This document provides an overview of acute pancreatitis, including: 1. It discusses the pathophysiology of acute pancreatitis, including local effects within the pancreas and general systemic effects involving multiple organ systems. 2. The most common causes of acute pancreatitis are gallstones and alcohol consumption. Radiology findings and severity scores can help assess prognosis. 3. Treatment involves pain relief, fluid resuscitation for shock, and monitoring for complications like necrosis which may require drainage or necrosectomy.

1. LECTURE 5 Acute Pancreatitis National O. Bogomolets Medical University Faculty Surgery Department N1 Kyiv 2007 Prof. Kucher M.

2. Pancreas embryology The ventral pancreas develops in association with the biliary tree, and its duct joins the common bile duct before emptying into the duodenum through the papilla of Vater. During gestation, the duodenum rotates clockwise on its long axis, and the bile duct and ventral pancreas pass round behind it to fuse with the dorsal pancreas. Most of the duct that drains the dorsal pancreas joins the duct draining the ventral pancreas to form the main pancreatic duct (of Wirsung); the rest of the dorsal duct becomes the accessory pancreatic duct (of Santorini) and enters the duodenum 2.5 cm proximal to the main duct.

3. Surgical anatomy. The pancreas lies retroperitoneally, behind the lesser sac and stomach. The head of the gland lies within the C-loop of the duodenum, with which it shares a blood supply from the coeliac and superior mesenteric arteries. The superior mesenteric vein runs upwards to the left of the uncinate process, and joins the splenic vein behind the neck of the pancreas to form the portal vein. The body and tail of the pancreas lie in front of the splenic vein as far as the splenic hilum, and receive arterial blood from the splenic artery. The close association between the common bile duct and the head of pancreas explains why obstructive jaundice is so common in cancer of the head of the pancreas, and why gallstones frequently give rise to acute pancreatitis.

21. Balthazar Scoring for the Grading of Acute Pancreatitis The CT Severity Score is the sum of the CT Grade and Necrosis Grade Scores. CT Grade Score : 4 points Two or more fluid collections and / or gas bubbles in or adjacent to pancreas Grade E 3 points Fluid collection in a single location Grade D 2 points Pancreatic gland abnormalities and peripancreatic inflammation Grade C 1 point Focal or diffuse enlargement of the pancreas Grade B 0 points Normal CT Grade A CT Grade Points Appearance on CT CT Grade

22. Balthazar Scoring for the Grading of Acute Pancreatitis The CT Severity Score is the sum of the CT Grade and Necrosis Grade Scores. Necrosis Grade Score : 6 points Over 50% necrosis 4 points 30 to 50% necrosis 2 points 0 to 30% necrosis 0 points No necrosis Points Necrosis Percentage

24. CT scanning is used to recognise abscess or pseudocyst formation or necrosis. Even if a CT scan is not required for diagnostic purposes, it should be performed 3–10 days after the start of a severe attack. If signs of necrosis are seen, a fine needle aspirate of the pancreatic fluid is indicated to identify whether the tissue is infected or not. Sterile necrosis should be managed conservatively but, if there is infection, open necrosectomy is indicated. Repeat CT scanning is recommended every 1–2 weeks