pancreatitis arises suddenly and may be accompanied by severe abdominal pain.[hopkinsmedicine.org]
    • Signs and symptoms include severe abdominal pain, nausea, vomiting, diarrhea, fever, and shock.[icd10data.com]
    • If severe abdominal pain develops that is different than previous types of pain, or that does not get betting within a couple of hours, the person may need to be evaluated for acute pancreatitis.[pancreas.org]
    • 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]
    • Acute attacks are often characterized by severe abdominal pain that radiates from the upper belly through to the back and can cause effects ranging from mild pancreatic swelling to life-threatening failure of many organs.[labtestsonline.org]
    Cullen's Sign
    • […] occur as well leading to hemorrhage Phase 3 Release of systemic inflammatory mediators systemic immune response syndrome and multisystem organ dysfunction (i.e. acute renal failure, cardiac dysfunction, ARDS, disseminated intravascular coagulation) Cullen’s[rebelem.com]
    • […] elements Clinical Presentation Signs and symptoms Gastrointestinal Sudden upper abdominal pain – may radiate to flank, lower abdomen Nausea, emesis Retroperitoneal hemorrhage – indicates poorer prognosis Grey Turner sign – grey discoloration over flank Cullen[arupconsult.com]
    • […] tenderness , distention , and guarding Ileus with reduced bowel sounds and tympany on percussion Ascites , pleural effusion Possibly jaundice in patients with biliary pancreatitis Signs of shock : tachycardia , hypotension , oliguria / anuria Skin changes Cullen's[amboss.com]
    • (Rare) signs of haemorrhage 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]
    • There may be bruising around the umbilicus (Cullen’s sign) and in the loin region (Grey Turner’s sign), but these are rare manifestations (Alexander et al, 2000).[nursingtimes.net]
    Grey Turner's Sign
    • Turner sign – grey 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]
    • Turner's sign : flank ecchymosis with discoloration Fox's sign : ecchymosis over the inguinal ligament References: [1] [5] [6] Diagnostics Acute pancreatitis is diagnosed based on a typical clinical presentation, with abdominal pain radiating to the[amboss.com]
    • (Rare) signs of haemorrhage 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]
    • There may be bruising around the umbilicus (Cullen’s sign) and in the loin region (Grey Turner’s sign), but these are rare manifestations (Alexander et al, 2000).[nursingtimes.net]
    • Turner’s sign) Differential Diagnosis: Abdominal Pathology Perforated viscus Peptic ulcer Biliary colic Cholecystitis Cholangitis Bowel obstruction Abdominal aortic aneurysm Ectopic pregnancy Cardiopulmonary Pathology Acute myocardial infarction ARDS[rebelem.com]
    Abdominal Tenderness
    • Clinical description Severe upper abdominal pain with abrupt onset, and nausea and vomiting with features of epigastric or diffuse abdominal tenderness are the common clinical findings.[orpha.net]
    • tenderness or lump (mass) Fever Low blood pressure Rapid heart rate Rapid breathing (respiratory) rate Lab tests that show the release of pancreatic enzymes will be done.[uihc.org]
    • tenderness , distention , and guarding Ileus with reduced bowel sounds and tympany on percussion Ascites , pleural effusion Possibly jaundice in patients with biliary pancreatitis Signs of shock : tachycardia , hypotension , oliguria / anuria Skin changes[amboss.com]
    • Physically, the patient with pancreatitis may appear acutely unwell with signs of shock, abdominal tenderness and guarding/rigidity (Henry and Thompson, 2001).[nursingtimes.net]
    • Some people have only slight abdominal tenderness and in 5 to 10 percent of people, there is no pain at all.[uptodate.com]
    Abdominal Distension
    • Cardinals: Jaundice, Cyanosis, Dehydration Respiratory: Signs of pleural effusion – usually left sided (sometimes) Abdominal: Marked epigastric tenderness with voluntary and involuntary guarding /- rigidity, Abdominal distension, Reduced bowel sound,[epomedicine.com]
    • Signs may include pyrexia, abdominal distension, and peritonism.[academic.oup.com]
    • As many patients present with abdominal distension, it is important to exclude an acute abdomen secondary to perforated viscus, cholecystitis, appendicitis, ectopic pregnancy, ischemic bowel, and small or large bowel obstruction.[clinicaladvisor.com]
    • Imaging is indicated during the initial presentation if: the diagnosis of acute pancreatitis is uncertain there is abdominal distension and tenderness, fever 102, or leukocytosis there is a Ranson score 3 or APACHE score 8 there is no improvement after[en.wikipedia.org]
    • Although ACS is a clinical diagnosis, at times the diagnosis is suggested on CT in patients who exhibit the “round-belly sign”, defined as abdominal distension with an increased ratio of anteroposterior-to-transverse abdominal diameter (ratio 0.80) (1[pancreapedia.org]
    Acute Abdomen
    • Summary Acute pancreatitis is a common cause of acute abdomen.[crcpress.com]
    • . acute pancreatitis Etymology: Gk, pan, all, kreas, flesh, itis, inflammation a sudden inflammation of the pancreas caused by autodigestion and marked by symptoms of acute abdomen and escape of pancreatic enzymes into the pancreatic tissues.[medical-dictionary.thefreedictionary.com]
    • abdomen – to rule out hollow viscus perforation Differential diagnoses: Acute Pancreatitis Acute Cholecystitis Inferior wall MI Peptic Ulcer Disease Lab Reports: Serum Amylase: 2,399 IU/L TLC: 14,100/cu.mm DLC: Neutrophils 87%; Lymphocytes 12%; Eosinophil[epomedicine.com]
    • As many patients present with abdominal distension, it is important to exclude an acute abdomen secondary to perforated viscus, cholecystitis, appendicitis, ectopic pregnancy, ischemic bowel, and small or large bowel obstruction.[clinicaladvisor.com]
    • "Serum amylase, isoamylase, and lipase in the acute abdomen.[en.wikipedia.org]
    Loss of Appetite
    • Watch for loss of appetite, lethargy, or vomiting.[petplace.com]
    • 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]
    • Nausea and/or vomiting Signs of pain Diarrhea Loss of appetite Dehydration Fever Lethargy and weakness Shock Causes of Acute Pancreatitis in Cats The cause of acute pancreatitis in cats is not well understood.[wagwalking.com]
    • The following symptoms may also be present: vomiting nausea diarrhea loss of appetite rapid pulse pain with coughing, vigorous movements, and deep breathing tenderness when the abdomen is touched fever and a temperature of at least 100.4 F (38 C) jaundice[medicalnewstoday.com]
    • Symptoms and signs [ edit ] The most common symptoms and signs include: 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[en.wikipedia.org]
    Abdominal Pain Radiating to the Back
    • pain radiating to the back, and either detection of highly elevated pancreatic enzymes or characteristic findings on imaging.[amboss.com]
    • It presents with the cardinal features of acute upper abdominal pain radiating to the back, elevated levels of the pancreatic enzymes amylase and lipase, and characteristic features on imaging.[diapedia.org]
    • pain radiating to the back.[medbullets.com]
    • Symptoms and signs [ edit ] The most common symptoms and signs include: 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[en.wikipedia.org]
    Food Poisoning
    • It could mean something else such as a gut infection or food poisoning. 4 Open up to your doctor about your alcohol consumption.[wikihow.com]
    • Infections Bacterial infections that can lead to acute pancreatitis include Salmonellosis, a type of food poisoning caused by the bacterium Salmonella, or Legionnaires' disease , an infection caused by the bacterium Legionella pneumophila found in plumbing[medicalnewstoday.com]
    Chronic Abdominal Pain
    • Chronic pancreatitis is complicated by chronic abdominal pain that is difficult to manage, diabetes and its complications, chronic diarrhea from malabsorption, and frequent hospitalizations.[clinicaladvisor.com]
    • Prospective evaluation of endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography in patients with chronic abdominal pain of suspected pancreatic origin.[tropicalgastro.com]
    Decreased Bowel Sounds
    • Physical exam shows low grade fever, epigastric tenderness, and decreased bowel sounds.[medbullets.com]
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  • respiratoric
    Pleural Effusion
    • Demonstration of a pleural effusion indicates severe disease.[academic.oup.com]
    • Conventional x-ray Colon cutoff sign : dilatation of a segment of large bowel near the pancreas Sentinel loop sign : dilatation of a segment of small intestine near the pancreas Possible complications: pleural effusions , pancreatic calcium stones, intestinal[amboss.com]
    • SGPT (ALT): 20 IU/L USG abdomen: Bulky pancreas with localized pancreatic collection likely pancreatitis Hepatomegaly and Splenomegaly Gall bladder sludge Bilateral increased cortical echo texture Ascites Left sided pleural effusion CT Abdomen Revealed[epomedicine.com]
    • Similarly, hepatic etiologies should be considered in those that present with ascites or pleural effusion.[clinicaladvisor.com]
    • Acute pancreatitis - causes, symptoms, diagnosis, treatment, pathology Image result for pancreatitis nursing Complications of note are pleural effusions and ARDS.[pinterest.com]
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  • Entire body system
    Fever
    • 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]
    • Signs and symptoms include severe abdominal pain, nausea, vomiting, diarrhea, fever, and shock.[icd10data.com]
    • Other symptoms include nausea, vomiting, fever, and an increased pulse rate.[pancreas.org]
    • Other symptoms can include: Swollen and tender abdomen Nausea and vomiting Fever Rapid pulse[pancreasfoundation.org]
    • […] foods have a high fat content Becomes constant and more severe, lasting for several days May be worse when lying flat on the back May spread (radiate) to the back or below the left shoulder blade People with acute pancreatitis often look ill and have a fever[uihc.org]
    Severe Pain
    • Common symptoms are severe pain in the upper abdomen, nausea, and vomiting.[cochrane.org]
    • What we mean by severe pain Severe pain: always there and so bad it’s hard to think or talk you can’t sleep it’s very hard to move, get out of bed, go to the bathroom, wash or dress Moderate pain: always there makes it hard to concentrate or sleep you[beta.nhs.uk]
    • The main symptom is severe pain in your upper belly.[summitmedicalgroup.com]
    • Chronic pancreatitis is primarily marked by severe pain and loss of pancreatic function.[my.clevelandclinic.org]
    Patient Appears Acutely Ill
    • Generally patients appear acutely ill and sweaty and report feelings of malaise, while about 20% experience upper abdominal distention attributable to gastric distention or displacement of the stomach by a pancreatic inflammatory mass.[physio-pedia.com]
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  • Liver, Gall & Pancreas
    Pancreatic Pain
    • Free Access Free Access Free Access Opioids for acute pancreatitis pain Xavier Basurto Ona, David Rigau Comas, Gerard Urrútia Online Publication Date: July 2013 Review A full review, complete with results and discussion, possibly including meta-analyses[cochranelibrary.com]
    • In people with gallstone pancreatitis, gallbladder pain may occur before pancreatic pain.[uptodate.com]
    • Pain constant & gradually increases over 30- 60 minutes; pain radiates to the back; Vomiting & increased amylase; LFT’s may be increased if due to gall stones.[epomedicine.com]
    • "Opioids for acute pancreatitis pain".[en.wikipedia.org]
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  • Course
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  • 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.

    Pathology

    Other Pathologies
    Pancreatic Necrosis
    • Antibiotic therapy for prophylaxis against infection of pancreatic necrosis in acute pancreatitis.[lifeinthefastlane.com]
    • However, surgery should be considered in patients with infected pancreatic necrosis.[medicine.yale.edu]
    • What is pancreatic necrosis Severe pancreatitis causes death of parts of the pancreas.[surgery.usc.edu]
    • Acute pancreatitis or acute pancreatic necrosis [1] is a sudden inflammation of the pancreas .[en.wikipedia.org]
    • FNAB is indicated in patients with pancreatic necrosis on CT and clinical signs of sepsis.[academic.oup.com]
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  • Laboratory

    Urine
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  • Serum
    Hypertriglyceridemia
    • A fasting lipid profile is indicated if pancreatitis was due to hypertriglyceridemia.[clinicaladvisor.com]
    • Hypertriglyceridemia See hypertriglyceridemia for management of high TGs Disposition Discharge Mild case no biliary disease no systemic complication tolerating clears Patients can be discharged when oral analgesics control their pain their pain All other[wikem.org]
    • Etiology RAP has multiple causes, alcohol and cholelithiasis being the most frequent (followed by dietary causes, hypertriglyceridemia, biliary tract infection, congenital anomalies, duodenal obstruction, medications, and neoplasms).[orpha.net]
    • ., gallstones , constriction of the ampulla of Vater) 40% of cases Alcohol-induced ( 30% of cases) Idiopathic ( 15%–25% of cases) Other causes Hypertriglyceridemia , hypercalcemia Post- ERCP Toxic drugs ; (e.g., steroids, azathioprine ; , sulfonamides[amboss.com]
    • . • Metabolic defects—hypertriglyceridemia, hyperparathyroidism, hypercalcaemia. • Obstruction—ampullary tumours, congenital defects of pancreas or biliary tree, parasites. • Toxins—scorpion bites. • Trauma—blunt, iatrogenic injury during heart surgery[medical-dictionary.thefreedictionary.com]
    Base Deficit
    • Ranson Criteria Scoring – one point for each criterion met At admission or diagnosis Age – WBC count – 3 (16.0x10 9 /L) Blood glucose – Serum lactate dehydrogenase – AST – During initial 48 hours Hematocrit decrease – BUN increase – Serum calcium – Base[arupconsult.com]
    • deficit 4 mmol/L CT findings : pancreatic edema , peripancreatic fluid collection, and/or necrosis of 33% of the pancreas Amylase and lipase , which are used for the diagnosis of pancreatitis , cannot be used to predict the prognosis ![amboss.com]
    • deficit 4 MEq/L Fluid Sequestation 6L BISAP Bedside Index for Severity in Acute Pancreatitis [6] Decreased sensitivity, but outperforms in specificity as compared to Ranson and APACHE II [7] [8] Clinically more manageable to obtain, especially in the[wikem.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]
    • deficit 4 mEq/L Note: amylase and lipase not prognostic WBC 16,000/μL AST 250 IU/dL LDH 350 IU/L Blood glucose 200 mg/dL Risk of Mortality 3-4 signs 20% 5-6 signs 40% 7 signs 100% Patients often require ICU and the condition may be fatal Pulmonary complications[medbullets.com]
    Amylase Increased
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  • Pleura
    Pleural Effusion
    • Demonstration of a pleural effusion indicates severe disease.[academic.oup.com]
    • Conventional x-ray Colon cutoff sign : dilatation of a segment of large bowel near the pancreas Sentinel loop sign : dilatation of a segment of small intestine near the pancreas Possible complications: pleural effusions , pancreatic calcium stones, intestinal[amboss.com]
    • SGPT (ALT): 20 IU/L USG abdomen: Bulky pancreas with localized pancreatic collection likely pancreatitis Hepatomegaly and Splenomegaly Gall bladder sludge Bilateral increased cortical echo texture Ascites Left sided pleural effusion CT Abdomen Revealed[epomedicine.com]
    • Similarly, hepatic etiologies should be considered in those that present with ascites or pleural effusion.[clinicaladvisor.com]
    • Acute pancreatitis - causes, symptoms, diagnosis, treatment, pathology Image result for pancreatitis nursing Complications of note are pleural effusions and ARDS.[pinterest.com]
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  • Imaging

    X-ray
    Pancreatic Calcification
    • Table 3 Imaging in acute pancreatitis Modality Pertinent findings Abdominal X-ray Ileus, loss of psoas shadow, sentinel loop, pancreatic calcification, and calcified gallstones Chest X-ray Pleural effusions (usually on left) and pulmonary infiltrates[academic.oup.com]
    • calcification Abdominal USG: Can detect gallstones, biliary obstruction, pseudocyst formation CT abdomen: may be required if diagnosis uncertain, to rule out and find degree of: Peripancreatic collection; Necrosis and Abscess CT Guidelines for Acute[epomedicine.com]
    • Additionally, evidence of nephrolithiasis can sometimes be seen as well as foreign bodies or the telltale pancreatic calcifications of chronic pancreatitis.[clinicaladvisor.com]
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  • ECG

    QT, RR, ST Intervals
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  • 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:

    • Recurrence: The pancreas may inflame again if the inciting factors aren’t dealt with accordingly.
    • Acute renal failure: The kidneys are the most sensitive organ to hypotensive and hypovolemic shock.
    • Acute respiratory distress syndrome (ARDS): The systemic inflammatory response may incapacitate the lung function and cause acute dyspnea.
    • Heart Failure: Persistent shock may lead to cardiac pump overload and results to failure.
    • Pancreatic cysts or abscess: The unabated exocrine auto-digestion may form abscess or cyst in the pancreatic parenchyma.
    • Ascites: The irritation of the retroperitoneum from the inflammation may propagate extracellular fluid build-up in the abdominal cavity.
    • Fungal superinfection: This may develop late in the clinical course [8].
    • Hypotension: The systemic inflammatory response to acute pancreatitis dilates the vessels and cause a drop in blood pressure.

    Complications

    Portal Vein Thrombosis
    • vein thrombosis fistula formation with pancreatic ascites : leakage of pancreatic secretions into the peritoneal cavity The role of imaging is manifold: to clarify the diagnosis when the clinical picture is confusing to assess severity ( Balthazar score[radiopaedia.org]
    • vein thrombosis Abdominal compartment syndrome Abdominal pseudoaneurysm Intraabdominal hemorrhage Systemic Cardiac dysfunction Renal failure Respiratory failure Shock Hypocalcemia (due to sequestration in necrotic fat) Hyperglycemia Pleural effusion[wikem.org]
    • vein thrombosis (Variceal hemorrhages) Renal: Oliguria, Azotemia, Renal artery/vein thrombosis, Acute Tubular Necrosis Metabolic: Hyperglycemia, Hypocalcemia, Encephalopathy, Sudden blindness (Purtscher’s retinopathy) CNS: Psychosis, Fat emboli Timeline[epomedicine.com]
    • vein thrombosis Neurologic Psychosis or encephalopathy (confusion, delusion and coma) Cerebral Embolism Blindness (angiopathic retinopathy with hemorrhage) Hematologic Anemia DIC Leucocytosis Dermatologic Painful subcutaneous fat necrosis Miscellaneous[en.wikipedia.org]
    Paralytic Ileus
    • Bowel sounds may become absent as paralytic ileus develops (Haslett et al, 1999).[nursingtimes.net]
    • ileus, GI hemorrhage, bowel infarction Hepatobiliary – jaundice, obstruction of the common bile duct Metabolic Malnutrition Hypocalcemia Hypoglycemia Hematological Disseminated intravascular coagulation Vein thrombosis – portal, mesenteric, splanchnic[arupconsult.com]
    • ileus We list the most important complications.[amboss.com]
    • Jejunal feeding is advocated if gastric feeding fails. 10 However, paralytic ileus is common in SAP and parenteral nutrition (PN) is recommended if enteral feeding has failed after 5–7 days; glutamine-enriched PN should be considered. 8 All patients should[academic.oup.com]
    • TPN for specific indications like Paralytic ileus.[epomedicine.com]
    Ileus
    • Bowel sounds may become absent as paralytic ileus develops (Haslett et al, 1999).[nursingtimes.net]
    • Table 3 Imaging in acute pancreatitis Modality Pertinent findings Abdominal X-ray Ileus, loss of psoas shadow, sentinel loop, pancreatic calcification, and calcified gallstones Chest X-ray Pleural effusions (usually on left) and pulmonary infiltrates[academic.oup.com]
    • Cardinal symptoms Constant, severe epigastric pain Classically radiating towards the back Worse after meals and when supine Colicky pain if caused by gallstones Nausea , vomiting Further symptoms Fever Abdominal tenderness , distention , and guarding Ileus[amboss.com]
    • […] healthcare spending, accounting for an estimated annual spend of US 4–7 million per million inhabitants in western countries. 2,3 The main symptoms include severe upper abdominal pain (often sudden onset), nausea, vomiting, bloating and the development of ileus[ueg.eu]
    • Patients with pancreatitis may display localized ileus of the small bowel or "sentinel loop".[clinicaladvisor.com]
    Fever
    • 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]
    • Signs and symptoms include severe abdominal pain, nausea, vomiting, diarrhea, fever, and shock.[icd10data.com]
    • Other symptoms include nausea, vomiting, fever, and an increased pulse rate.[pancreas.org]
    • Other symptoms can include: Swollen and tender abdomen Nausea and vomiting Fever Rapid pulse[pancreasfoundation.org]
    • […] foods have a high fat content Becomes constant and more severe, lasting for several days May be worse when lying flat on the back May spread (radiate) to the back or below the left shoulder blade People with acute pancreatitis often look ill and have a fever[uihc.org]
    Intestinal Obstruction
    • Obstruction is most frequently due to gallstones and sometimes to biliary sludge.[labtestsonline.org]
    • Intestinal obstruction caused by a tumor or foreign body.[petplace.com]
    • The pancreas does not show up easily on x-rays, although your vet may take one in order to ensure there are no intestinal obstructions present.[wagwalking.com]
    • obstructions Mesenteric ischemia Nephrolithiasis Pancreatic cancer Perforated duodenal/gastric ulcer Tubo-ovarian abscess Epidemiology Incidence – 30-40/100,000 in the U.S.[arupconsult.com]
    • H/O and P/E correlate – severe pain associated with marked tenderness Intestinal obstruction Pain colicky, obstructive pattern seen on imaging Dissecting aortic aneurysm Sudden onset, pain may radiate to lower extremities Perforated PUD RUQ or mid-epigastric[epomedicine.com]
    Acute Pancreatitis
    • Acute pancreatitis or acute pancreatic necrosis [1] is a sudden inflammation of the pancreas .[en.wikipedia.org]
    • Tomography in Acute Pancreatitis Classification and Timing of Intervention in Acute Pancreatitis Nutritional Support in Acute Pancreatitis Infection in Acute Pancreatitis Role of Antibiotics in Acute Pancreatitis Role of ERCP in Acute Pancreatitis Endoscopic[elsevier.com]
    • Read more about the causes of acute pancreatitis and preventing acute pancreatitis .[beaconmedicalgroup.nhs.uk]
    Shock
    • When severe, may lead to local necrosis, hemorrhage, and shock.[medical-dictionary.thefreedictionary.com]
    • Systemic complications involve sepsis , ARDS , organ failure, and shock and are associated with a considerable rise in mortality .[amboss.com]
    • Clinical shock developed during the course of illness in 34 % of study patients whose admission pH was 7.35.[acutecaretesting.org]
    • , including: Restlessness A fast heartbeat Lightheadedness Confusion A cold sweat If you have any of these signs of shock, get emergency care or call 911 right away.[summitmedicalgroup.com]
    • Signs and symptoms include severe abdominal pain, nausea, vomiting, diarrhea, fever, and shock.[icd10data.com]
    Sudden Death
    • death, Pericardial effusion Hematologic: Disseminated Intravascular Coagulation (DIC) Gastrointestinal hemorrhage: Peptic ulcer disease, Erosive gastritis, Hemorrhagic pancreatic necrosis with erosion into major blood vessels, Portal vein thrombosis[epomedicine.com]
    Acute Cholecystitis
    • cholecystitis Acute coronary syndromes Aortic dissection Appendicitis Cholangitis Diabetic ketoacidosis Ectopic pregnancy Gastric outlet obstruction Gastric volvulus Intestinal obstructions Mesenteric ischemia Nephrolithiasis Pancreatic cancer Perforated[arupconsult.com]
    • cholecystitis Cholangitis Symptomatic cholelithiasis Acalculous cholecystitis Myocardial Ischemia Splenic Infarctionenlargement /rupture/aneurysm Pericarditis / Myocarditis Aortic dissection Hepatitis Pyelonephritis Pneumonia Pyogenic liver abscess Fitz-Hugh-Curtis[wikem.org]
    • Cholecystitis Inferior wall MI Peptic Ulcer Disease Lab Reports: Serum Amylase: 2,399 IU/L TLC: 14,100/cu.mm DLC: Neutrophils 87%; Lymphocytes 12%; Eosinophil 1% Platelets: 3,05,000/cu.mm Urine R/E: All parameters within normal limits UPT: Negative Serum[epomedicine.com]
    • Differential diagnosis [9] [ edit ] Perforated peptic ulcer Biliary colic Acute cholecystitis Pneumonia Pleuritic pain Myocardial infarction Biochemical [ edit ] Elevated serum amylase and lipase levels, in combination with severe abdominal pain, often[en.wikipedia.org]
    • A case of concomitant perforated acute cholecystitis and pancreatitis.[pancreapedia.org]
    Hyperglycemia
    • Hyperglycemia develops rather often in the early phase of acute pancreatitis, mainly in patients with severe disease [1–3].[link.springer.com]
    • […] is important due to the risk of profound hypovolemia [11] Maintain urine output at 0.5 mL/kg Analgesia and Antiemetics Antiemetics Electrolyte managment Monitor for Hypocalcemia Treat if symptomatic Glycemic control Monitor for development of hypo or hyperglycemia[wikem.org]
    • […] biliary pancreatitis than in patients with alcoholic pancreatitis Important predictors of severity Age 55 Gastrointestinal bleeding Abnormal hematocrit within 48 hours Acute hemorrhagic pancreatitis : Hct Third space fluid loss : Hct Hypocalcemia and/or hyperglycemia[amboss.com]
    • Systemic complications [ edit ] Systemic complications include ARDS , multiple organ dysfunction syndrome , DIC , hypocalcemia (from fat saponification), hyperglycemia and insulin dependent diabetes mellitus (from pancreatic insulin-producing beta cell[en.wikipedia.org]
    • Peptic ulcer disease, Erosive gastritis, Hemorrhagic pancreatic necrosis with erosion into major blood vessels, Portal vein thrombosis (Variceal hemorrhages) Renal: Oliguria, Azotemia, Renal artery/vein thrombosis, Acute Tubular Necrosis Metabolic: Hyperglycemia[epomedicine.com]
    Hypokalemia
    • E) Correct Electrolyte Abnormalities if present: Hypocalcemia: Calcium gluconate 10%: 10 mL IV over 15–20 min Hypokalemia: KCl 10 mEq/h IV over 1 hr Hypomagnesemia (alcohol abuse): MgSO4: 2 g IV piggyback F) Pain Management in Acute Pancreatitis Past[epomedicine.com]
    Acidosis
    • The notion that these might be useful prognostic markers is based partially on the observation that metabolic acidosis (characterized by reduced pH, bicarbonate and base excess) is a frequent complication of severe acute pancreatitis and other acute conditions[acutecaretesting.org]
    • 48 hours Acute hemorrhagic pancreatitis : Hct Third space fluid loss : Hct Hypocalcemia and/or hyperglycemia Inflammatory markers : CRP , IL-6 , IL-8 Evidence of shock and/or organ failure AST , ALT BUN , creatinine LDH ABG : pO 2 60 mmHg , metabolic acidosis[amboss.com]
    • Intestinal perforation by a foreign body or tumor Diabetes mellitus with ketoacidosis (accumulation of acid ketone by-products in the blood resulting in metabolic acidosis) can cause symptoms similar to those observed in dogs with pancreatitis.[petplace.com]
    • Complications of Acute Pancreatitis Abdominal compartment syndrome Acidosis Acute renal failure Acute respiratory distress syndrome Ascites Bowel infarction Development of chronic pancreatitis Disseminated intravascular coagulation Gastric varices Ileus[aafp.org]
    • 1.8 Ca2 2, PaO2 60mmHg Mortality based on score 0-2 risk factors: mortality 1% 6 risk factors: mortality around 100% COMPLICATIONS General/ systemic complications pain SIRS renal failure, liver failure and MODS metabolic derangement (e.g. metabolic acidosis[lifeinthefastlane.com]
    Metabolic Acidosis
    • The notion that these might be useful prognostic markers is based partially on the observation that metabolic acidosis (characterized by reduced pH, bicarbonate and base excess) is a frequent complication of severe acute pancreatitis and other acute conditions[acutecaretesting.org]
    • acidosis with a base deficit 4 mmol/L CT findings : pancreatic edema , peripancreatic fluid collection, and/or necrosis of 33% of the pancreas Amylase and lipase , which are used for the diagnosis of pancreatitis , cannot be used to predict the prognosis[amboss.com]
    • Intestinal perforation by a foreign body or tumor Diabetes mellitus with ketoacidosis (accumulation of acid ketone by-products in the blood resulting in metabolic acidosis) can cause symptoms similar to those observed in dogs with pancreatitis.[petplace.com]
    • acidosis, electrolyte abnormalities) ileus infection pancreatic (e.g. gut transolcation leading to infected pancreatic necrosis) extra-pancreatic Hypotension and shock “Third space losses” (capillary leak, particularly sequestration in the abdomen) Systemic[lifeinthefastlane.com]
    • acidosis, hypomagnesia Hematologic: Vascular thrombosis, disseminated intravascular coagulation [12] Death may also occur as a result of systemic involvement with pancreatitis.[physio-pedia.com]
    Diabetes Mellitus
    • Also, some dogs with diabetes mellitus may have complicating pancreatitis.[petplace.com]
    • Article date: September 2012 DPP-4 inhibitors are indicated for the improvement of glycaemic control in adults with type 2 diabetes mellitus.[gov.uk]
    • It is also important to know that pancreatitis is frequently associated with diabetes mellitus.[physio-pedia.com]
    • Systemic complications [ edit ] Systemic complications include ARDS , multiple organ dysfunction syndrome , DIC , hypocalcemia (from fat saponification), hyperglycemia and insulin dependent diabetes mellitus (from pancreatic insulin-producing beta cell[en.wikipedia.org]
    Hypotension
    • Hemorrhage in acute pancreatitis is not usually large enough to cause hypotension.[medbullets.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]
    • […] vomiting Further symptoms Fever Abdominal tenderness , distention , and guarding Ileus with reduced bowel sounds and tympany on percussion Ascites , pleural effusion Possibly jaundice in patients with biliary pancreatitis Signs of shock : tachycardia , hypotension[amboss.com]
    • […] of acute pancreatitis is “I GET SMASHED” Idiopathic Gall stones Ethanol Trauma Steroids Mumps and other viruses (EBV, CMV, HIV) Autoimmune diseases (SLE, polyarteritis nodosa, pregnancy) Scorpion stings Hypercalcaemia, hyperlipidaemia, hypothermia, hypotension[lifeinthefastlane.com]
    • Clinical findings Abdominal pain, nausea, vomiting, hypotension.[medical-dictionary.thefreedictionary.com]
    Pancreatitis
    • Acute pancreatitis or acute pancreatic necrosis [1] is a sudden inflammation of the pancreas .[en.wikipedia.org]
    • Pancreatitis: Acute biliary pancreatitis with a thickened pancreas and an effusion around the pancreatic tail and around the spleen Pancreatitis: Pancreatitis of the pancreatic tail with a thickened pancreatic tail Pancreatitis: Pancreatitis of the tail[ultrasoundcases.info]
    • Autoimmune pancreatitis Autoimmune pancreatitis, a relatively newly described entity, is an extremely rare cause of acute pancreatitis (prevalence, 0.82 per 100,000 individuals).[emedicine.medscape.com]
    • This review applies only to cases of acute pancreatitis, not to chronic pancreatitis, flair-ups of chronic pancreatitis (i.e. acute-on-chronic pancreatitis), groove pancreatitis, auto-immune pancreatitis and other forms of pancreatitis (e.g. tuberculous[pancreapedia.org]
    • Alcoholic pancreatitis — Alcohol is a common cause of acute pancreatitis.[uptodate.com]
    Hypertriglyceridemia
    • A fasting lipid profile is indicated if pancreatitis was due to hypertriglyceridemia.[clinicaladvisor.com]
    • Hypertriglyceridemia See hypertriglyceridemia for management of high TGs Disposition Discharge Mild case no biliary disease no systemic complication tolerating clears Patients can be discharged when oral analgesics control their pain their pain All other[wikem.org]
    • Etiology RAP has multiple causes, alcohol and cholelithiasis being the most frequent (followed by dietary causes, hypertriglyceridemia, biliary tract infection, congenital anomalies, duodenal obstruction, medications, and neoplasms).[orpha.net]
    • ., gallstones , constriction of the ampulla of Vater) 40% of cases Alcohol-induced ( 30% of cases) Idiopathic ( 15%–25% of cases) Other causes Hypertriglyceridemia , hypercalcemia Post- ERCP Toxic drugs ; (e.g., steroids, azathioprine ; , sulfonamides[amboss.com]
    • . • Metabolic defects—hypertriglyceridemia, hyperparathyroidism, hypercalcaemia. • Obstruction—ampullary tumours, congenital defects of pancreas or biliary tree, parasites. • Toxins—scorpion bites. • Trauma—blunt, iatrogenic injury during heart surgery[medical-dictionary.thefreedictionary.com]
    Peptic Ulcer
    • General imaging differential considerations include: pancreatic ductal adenocarcinoma autoimmune pancreatitis peptic ulcer disease with posterior perforation pancreatic lymphoma (diffuse pattern)[radiopaedia.org]
    • Ulcer Disease Lab Reports: Serum Amylase: 2,399 IU/L TLC: 14,100/cu.mm DLC: Neutrophils 87%; Lymphocytes 12%; Eosinophil 1% Platelets: 3,05,000/cu.mm Urine R/E: All parameters within normal limits UPT: Negative Serum Calcium: 8.1 mg/dl LFTs: Total Bilirubin[epomedicine.com]
    • […] flanks) - retroperitoneal hemorrhage Pulmonary Findings Hypoxemia , ARDS , tachypnea Indicates severe pancreatitis Diaphragmatic inflammation, pancreatico-pleural fistula Differential Diagnosis Epigastric Pain Gastroesophageal reflux disease (GERD) Peptic[wikem.org]
    • ulcer Biliary colic Cholecystitis Cholangitis Bowel obstruction Abdominal aortic aneurysm Ectopic pregnancy Cardiopulmonary Pathology Acute myocardial infarction ARDS Pericarditis Ranson’s Criteria (Rosen’s) Diagnostics: Basic Diagnostic Criteria (must[rebelem.com]
    • Differential Diagnosis of Acute Pancreatitis Acute myocardial infarction Cholangitis Cholecystitis Diabetic ketoacidosis Gastric outlet obstruction Gastric volvulus Hepatitis Intestinal infarction Pancreatic cancer Perforated peptic ulcer Tubo-ovarian[aafp.org]
    Appendicitis
    • Abdominal CT is often performed initially to help delineate the cause of acute abdominal pain and eliminate other life-threatening etiologies that may include perforated viscus, appendicitis or even aortic dissection (see C.[clinicaladvisor.com]
    • […] plus one fluid collection 3 points E – multiple of extensive fluid collections 4 points Necrosis score None 0 points 2 points One-third but 4 points One-half 6 points Differential Diagnosis Acute cholecystitis Acute coronary syndromes Aortic dissection Appendicitis[arupconsult.com]
    • Pneumonia Pyogenic liver abscess Fitz-Hugh-Curtis Syndrome Hepatomegaly due to CHF Bowel obstruction SMA syndrome Pulmonary embolism Bezoar Diffuse Abdominal pain Abdominal aortic aneurysm Aortocaval fistula Acute gastroenteritis Aortoenteric fisulta Appendicitis[wikem.org]
    • Fitz-Hugh-Curtis syndrome Gonococcal perihepatitis w/ RUQ pain, adnexal tenderness Pneumonia Fever and respiratory symptomss (dyspnea, cough, sputum, chest pain) present Appendicitis Pain may start in epigastrium but eventually moves to RLQ test Some[epomedicine.com]
    • Acute Pancreatitis Disorders presenting with symptoms similar to those of acute pancreatitis include perforated gastric or duodenal ulcer , mesenteric infarction, medications, strangulating intestinal obstruction, dissecting aneurysm , biliary colic, appendicitis[physio-pedia.com]
    Hypoxia
    • Doctors treat hypoxia by giving oxygen through a face mask.[wakegastro.com]
    • Symptoms of severe pancreatitis development include tachycardia, hypoxia, tachypnea, and changes in mental status. [1] [2] Complications that may occur with severe forms of this disease include pancreatic fluid-filled collections (57% of cases), pseudocysts[physio-pedia.com]
    Acute Tubular Necrosis
    • Tubular Necrosis Metabolic: Hyperglycemia, Hypocalcemia, Encephalopathy, Sudden blindness (Purtscher’s retinopathy) CNS: Psychosis, Fat emboli Timeline of complications in Acute Pancreatitis Period 1 (Hemodynamic violations and pancreatogenic shock):[epomedicine.com]
    Psychosis
    • […] major blood vessels, Portal vein thrombosis (Variceal hemorrhages) Renal: Oliguria, Azotemia, Renal artery/vein thrombosis, Acute Tubular Necrosis Metabolic: Hyperglycemia, Hypocalcemia, Encephalopathy, Sudden blindness (Purtscher’s retinopathy) CNS: Psychosis[epomedicine.com]
    • Pericardial effusion vascular thrombosis Gastrointestinal Gastrointestinal hemorrhage from stress ulceration; gastric varices (secondary to splenic vein thrombosis) Gastrointestinal obstruction Hepatobiliary Jaundice Portal vein thrombosis Neurologic Psychosis[en.wikipedia.org]
    Disseminated Intravascular Coagulation
    • intravascular coagulation Vein thrombosis – portal, mesenteric, splanchnic Renal – acute renal failure Cardiovascular – circulatory failure (shock) Respiratory – hypoxic acute respiratory failure Tests generally appear in the order most useful for common[arupconsult.com]
    • A body-wide clotting disorder (“disseminated intravascular coagulation”) occasionally may complicate pancreatitis and require additional treatment including heparin administration.[petplace.com]
    • intravascular coagulation) Cullen’s Sign Presentation: History Symptoms Abdominal pain Typically epigastric but may be RUQ or LUQ Will become more diffuse as inflammation progresses Rapid onset of pain over a few hours Pain is constant, often severe[rebelem.com]
    • In 5 percent cases, it may result in ARDS (acute respiratory distress syndrome), DIC (disseminated intravascular coagulation), etc.[en.wikipedia.org]
    • Complications of Acute Pancreatitis Abdominal compartment syndrome Acidosis Acute renal failure Acute respiratory distress syndrome Ascites Bowel infarction Development of chronic pancreatitis Disseminated intravascular coagulation Gastric varices Ileus[aafp.org]
    Hypercalcemia
    • Hypercalcemia Hypercalcemia from any cause can lead to acute pancreatitis.[emedicine.medscape.com]
    • ., gallstones , constriction of the ampulla of Vater) 40% of cases Alcohol-induced ( 30% of cases) Idiopathic ( 15%–25% of cases) Other causes Hypertriglyceridemia , hypercalcemia Post- ERCP Toxic drugs ; (e.g., steroids, azathioprine ; , sulfonamides[amboss.com]
    • While the most likely cause for acute pancreatitis is gallstones and alcohol, other common causes include medications, elevated triglycerides, hypercalcemia, abdominal trauma, post-ERCP pancreatitis, and pancreas divisum.[medicine.yale.edu]
    • Many medications, and conditions such as hyperlipidemia (high levels of fat in the blood), and hypercalcemia (high levels of calcium in the blood) may also cause pancreatitis.[surgery.usc.edu]
    • Conditions that can lead to pancreatitis include: Alcoholism Gallstones Abdominal surgery Certain medications Cigarette smoking Cystic fibrosis Family history of pancreatitis High calcium levels in the blood (hypercalcemia), which may be caused by an[mayoclinic.org]
    Ascites
    • […] saponification) reduces serum calcium levels Intravascular volume depletion Pancreatic vasodilatation and capillary leakage drains circulatory volume accumulation of fluid in the pancreas, peripancreatic tissue, retroperitoneum, and intraperitoneum ( ascites[amboss.com]
    • : Finding consistent with ascites with acute severe pancreatitis (modified CT Severity index 4 2 2 8 with moderate ascites) Mild hepatomegaly with fatty change in liver Minimal Left sided pleural effusion with Left lower lobe atelectasis Diagnosis: Severe[epomedicine.com]
    • Minor or major pancreatic duct rupture can cause pancreatic ascites from leakage of pancreatic fluid into the lesser and greater peritoneal compartments.[pancreapedia.org]
    • Additionally, the abdomen should be assessed for evidence of ascites or hemorrhage (see section D.[clinicaladvisor.com]
    • Complications of acute pancreatitis may include: Acute kidney failure Long-term lung damage (ARDS) Buildup of fluid in the abdomen ( ascites ) Cysts or abscesses in the pancreas Heart failure When to Contact a Medical Professional Call your provider if[uihc.org]
    Pancreatic Adenocarcinoma
    • Interstitial pancreatitis due to pancreatic adenocarcinoma.[pancreapedia.org]
    • adenocarcinoma lymphoma hereditary pancreatitis (autosomal dominant) SPINK1 gene mutation 5 malnutrition infection viral: mumps , Coxsackie, hepatitis, infectious mononucleosis , AIDS parasitic: ascariasis 5 , Clonorchis structural: not a cause, but[radiopaedia.org]
    Hypocalcemia
    • […] and procalcitonin levels Alkaline phosphatase (evidence of gallstone pancreatitis ) γ-GT and MCV (toxicity caused by ethyl compounds) Determining calcium values is very important: Hypercalcemia may cause pancreatitis , which may then, in turn, cause hypocalcemia[amboss.com]
    • […] necessary [1] IV Fluids Volume resuscitation and constant monitoring of fluid status is important due to the risk of profound hypovolemia [11] Maintain urine output at 0.5 mL/kg Analgesia and Antiemetics Antiemetics Electrolyte managment Monitor for Hypocalcemia[wikem.org]
    • […] complications Pancreatitic – acute fluid collection, necrosis, pseudocyst formation, abscess formation, ascites Intestinal – paralytic ileus, GI hemorrhage, bowel infarction Hepatobiliary – jaundice, obstruction of the common bile duct Metabolic Malnutrition Hypocalcemia[arupconsult.com]
    • E) Correct Electrolyte Abnormalities if present: Hypocalcemia: Calcium gluconate 10%: 10 mL IV over 15–20 min Hypokalemia: KCl 10 mEq/h IV over 1 hr Hypomagnesemia (alcohol abuse): MgSO4: 2 g IV piggyback F) Pain Management in Acute Pancreatitis Past[epomedicine.com]
    • Systemic complications [ edit ] Systemic complications include ARDS , multiple organ dysfunction syndrome , DIC , hypocalcemia (from fat saponification), hyperglycemia and insulin dependent diabetes mellitus (from pancreatic insulin-producing beta cell[en.wikipedia.org]
    Retroperitoneal Hemorrhage
    • […] of peripancreatic fat In 20% of patients, pancreatitis progresses to coagulation necrosis of glandular elements Clinical Presentation Signs and symptoms Gastrointestinal Sudden upper abdominal pain – may radiate to flank, lower abdomen Nausea, emesis Retroperitoneal[arupconsult.com]
    • […] back The onset may be less abrupt and the pain poorly localized Nausea/vomiting noted in most Abdominal distention is frequent complaint Cullen sign (ecchymosis of periumbilical region) - intrabdominal hemorrhage Turner sign (ecchymosis of flanks) - retroperitoneal[wikem.org]
    • […] distension, Reduced bowel sound, Palpable pseudocyst (sometimes) Uncommon signs associated with severe necrotizing pancreatitis: Cullen’s sign (Periumbilical discoloration due to peritoneal hemorrhage) Grey-Turner’s sign (Flank discoloration due to retroperitoneal[epomedicine.com]
    Dissecting Aortic Aneurysm
    • H/O and P/E correlate – severe pain associated with marked tenderness Intestinal obstruction Pain colicky, obstructive pattern seen on imaging Dissecting aortic aneurysm Sudden onset, pain may radiate to lower extremities Perforated PUD RUQ or mid-epigastric[epomedicine.com]
    Acute Myocardial Infarction
    • myocardial infarction ARDS Pericarditis Ranson’s Criteria (Rosen’s) Diagnostics: Basic Diagnostic Criteria (must have at least 2 out of 3) Signs/symptoms consistent with pancreatitis Lipase elevation: 3X normal reference range (value depends on lab)[rebelem.com]
    • Differential Diagnosis of Acute Pancreatitis Acute myocardial infarction Cholangitis Cholecystitis Diabetic ketoacidosis Gastric outlet obstruction Gastric volvulus Hepatitis Intestinal infarction Pancreatic cancer Perforated peptic ulcer Tubo-ovarian[aafp.org]
    Hypomagnesemia
    • E) Correct Electrolyte Abnormalities if present: Hypocalcemia: Calcium gluconate 10%: 10 mL IV over 15–20 min Hypokalemia: KCl 10 mEq/h IV over 1 hr Hypomagnesemia (alcohol abuse): MgSO4: 2 g IV piggyback F) Pain Management in Acute Pancreatitis Past[epomedicine.com]
    • Hypocalcemia and hypomagnesemia should be corrected intravenously.[aafp.org]
    Acute Respiratory Distress Syndrome
    • Information provided by (Responsible Party): Erzhen Chen, Ruijin Hospital Acute lung injury (ALI) and acute respiratory distress syndrome(ARDS) represent the most common and earliest organ dysfunction in acute pancreatitis, presenting as dyspnea and intractable[clinicaltrials.gov]
    • In 5 percent cases, it may result in ARDS (acute respiratory distress syndrome), DIC (disseminated intravascular coagulation), etc.[en.wikipedia.org]
    • Complications of Acute Pancreatitis Abdominal compartment syndrome Acidosis Acute renal failure Acute respiratory distress syndrome Ascites Bowel infarction Development of chronic pancreatitis Disseminated intravascular coagulation Gastric varices Ileus[aafp.org]
    • Local inflammatory mediators are released, leading to distant extra-pancreatic organ dysfunction, including shock, acute respiratory distress syndrome (ARDS), and renal failure. 1,2,8 The inciting factor that leads to inappropriate trypsin activation[acep.org]
    • distress syndrome (ARDS) develops as a complication.[physio-pedia.com]
    Abdominal Aortic Aneurysm
    • aortic aneurysm Aortocaval fistula Acute gastroenteritis Aortoenteric fisulta Appendicitis (early) Bowel obstruction Large bowel obstruction Ogilvie's syndrome Small bowel obstruction Bowel perforation Gastroparesis Diabetic ketoacidosis Inflammatory[wikem.org]
    • aortic aneurysm Ectopic pregnancy Cardiopulmonary Pathology Acute myocardial infarction ARDS Pericarditis Ranson’s Criteria (Rosen’s) Diagnostics: Basic Diagnostic Criteria (must have at least 2 out of 3) Signs/symptoms consistent with pancreatitis Lipase[rebelem.com]
    Viral Hepatitis
    • hepatitis) or High levels of calcium or triglycerides in the blood Since gallstones are a major cause of acute pancreatitis, people at risk of gallstones are also at risk for acute pancreatitis.[cedars-sinai.edu]
    • Hepatomegaly from alcoholic or viral hepatitis may be evident by palpation and percussion.[clinicaladvisor.com]
    • ., vildagliptin , sitagliptin , saxagliptin , linagliptin ), tetracycline , sulfonamides , estrogens , azathioprine and mercaptopurine , pentamidine , salicylates , steroids , Depakote [ citation needed ] Infections: mumps , viral hepatitis , coxsackie[en.wikipedia.org]
    Food Poisoning
    • It could mean something else such as a gut infection or food poisoning. 4 Open up to your doctor about your alcohol consumption.[wikihow.com]
    • Infections Bacterial infections that can lead to acute pancreatitis include Salmonellosis, a type of food poisoning caused by the bacterium Salmonella, or Legionnaires' disease , an infection caused by the bacterium Legionella pneumophila found in plumbing[medicalnewstoday.com]
    Hypovolemia
    • Instructions regarding a light diet and avoidance of alcohol is necessary [1] IV Fluids Volume resuscitation and constant monitoring of fluid status is important due to the risk of profound hypovolemia [11] Maintain urine output at 0.5 mL/kg Analgesia[wikem.org]
    • The inflammatory response leads to the secondary manifestations of pancreatitis: hypovolemia from capillary permeability, acute respiratory distress syndrome, disseminated intravascular coagulations, renal failure, cardiovascular failure, and gastrointestinal[en.wikipedia.org]
    • This includes aggressive fluid management, adequate opiate analgesia, early nutrition, and oxygen administration.8 Fluid resuscitation is an especially important aspect of treatment. 1,3,19,23 Hypovolemia plays a central role in pancreatic necrosis by[acep.org]
    • […] vessels (splenic vein i.e. sinistral portal HTN, portal vein) Bowel obstruction Obstructive Jaundice Systemic Complications of Acute Pancreatitis Pulmonary: Pleural effusion, Atelectasis, Mediastinal abscess, Pneumonitis, ARDS Cardiovascular: Hypotension (Hypovolemia[epomedicine.com]
    Perforated Peptic Ulcer
    • Differential Diagnosis of Acute Pancreatitis Acute myocardial infarction Cholangitis Cholecystitis Diabetic ketoacidosis Gastric outlet obstruction Gastric volvulus Hepatitis Intestinal infarction Pancreatic cancer Perforated peptic ulcer Tubo-ovarian[aafp.org]
    • peptic ulcer Sentinel loop sign, Colon ‘cut-off’ sign, Renal halo sign May show gallstone, pancreatic calcification Abdominal USG: Can detect gallstones, biliary obstruction, pseudocyst formation CT abdomen: may be required if diagnosis uncertain, to[epomedicine.com]
    • Differential diagnosis [9] [ edit ] Perforated peptic ulcer Biliary colic Acute cholecystitis Pneumonia Pleuritic pain Myocardial infarction Biochemical [ edit ] Elevated serum amylase and lipase levels, in combination with severe abdominal pain, often[en.wikipedia.org]
    Pancreatic Pseudocyst
    • Localized complications of pancreatitis include necrosis , pancreatic pseudocysts , and abscesses .[amboss.com]
    • Free Access Management strategies for pancreatic pseudocysts Kurinchi Selvan Gurusamy, Elena Pallari, Neil Hawkins, Stephen P Pereira, Brian R Davidson Online Publication Date: April 2016 Review A full review, complete with results and discussion, possibly[cochranelibrary.com]
    • It will also show if there is fluid in the abdomen or pancreatic "pseudocysts" (pockets of enzymes that can burst, damaging nearby tissues and organs).[cedars-sinai.edu]
    • pseudocyst acute pancreatic fluid collection that has persisted 4 weeks and developed a well-defined wall acute necrotic collection pancreatic fluid collection with areas of necrosis occurring within 4 weeks and lacking a defined wall may be isolated[lifeinthefastlane.com]
    • A pancreatic pseudocyst is a collection of pancreatic enzymes, fluid, and tissue debris that sometimes forms in and around the pancreas.[merckmanuals.com]
    Diabetic Ketoacidosis
    • ketoacidosis Ectopic pregnancy Gastric outlet obstruction Gastric volvulus Intestinal obstructions Mesenteric ischemia Nephrolithiasis Pancreatic cancer Perforated duodenal/gastric ulcer Tubo-ovarian abscess Epidemiology Incidence – 30-40/100,000 in[arupconsult.com]
    • ketoacidosis Inflammatory bowel disease Mesenteric ischemia Pancreatitis Peritonitis Sickle cell crisis Spontaneous bacterial peritonitis Volvulus Evaluation Two of the following: Characteristic abdominal pain Lipase level 3x upper limit of normal Negative[wikem.org]
    • Differential Diagnosis of Acute Pancreatitis Acute myocardial infarction Cholangitis Cholecystitis Diabetic ketoacidosis Gastric outlet obstruction Gastric volvulus Hepatitis Intestinal infarction Pancreatic cancer Perforated peptic ulcer Tubo-ovarian[aafp.org]
    • Hyperamylasaemia may be caused by bowel perforation, obstruction or ischaemia, fallopian tube pathology, diabetic ketoacidosis, and pneumonia or neoplasm, particularly when associated with renal failure. 4 establish the diagnosis; determine the cause;[academic.oup.com]
    • ketoacidosis. [2] [5] [9] [12] Chronic Pancreatitis Patients who do not present with a typical history of alcohol abuse and frequent episodes of acute pancreatitis, pancreatic malignancy must be ruled out as the cause of pain.[physio-pedia.com]
    Pancreatic Abscess
    • Pancreatic abscess can complicate pancreatitis and usually requires surgical treatment.[petplace.com]
    • References: [12] [13] Complications Localized Bacterial superinfection of necrotic tissue Pancreatic pseudocysts Pancreatic abscess Walled-off infected necrotic tissue ; or pancreatic pseudocyst ; typically develops 4 weeks after an attack of acute pancreatitis[amboss.com]
    • If a pseudocyst becomes infected, it is called a pancreatic abscess.[ddc.musc.edu]
    • abscess a presence of infection without significant necrosis extremely rare term not in current use 8 vascular complications haemorrhage: resulting from erosion of blood vessels and tissue necrosis pseudoaneurysm : autodigestion of arterial walls by[radiopaedia.org]
    • Remember that pseudocysts take about 4 weeks and pancreatic abscesses about 5 weeks to form after initial onset of symptoms. 1 Pancreatic necrosis is best evaluated by obtaining a contrast-enhanced CT scan 2-4 days after admission, as CT done on admission[acep.org]
    Leukocytosis
    • […] measures not necessary as they do not provide prognostication Amylase Do not order – lipase offers improved sensitivity ( Choosing Wisely: Fifteen Things Physicians and Patients Should Question , 2016; American Society for Clinical Pathology) CBC – leukocytosis[arupconsult.com]
    • CBC and HCt : Leukocytosis with shift to left (Inflammation or SIRS) HCt (Hemoconcentration due to fluid sequestration) HCt (Dehydration or Hemorrhage) 5.[epomedicine.com]
    • […] may still die if pancreatic necrosis later becomes infected Organ system failure tends to be worse and mortality tends to be higher Confirmation of the diagnosis is invasive, i.e. by samples and culture consider FNA of the necrotic area if fever and leukocytosis[lifeinthefastlane.com]
    • Complete blood count should be ordered at presentation to evaluate for leukocytosis that may indicate cholangitis, cholecystitis, pancreatic abscess, or other potential etiology of diffuse abdominal pain including perforated viscus, appendicitis, pyelonephritis[clinicaladvisor.com]
    • Imaging is indicated during the initial presentation if: the diagnosis of acute pancreatitis is uncertain there is abdominal distension and tenderness, fever 102, or leukocytosis there is a Ranson score 3 or APACHE score 8 there is no improvement after[en.wikipedia.org]
    Fat Necrosis
    • Possible pathways of enzyme activation: (1) Pancreatic duct obstruction Increased intrapancreatic ductal pressure results in accumulation of enzyme-rich interstitial fluid; lipase (one of the few enzymes secreted in activated form) results in fat necrosis[medical-dictionary.thefreedictionary.com]
    • necrosis Miscellaneous Subcutaneous fat necrosis Arthalgia Epidemiology [ edit ] In the United States, the annual incidence is 18 cases of acute pancreatitis per 100,000 population, and it accounts for 220,000 hospitalizations in the US. [52] In a European[en.wikipedia.org]
    • Blood biochemistry: Blood sugar: may  due to insulin producing Beta-cell dysfunction Serum calcium:  (due to hypoalbuminemia or fat necrosis) or  (if hypercalcemia is etiology) Lipid profile: to rule out hypertriglyceridemia as the cause 6.[epomedicine.com]
    • Mortality in patients with infected pancreatic necrosis is 25–30%, compared with 10–12% in those with sterile necrosis. 3 Table 1 Local or regional complications defining SAP Local Pancreatic parenchymal necrosis (sterile or infected) Peripancreatic fat[academic.oup.com]
    • Panniculitis, tender red-brown nodules, usually located on the lower extremities, secondary to subcutaneous fat necrosis, can rarely be seen and is often associated with pancreatic malignancy.[clinicaladvisor.com]
    Pancreatic Necrosis
    • Antibiotic therapy for prophylaxis against infection of pancreatic necrosis in acute pancreatitis.[lifeinthefastlane.com]
    • However, surgery should be considered in patients with infected pancreatic necrosis.[medicine.yale.edu]
    • What is pancreatic necrosis Severe pancreatitis causes death of parts of the pancreas.[surgery.usc.edu]
    • Acute pancreatitis or acute pancreatic necrosis [1] is a sudden inflammation of the pancreas .[en.wikipedia.org]
    • FNAB is indicated in patients with pancreatic necrosis on CT and clinical signs of sepsis.[academic.oup.com]

    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].

    Causes

    Hypokalemia
    • E) Correct Electrolyte Abnormalities if present: Hypocalcemia: Calcium gluconate 10%: 10 mL IV over 15–20 min Hypokalemia: KCl 10 mEq/h IV over 1 hr Hypomagnesemia (alcohol abuse): MgSO4: 2 g IV piggyback F) Pain Management in Acute Pancreatitis Past[epomedicine.com]
    Metabolic Acidosis
    • The notion that these might be useful prognostic markers is based partially on the observation that metabolic acidosis (characterized by reduced pH, bicarbonate and base excess) is a frequent complication of severe acute pancreatitis and other acute conditions[acutecaretesting.org]
    • acidosis with a base deficit 4 mmol/L CT findings : pancreatic edema , peripancreatic fluid collection, and/or necrosis of 33% of the pancreas Amylase and lipase , which are used for the diagnosis of pancreatitis , cannot be used to predict the prognosis[amboss.com]
    • Intestinal perforation by a foreign body or tumor Diabetes mellitus with ketoacidosis (accumulation of acid ketone by-products in the blood resulting in metabolic acidosis) can cause symptoms similar to those observed in dogs with pancreatitis.[petplace.com]
    • acidosis, electrolyte abnormalities) ileus infection pancreatic (e.g. gut transolcation leading to infected pancreatic necrosis) extra-pancreatic Hypotension and shock “Third space losses” (capillary leak, particularly sequestration in the abdomen) Systemic[lifeinthefastlane.com]
    • acidosis, hypomagnesia Hematologic: Vascular thrombosis, disseminated intravascular coagulation [12] Death may also occur as a result of systemic involvement with pancreatitis.[physio-pedia.com]
    Hypoxia
    • Doctors treat hypoxia by giving oxygen through a face mask.[wakegastro.com]
    • Symptoms of severe pancreatitis development include tachycardia, hypoxia, tachypnea, and changes in mental status. [1] [2] Complications that may occur with severe forms of this disease include pancreatic fluid-filled collections (57% of cases), pseudocysts[physio-pedia.com]
    Hypovolemia
    • Instructions regarding a light diet and avoidance of alcohol is necessary [1] IV Fluids Volume resuscitation and constant monitoring of fluid status is important due to the risk of profound hypovolemia [11] Maintain urine output at 0.5 mL/kg Analgesia[wikem.org]
    • The inflammatory response leads to the secondary manifestations of pancreatitis: hypovolemia from capillary permeability, acute respiratory distress syndrome, disseminated intravascular coagulations, renal failure, cardiovascular failure, and gastrointestinal[en.wikipedia.org]
    • This includes aggressive fluid management, adequate opiate analgesia, early nutrition, and oxygen administration.8 Fluid resuscitation is an especially important aspect of treatment. 1,3,19,23 Hypovolemia plays a central role in pancreatic necrosis by[acep.org]
    • […] vessels (splenic vein i.e. sinistral portal HTN, portal vein) Bowel obstruction Obstructive Jaundice Systemic Complications of Acute Pancreatitis Pulmonary: Pleural effusion, Atelectasis, Mediastinal abscess, Pneumonitis, ARDS Cardiovascular: Hypotension (Hypovolemia[epomedicine.com]
    Diabetic Ketoacidosis
    • ketoacidosis Ectopic pregnancy Gastric outlet obstruction Gastric volvulus Intestinal obstructions Mesenteric ischemia Nephrolithiasis Pancreatic cancer Perforated duodenal/gastric ulcer Tubo-ovarian abscess Epidemiology Incidence – 30-40/100,000 in[arupconsult.com]
    • ketoacidosis Inflammatory bowel disease Mesenteric ischemia Pancreatitis Peritonitis Sickle cell crisis Spontaneous bacterial peritonitis Volvulus Evaluation Two of the following: Characteristic abdominal pain Lipase level 3x upper limit of normal Negative[wikem.org]
    • Differential Diagnosis of Acute Pancreatitis Acute myocardial infarction Cholangitis Cholecystitis Diabetic ketoacidosis Gastric outlet obstruction Gastric volvulus Hepatitis Intestinal infarction Pancreatic cancer Perforated peptic ulcer Tubo-ovarian[aafp.org]
    • Hyperamylasaemia may be caused by bowel perforation, obstruction or ischaemia, fallopian tube pathology, diabetic ketoacidosis, and pneumonia or neoplasm, particularly when associated with renal failure. 4 establish the diagnosis; determine the cause;[academic.oup.com]
    • ketoacidosis. [2] [5] [9] [12] Chronic Pancreatitis Patients who do not present with a typical history of alcohol abuse and frequent episodes of acute pancreatitis, pancreatic malignancy must be ruled out as the cause of pain.[physio-pedia.com]

    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.

    Other symptoms

    Hereditary Pancreatitis
    • In a small percentage of the cases, the cause is unknown and, very rarely, patients can have chronic pancreatitis that tends to run in families (hereditary pancreatitis).[my.clevelandclinic.org]
    • A person with hereditary pancreatitis usually has the typical symptoms that come and go over time.[wakegastro.com]
    • Hereditary pancreatitis Hereditary pancreatitis is an autosomal dominant gain-of-function disorder related to mutations of the cationic trypsinogen gene ( PRSS1 ), which has an 80% penetrance.[emedicine.medscape.com]
    • […] corticosteroids and nonsteroidal anti-inflammatory drugs, some antibiotics, and blood pressure lowering drugs, such as thiazide diuretics) Structural abnormalities of the pancreas or the common bile duct, including pancreas divisum Genetic mutations, including hereditary[uchospitals.edu]
    • Cell Autotransplantation Puestow Procedure Total Pancreatectomy Whipple Procedure Diseases of the Pancreas/Biliary System Acute Pancreatitis Cholangitis Cholecystitis Chronic Pancreatitis Diabetes Gallstone Pancreatitis Gallstones and Bile Duct Stones Hereditary[ddc.musc.edu]

    Self-assessment

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    References

    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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