Acute pancreatitis is an inflammation of the pancreas with an annual incidence of 5 to 50 per 100,000 people. It can range from mild to severe with mortality over 10% for severe cases. The pancreas is located in the retroperitoneum behind the stomach. Common causes are gallstones and excessive alcohol use which cause a pathological activation of pancreatic enzymes. Clinical features include abdominal pain but examination may also find signs of dehydration, fever, and tenderness. Diagnosis is made based on elevated serum amylase and lipase levels along with CT scan findings. Mild cases are treated conservatively with IV fluids while severe cases can lead to multiorgan failure.
6. INTRODUCTION
• ANNUAL INCIDENCE: 5 TO 50 PER 100 000
• RESPONSIBLE FOR 300,000 HOSPITAL ADMISSIONS ANNUALLY IN
UNITED STATES
• MORTALITY OF >1% IN MILD PANCREATITIS
• 10 TO 30% MORTALITY IN SEVERE PANCREATITIS
• MOST COMMON CAUSE OF DEATH: MULTIORGAN DYSFUNCTION
SYNDROME]
• MORTALITY HAS BIMODAL DISTRIBUTION
8. PATHOPHYSIOLOGY
• THE EXACT MECHANISM WHEREBY PREDISPOSING FACTORS SUCH AS ETHANOL
AND GALLSTONES PRODUCE PANCREATITIS IS NOT COMPLETELY KNOWN. MOST
RESEARCHERS BELIEVE THAT AP IS THE FINAL RESULT OF ABNORMAL
PANCREATIC ENZYME ACTIVATION INSIDE ACINAR CELLS
12. INVESTIGATION
• DIAGNOSIS MADE ON THE BASIS OF CLINICAL PRESENTATION
• ELEVATED SERUM AMYLASE 3-4 TIMES NORMAL
• CONTRAST-ENHANCED CT IS THE BEST SINGLE IMAGING
INVESTIGATION.
13.
14.
15.
16. ASSESSMENT OF SEVERITY
• MILD ACUTE PANCREATITIS
• NO ORGAN FAILURE
• NO LOCAL OR SYSTEMIC COMPLICATIONS
• MODERATELY SEVERE ACUTE PANCREATITIS
• TRANSIENT ORGAN FAILURE
• AND/OR LOCAL OR SYSTEMIC COMPLICATIONS WITHOUT PERSISTENT ORGAN
FAILURE
• SEVERE ACUTE PANCREATITIS
• PERSISTENT ORGAN FAILURE
• SINGLE ORGAN FAILURE
• MULTIPLE ORGAN FAILURE
17.
18. MANAGEMENT
• FOR MILD PANCREATITIS
• CONSERVATIVE APPROACH IS INDICATED
• IV FLUID ADMINISTRATION
• FREQUENT BUT NON-INVASIVE OBSERVATION( RENAL.
• ANTIBIOTICS NOT INDICATED
• ANALGESICS AND ANTIEMETICS SHOULD BE GIVEN
• CT SCANNING IS UNNECESSARY UNLESS THERE IS EVIDENCE
OF DETERIORATION.
19.
20. REFERENCES
• SCHWART’S PRINCIPLES OF SURGERY 10TH EDITION
• BAILEY AND LOVE’S SHORT PRACTICE OF SURGERY 27TH EDITION
• SABISTON TEXTBOOK OF SURGERY 20TH EDITION
• HTTPS://WWW.NCBI.NLM.NIH.GOV/PMC/ARTICLES/PMC9406704/#:~:TEXT=AP%
20IS%20DIAGNOSED%20ON%20THE,LATTER%20OCCURS%20SLIGHTLY%20LESS%2
0FREQUENTLY.
• HTTPS://WWW.OSMOSIS.ORG/ANSWERS/RANSONS-CRITERIA
Editor's Notes
The exocrine pancreas begins development during the fourth week of gestation. Pluripotent pancreatic epithelial stem cells give rise to exocrine and endocrine cell lines as well as the intricate pancreatic ductal network. Initially, dorsal and ventral buds appear from the primitive duodenal endoderm (Fig. 55-2A). The dorsal bud typically appears first and ultimately develops into the superior head, neck, body, and tail of the mature pancreas. The ventral bud develops as part of the hepatic diverticulum and maintains communication with the biliary tree throughout development. The ventral bud will become the inferior part of the head and uncinate process of the gland. Between the fourth and eighth weeks, the ventral bud rotates posteriorly in a clockwise fashion to fuse with the dorsal bud (Fig. 55-2B). At approximately 8 weeks of gestation, the dorsal and ventral buds are fused
Head occupies 30% of the gland by mass and body and tail together constitute 70%
Head lies within the curve of the duodenum, overlying the body of second lumbar vertebra and vena cava
The head lies to the right of midline within the C loop of the duodenum, immediately anterior to the vena cava at the confluence of the renal veins. The uncinate process extends from the head of the pancreas behind the superior mesenteric vein (SMV) and terminates adjacent to the superior mesenteric artery (SMA). The neck is the short segment of pancreas that immediately overlies the SMV. The body and tail of the pancreas then extend across the midline, anterior to Gerota fascia and slightly cephalad, terminating within the splenic hilum
The head lies within the curve of the duodenum, overlying the body of the second lumbar vertebra and the vena cava. The aorta and the superior mesenteric vessels lie behind the neck of the gland. Coming off the side of the pancreatic head and passing to the left and behind the superior mesenteric vein is the uncinate process of the pancreas. Behind the neck of the pancreas, near its upper border, the superior mesenteric vein joins the splenic vein to form the portal vein (Figures 68.1 and 68.2). The tip of the pancreatic tail extends up to the splenic hilum
In first 2 weeks also known as early phase multiorgan dysfunction syndrome is final result of intense inflammatory cascade triggered initially by pancreatic inflammation.
Mortality after 2 weeks, aka late period is due to septic complications
Following biliary, upper gastrointestinal or cardiothoracic surgery
Gallstones
Alcoholism
Post ERCP
Abdominal trauma
Ampullary tumour
Drugs (corticosteroids, azathioprine, asparaginase, valproic acid, thiazides, oestrogens)
Hyperparathyroidism
Hypercalcaemia
Pancreas divisum
Autoimmune pancreatitis
Hereditary pancreatitis
Viral infections (mumps, coxsackie B)
Malnutrition
Scorpion bite
Idiopathic
