This document discusses pancreatitis, which can be acute or chronic. Acute pancreatitis involves sudden onset of abdominal pain with elevated pancreatic enzymes, while chronic pancreatitis features recurring pain with steatorrhea and glucose intolerance. Causes include gallstones, alcoholism, hypertriglyceridemia, and certain drugs. The pathophysiology in both involves premature activation of pancreatic enzymes damaging local tissue. Diagnosis involves blood tests, imaging like CT or MRI. Treatment focuses on pain control, bowel rest, antibiotics for necrosis, and surgery for complications like pseudocysts or infected necrosis.

1. Pancreatitis
Acute or Chronic
inflammation of pancreas

2. Types
 Acute-
 Acute onset, boring epigastric pain
 Associated with nausea & vomiting
 Lipase & amylase >3 times elevated
 Chronic-
 Recurrent or persistent boring epigastric pain
 Associated with steatorrhea ± glucose intolerance
 ± elevated amylase/lipase

3. Causes
 Gallstones or biliary sludge
 Alcoholism
 Others-
 Hypertriglyceridemia- TG >1000 mg/dl
 Hypercalcemia
 Mumps, coxsackie virus
 Trauma or post-ERCP
 Pancreas divisum
 Drugs- didanosine, pentamidine, HCTZ, Na valproate,
L-asparaginase, estrogen etc.

4. Pathophysiology
 Whatever the etiology,
causes raised pancreatic ductal pressure
 Premature activation of pancreatic enzymes-
trypsin, phospholipase, elastase
 Local tissue destruction &
activate inflammatory cascade
 Inflammation, edema, hemorrhage, necrosis
 Acute- SIRS with multiorgan dysfunction,
Chronic- fibrosis &
loss of function

5. Diagnosis
 History & examination
 Lipase ± amylase
 CBC, RBS, Ca, TG, bilirubin, SGOT, ABG
 AxR- calcification, gallstones, ileus
 CxR- atelectasis, effusion, ARDS
 US- gallstones, biliary tract
 CT scan- necrosis, fluid collection,
pseudocyst
 MRI/MRCP
 ERCP/EUS- in chronic pancreatitis

6. Ranson’s prognostic criteria- Acute
 On admission-
 Age >55 years
 Blood glucose >200
 LDH >350
 SGOT >250
 WBC/TLC >16000
 Px-
 <3- mortality ~5%
 >3- mortality 15-20%
 After 48 hours-
 Hct drop >10%
 BUN increase >5
 Ca <8
 PaO2 <60
 Base deficit >4
 Estimated fluid sequestration
>6 litres

7. Balthazar CT grading- Acute
CT severity index based on
CT appearance & %age necrosis

8. Treatment
 Pain control- opioids
 Bowel rest & IV fluids
 Antiemetics & PPI
 Post-pyloric enteral feeding- NG feed
 IV Abx- if necrosis >30% or abscess
 Enzyme & dietary supplementation- chronic
 ERCP with sphincterotomy, if required- acute
 Surgery-
 Infected necrosis- acute
 Pseudocyst drainage, possible endoscopically too
 Bypass or partial/total resection for pain control- chronic