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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 significant mortality, around 5%.
<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.