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Acute pancreatitis: Difference between revisions
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In case of jaundice, elevated [[bilirubin]], elevated [[Liver function test|liver tests]] or [[Cholestatic enzyme|cholestatic enzymes]], [[Choledocholithiasis|gallstone]] or another obstruction of the biliary tree is the likely cause. | In case of jaundice, elevated [[bilirubin]], elevated [[Liver function test|liver tests]] or [[Cholestatic enzyme|cholestatic enzymes]], [[Choledocholithiasis|gallstone]] or another obstruction of the biliary tree is the likely cause. | ||
Imaging may be performed with [[ultrasound]], contrast [[CT]], or [[MRI]]. It is not necessary to obtain imaging in uncomplicated cases where the first two criteria are fulfilled. | === Imaging === | ||
Imaging may be performed with [[ultrasound]], contrast [[CT]], or [[MRI]]. It is not necessary to obtain imaging in uncomplicated cases where the first two criteria are fulfilled. Ultrasound is usually the first choice modality. If complications are suspected, CT is usually the better first choice. | |||
On abdominal ultrasound, the pancreas appears enlarged and hypoechoic. Local complications (peripancreatic fluid collection/acute necrotic collection) are visible as anechoic masses, with internal echoes if they contain necrosis. | On abdominal ultrasound, the pancreas appears enlarged, oedematous, and hypoechoic. There may be peripancreatic fluid and the margins of the pancreas are indistinct. Local complications (peripancreatic fluid collection/acute necrotic collection) are visible as anechoic masses, with internal echoes if they contain necrosis. | ||
On contrast CT, the pancreas is focally or diffusely enlarged. In oedematous pancreatitis there is heterogenous contrast enhancement. In necrotic pancreatitis there is a lack of contrast enhancement. CT may also show a gallstone. | On contrast CT, the pancreas is focally or diffusely enlarged. In oedematous pancreatitis there is heterogenous contrast enhancement. In necrotic pancreatitis there is a lack of contrast enhancement. CT may also show a gallstone if present, as well as any complication. Like on ultrasonography, there may be peripancreatic fluid and the pancreatic margins may be indistinct. | ||
After the diagnosis is made, the underlying cause must be sought. This includes a thorough history to look for risk factors, serum triglyceride level, calcium level, and abdominal ultrasound for gallstone. Endoscopic ultrasound may be used if initial investigations does not reveal the etiology. | === Etiology === | ||
After the diagnosis is made, the underlying cause must be sought. This includes a thorough history to look for risk factors, serum triglyceride level, calcium level, and abdominal ultrasound for gallstone. [[Endoscopic ultrasound]] may be used if initial investigations does not reveal the etiology. | |||
=== Severity assessment === | |||
The severity of the pancreatitis must be assessed, both based on clinical assessment and the SIRS score. Severe acute pancreatitis (as determined by the presence of [[haemodynamic instability]], [[hypoxaemia]], [[acid-base disorder]], [[altered mental status]], etc.) should be managed in an [[intensive care unit]]. High <abbr>[[CRP]]</abbr> (> 100 mg/L) suggests necrotising pancreatitis. Important to note that serum lipase/amylase are not predictors of severity, and so the degree of enzyme elevation does not correlate with the severity of the disease. | The severity of the pancreatitis must be assessed, both based on clinical assessment and the SIRS score. Severe acute pancreatitis (as determined by the presence of [[haemodynamic instability]], [[hypoxaemia]], [[acid-base disorder]], [[altered mental status]], etc.) should be managed in an [[intensive care unit]]. High <abbr>[[CRP]]</abbr> (> 100 mg/L) suggests necrotising pancreatitis. Important to note that serum lipase/amylase are not predictors of severity, and so the degree of enzyme elevation does not correlate with the severity of the disease. | ||