Acute pancreatitis overview
|
Acute pancreatitis Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Acute pancreatitis overview On the Web |
|
American Roentgen Ray Society Images of Acute pancreatitis overview |
|
Risk calculators and risk factors for Acute pancreatitis overview |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]
Overview
Acute pancreatitis is a rapidly-onset inflammation of the pancreas. Depending on its severity, it can have severe complications and high mortality despite treatment. While mild cases are often successfully treated with conservative measures, such as NPO (abstaining from any oral intake) and IV fluid rehydration, severe cases may require admission to the ICU or even surgery (often more than one intervention) to deal with complications of the disease process.
Historical Perspective
Dutch physician and anatomist, Nicholaes Tulp in the year 1652 gave the first clear description of acute pancreatitis. The first systemic analysis of acute pancreatitis was presented by Reginald Huber Fitz in 1889. During the 20th century many theories were proposed with regards to whether surgery is to be preferred as the initial approach to the treatment of acute pancreatitis. Hans Chiari in 1896 proposed that the basic mechanism of the disease was autodigestion of pancreas. The father of modern anatomical pathology, Giovanni Battista Morgagni gave the first description of pancreatic pseudocysts.
Classification
Acute pancreatitis can either be classified according to its phase (early or late), or according to its level of severity.
Pathophysiology
The pathophysiology of acute pancreatitis involves acute inflammation and edema of the pancreas. The process is mediated by the abnormal activation of trypsinogen to trypsin inside the pancreas, and the involvement of other mediators such as cathepsin, lysosomal enzymes, and caspases. Intrapancreatic activation of amylase and lipase is what causes necrosis of pancreatic cells.
Causes
There are many causes for acute pancreatitis. The most common causes are often taught using the mnemonic "I GET SMASHED" shown below. These causes include; idiopathic, alcohol, gallstones, trauma, steroids, scorpion bites, mumps, autoimmune diseases, ERCP, and certain medications.
Differentiating Acute pancreatitis from Other Diseases
Acute pancreatitis should be differentiated from other conditions that may produce symptoms similar to that of acute pancreatitis. These conditions include gallstones, pancreatic cysts, pancreatic pseudocysts, and chronic pancreatitis.
Epidemiology and Demographics
Annual incidence in the U.S. is 18 per 100,000 population. In a European cross-sectional study, incidence of acute pancreatits increased from 12.4 to 15.9 per 100,000 annually from 1985 to 1995; however, mortality remained stable as a result of better outcomes. [1]
Risk Factors
There are several factors that can put someone at risk for acute pancreatitis. The most common cause and most common risk factor is heavy alcohol use. Other risk factors include trauma, family history, hypertrigyceridemia, cycstic fibrosis, renal failure, SLE, being on certain medications, and male gender.
Natural History, Complications and Prognosis
Pancreatitis can be mild or severe, and the natural history will depend on the severity of the condition, and the timeliness of intervention. Acute pancreatitis can result in complications such as hemorrhagic pancreatitis, multisystem organ failure, infection, SIRS, ARDS, hyperglycemia, hypocalcemia, shock, hemmorrhage, thrombosis, common bile duct obstruction, and the development of chronic pancreatitis. Prognosis can be determined with the use of many criteria such as Ranson's criteria, the Glasgow score, the APACHE II score, and the BISAP score.
Diagnosis
History and Symptoms
Severe upper abdominal pain, with radiation through to the back, is the hallmark of acute pancreatitis. Nausea and vomiting (emesis) are prominent symptoms.
CT
Although ultrasound imaging and CT scanning of the abdomen can be used to confirm the diagnosis of pancreatitis, neither is usually necessary as a primary diagnostic modality[2] . In addition, CT contrast may exacerbate pancreatitis,[3] although this is disputed.[4]
Ultrasound
Although ultrasound imaging and CT scanning of the abdomen can be used to confirm the diagnosis of pancreatitis, neither is usually necessary as a primary diagnostic modality[2]
References
- ↑ Eland IA, Sturkenboom MJ, Wilson JH, Stricker BH (2000). "Incidence and mortality of acute pancreatitis between 1985 and 1995". Scand J Gastroenterol. 35 (10): 1110–6. PMID 11099067.
- ↑ 2.0 2.1 Fleszler F, Friedenberg F, Krevsky B, Friedel D, Braitman L (2003). "Abdominal computed tomography prolongs length of stay and is frequently unnecessary in the evaluation of acute pancreatitis". Am J Med Sci. 325 (5): 251–5. PMID 12792243.
- ↑ McMenamin D, Gates L (1996). "A retrospective analysis of the effect of contrast-enhanced CT on the outcome of acute pancreatitis". Am J Gastroenterol. 91 (7): 1384–7. PMID 8678000.
- ↑ Hwang T, Chang K, Ho Y (2000). "Contrast-enhanced dynamic computed tomography does not aggravate the clinical severity of patients with severe acute pancreatitis: reevaluation of the effect of intravenous contrast medium on the severity of acute pancreatitis". Arch Surg. 135 (3): 287–90. PMID 10722029.