Acute Pancreatitis-Inflammation of pancreas by enzyme-mediated autodigestion.

Anatomy:

• 

               Lies in upper left part of the abdomen.

               12-15 cm long

               divided into head, neck, body, tail.Further the head is divided into head proper and uncinate process.

                Made up of two types of glands; Exocrine and Endocrine

Histology:

               About 90 % of the pancreas is exocrine tissue that produces pancreatic enzymes for digestion and the remaining tissue is made up of endocrine cells (Islets of Langerhens) which produces hormones.

Etiology:

• Gall stones,
• Ethanol,
• Trauma,
• Steroids,
• Mumps,
• Autoimmune,
• Scorpion venom,
• Hypercalcemia, Hyperlipidemia,
• Post ERCP,
• Drugs.

Pathophysiology:

Causative factors ⇾ premature intracellular trypsinogen activation ⇾ release of protease that digests the pancreas and surrounding tissue.

！Normally pancreas has poorly developed capsule so the inflammation spreads to the adjacent structures ( common bile duct , splenic vein , duodenum , transverse colon )

Symptoms:

• Severe, constant upper abdominal pain which radiates to back
• Nausea and vomitting
• Fever, loss of appetite, chills.
• Tachycardia,
• In severe case, patient becomes hypoxic and develops hypovolaemic shock with oliguria.
• In case of pancreatitis with haemorrhage, is a discolouration of the flanks ( Grey-turner’s sign) and umbilicus ( Cullen’s sign).

Glascow criteria for prognosis :

＞3 severe pancreatitis

Complications:

Local :                                                                    

1. Necrosis
2. Pseudocyst
3. Abscess                                

Systemic:

1. SIRS
2. Hyperglycemia
3. Hypocalcemia
4. DIC                    

Investigations:

1.Serum amylase or lipase concentrations, Arterial blood gas.

2.Ultrasound scan confirms swelling of pancreas, gallstones, biliary obstruction or pseudocyst formation.

3.Contrast enhanced pancreatic CT assess viability of pancreas if persisting organ failure, sepsis or clinical deterioration is present.

Management:

1. For pain- Opiate Analgesics
2. Fluid Replacement:Normal saline or other crystalloids.
3. Insertion of central venous line and urinary catheter.
4. Entereal feeding: Nasogastric feeding by nasojejunal route is effective.
5. Correction of hperglycemia by insulin and hypocalcemia by IV calcium.
6. In case infected necrosis, use antibiotics that penetrates necrotic tissue ( carbapenems, metronidazole)
7. Patient with cholangitis or jaundicce should undergo urgent ERCP to diagnose and treat choledocholithiasis.
8. Pseudocysts can be treated by drainage into stomach or duodenum.