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Acute pancreatitis: Difference between revisions
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'''Acute pancreatitis''' is a reversible inflammatory condition of the pancreas that varies in intensity from just oedema and [[adiponecrosis]] to widespread parenchymal necrosis. It occurs when something causes the digestive enzymes to be activated in the pancreas itself, which self-digest the organ. The disease has a | <section begin="radiology" />'''Acute pancreatitis''' is a reversible inflammatory condition of the pancreas that varies in intensity from just oedema and [[adiponecrosis]] to widespread parenchymal necrosis. It occurs when something causes the digestive enzymes to be activated in the pancreas itself, which self-digest the organ. The disease has a relatively high mortality, around 5%.<section end="radiology" /> | ||
In most patients the disease is mild and patients recover after a few days. However, 20% develop severe (necrotising) pancreatitis with complications or organ failure, which has a high mortality. Having many episodes of acute pancreatitis may lead to [[chronic pancreatitis]]. | In most patients the disease is mild and patients recover after a few days. However, 20% develop severe (necrotising) pancreatitis with complications or organ failure, which has a high mortality. Having many episodes of acute pancreatitis may lead to [[chronic pancreatitis]]. | ||
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Clinical deterioration, failure to improve after a week, or development of [[sepsis]] may occur during the disease course if local complications develop (especially if they become infected), or if the oedematous pancreatitis has progressed to a necrotising one. | Clinical deterioration, failure to improve after a week, or development of [[sepsis]] may occur during the disease course if local complications develop (especially if they become infected), or if the oedematous pancreatitis has progressed to a necrotising one. | ||
<section begin="radiology" /> | |||
== Diagnosis and evaluation == | == Diagnosis and evaluation == | ||
The diagnosis of acute pancreatitis is made when two of the following three are present: | The diagnosis of acute pancreatitis is made when two of the following three are present: | ||
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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. | 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. | ||
<section end="radiology" /> | |||
=== 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. | 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. | ||