|Video: Acute Pancreatitis Overview|
Overview Acute pancreatitis is a relatively common condition presenting with severe, acute, constant epigastric pain. Incidence of ~5 per 100,000/year. Acute pancreatitis has a significant mortality. Early complications include acute renal failure, DIC, hypocalcemia and ARDS.
Acute Pancreatitis: An inflammatory process in which pancreatic enzymes are activated and cause autodigestion of the gland.
Chronic Pancreatitis: Irreversible damage causing fibrosis and scarring to the pancreas, resulting in exocrine and endocrine dysfunction
Pancreatic pseudocyst: Cystic space within the pancreas not lined by epithelial cells, often associated with chronic pancreatitis.
Pancreatic anatomy Pancreas extends retroperitoneally across posterior abdominal wall. It means "All (pan) Flesh (Kreas)". The pancreas consists of the following parts:
The head is encircled by duodenum and tail in contact with spleen. Pancreas has a poorly developed capsule & therefore adjacent structures (common bile duct, duodenum, splenic vein, transverse colon) are commonly involved in inflammatory process.
Pancreatic physiology exocrine (98%) & endocrine (2%) functions
Exocrine: Pancreatic acinar cells produce digestive enzymes, which are stored in secretory granules. The Pancreatic exocrine secretion is regulated by cephalic, gastric & intestinal stimuli. Acinar cells secrete pancreatic juice made up the enzymes:
Exocrine section is stimulated by:
Endocrine: Islets of Langerhans – clusters of hormone-producing cells secreted directly into circulation. Endocrine cells of the pancreas:
|Cells of the Pancreas||Secretion||Function|
|Acinar cells secrete enzymes
into the duodenum
|Islets of Lagerhan secrete hormones
into the bloodstream
|Glucagon||Stimulates glucose release into the bloodstream from glucose stores|
|Insulin||Increases cell uptake and storage of glucose|
|Endoscopic retrograde cholangiopancreatography|
|Remember Amylase is not specific to the pancreas. It can be elevated in gastrointestinal ischemia with infarction or perforation, vomiting associated with pancreatitis can cause elevated amylase of salivary origin. Elevated serum lipase level is more specific than is amylase to pancreatic origin and remains elevated longer than does amylase|
Diagnosis Should be suspected in a patient with acute onset of a persistent, severe, epigastric pain with tenderness on palpation. Requires the presence of 2 of the following 3 criteria:
Glasgow Imrie criteria (PANCREAS)
Grades of severity
Difference between acute pancreatitis and chronic pancreatitis
Treatment of pancreatitis is mainly supportive and includes “pancreatic rest". Withholding food or liquids by mouth until symptoms subside, and adequate narcotic analgesia, usually with meperidine.
Continuous pancreatic inflammation may develop into full blown MODS or SIRS.
Signs of systemic inflammatory response syndrome (SIRS)
SIRS—defined by presence of two or more criteria:
Prognosis Mortality is associated with pancreatic necrosis and the presence of sepsis.
Difference between acute and chronic pancreatitis