Acute Pancreatitis Definition:
Acute Pancreatitis is a condition resulting from an acute inflammatory process in pancreas, manifested by upper abdominal pain and raised levels of pancreatic enzymes in blood, urine and peritoneal fluid.
Acute Pancreatitis Causes:
1. Gallstones
2. Alcohol abuse
These two causes result in 80 % of cases.
Other Causes of Acute Pancreatitis
i. Biliary stones.
ii. Urinal infection.
iii. Tumors (Pancreatic/Metastalic)
iv. Trauma to abdomen.
v. Hyper Parathyroidism
vi. Hyper lipidaemia.
vii. Drugs like thiacides, steroids, frusemide.
viii. Post Endoscopic Retrograde Cholangio Pancreatography (ERCP).
ix. Ascariasis
x. Post operations like lower Common Bile Duct (CBD) exploration and sphinteroplasty.
Clinical Features of Acute Pancreatitis
Symptoms of Acute Pancreatitis
1. Abdominal pain-
Gradual or rapid in onset.
Starts in upper abdominal and may encircle the abdomen to the back, varying in intensity from relatively mild to severe.
Pain often begins a few hours after a heavy meal or alcohol intake.
Normally lessens in severity over 72 hrs and is rarely significant beyond this time.
Vomiting-
At first usually of stomach contents and as it is repeated patient usually brings up small amounts of gastric juices, mucus and sometimes regurgitated bile.
General Condition-
General condition of patient may remain or in severe case patient is in shock with rapid shallow respiration, sweating, prostration and hypovolemia.
Signs of Acute Pancreatitis:-
Abdominal tenderness and guarding
Ileus.
Discoloration of posterior abdominal wall by extravacated blood in hemorrhagic pancreatitis (Grey Turner’s Sign) and around umbilicus (Cullen’s Sign).
Diagnosis of Acute Pancreatitis :-
Blood Investigations:-
1. Raised serum amylase upto 5 times the normal value.
2. Raised AST levels suggest gallstones as etiology.
3. Hyper glycaemia and hypocalcaemia.
4. Peritoneal lavage confirms the diagnosis. If an odorless, yellow to dark brown amylase rich fluid is aspirated.
X ray- abdomen and ultra sonography for diagnosis of gallstones.
CT scan- for better visualization of extra pancreatic inflammation and necrosis.
ERCP to diagnose and treat stones in CBD.
Treatment of Acute Pancreatitis
1. Relief of pain with pethidine.
2. Volume replacement in case of hypovolaemic shock with colloids and crystalloids (IV fluids). Dopamine if hypotension not responding to fluids.
3. Control of metabolic abnormalities like metabolic acidosis, hyperglycaemia and hypocalcaemia.
4. Suppression of pancreatic secretion.
a. Keep patient NBM.
b. Aspirate stomach contents with nasogastric (Ryle’s) tube.
c. H2 antagonist ranitidine intravenous.
d. Intravenous somatostatin.
5. Antibiotics for gram negative infection in and around necrolie tissue.
6. Respiratory support is needed if patient severely tachypnoeic and shows abnormalities in Arterial Blood Gases (ABG).
- Related Topics
- Complications of Pancreatitis | Acute Pancreatitis | Pancreatitis Renal Failure
- Digestive System Diseases | Acute Appendicitis | Acute Cholecystitis | Acute Pancreatitis
- Pancreas Pain Symptoms: Causes And Treatment For Acute Pancreatitis
- Pancreatitis Risk Factors | Obstructive and Gallstones Pancreatitis
- Diagnosis of Chronic Pancreatitis | Pancreatitis Function Test and Surgery
