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Acute pancreatitis: Difference between revisions

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Acute pancreatitis (view source)

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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]].
 
<section begin="clinical biochemistry" />
== Etiology ==
== Etiology ==
The most common causes are alcoholism and gallstones in the biliary tract distal to the pancreatic duct. These two factors are responsible for 80% of all cases of acute pancreatitis.
The most common causes are alcoholism and gallstones in the biliary tract distal to the pancreatic duct. These two factors are responsible for 80% of all cases of acute pancreatitis.
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* [[ERCP]]
* [[ERCP]]
* Drugs
* Drugs
 
<section end="clinical biochemistry" />
Other causes are Vascular ([[shock]], arteroembolism, polyarteritis nodosa), mutations (PRSS1, SPINK1), etc.
Other causes are Vascular ([[shock]], arteroembolism, polyarteritis nodosa), mutations (PRSS1, SPINK1), etc.


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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" />
<section end="radiology" /><section begin="clinical biochemistry" />
=== 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.
<section begin="clinical biochemistry" />
=== Severity assessment ===
=== 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.