acute hemorrhagic pancreatitis


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pancreatitis

 [pan″kre-ah-ti´tis]
inflammation of the pancreas, which is due to autodigestion of pancreatic tissue by its own enzymes.

Acute pancreatitis can arise from a variety of etiologic factors, but in most cases the specific cause is unknown. In some instances chronic alcoholism or toxicity from some other agent, such as glucocorticoids, thiazide diuretics, or acetaminophen, can bring on an acute attack of pancreatitis. In about half the patients a mechanical obstruction of the biliary tract is present, usually because of gallstones in the bile ducts. Viral infections also can cause an acute inflammation of the pancreas.

The patient with acute pancreatitis typically complains of epigastric pain that is accompanied by fever, malaise, nausea, and vomiting. Very mild cases can be overlooked or misdiagnosed quite easily. There is no specific laboratory diagnostic test for acute pancreatitis.

Treatment is largely symptomatic and designed to provide rest for the organ. Oral intake may be restricted and intravenous fluids given to maintain an adequate blood volume. Analgesic administration and other noninvasive techniques are necessary for the management of pain, which can be quite severe in some patients. Surgical removal of gallstones often has an excellent prognosis in acute pancreatitis related to obstruction of the biliary system by the stones. Alcoholic pancreatitis responds relatively well to conservative treatment if the patient stops drinking; however, there is a tendency toward recurrent attacks. Surgical removal of the pancreas is a drastic measure usually reserved for the severe form of the disease with life-threatening complications.

Chronic pancreatitis is characterized by progressive loss of the exocrine functions of the pancreas, that is, the production of pancreatic enzymes essential for normal digestion. There is relative preservation of the organ's endocrine functions until late in the disease. The specific cause of chronic pancreatitis can rarely be identified, but most of the factors that produce the acute form of the disease can also cause the chronic form. Alcoholism is considered by many to be one of the primary causes now that prompt diagnosis and treatment of biliary obstruction have reduced the incidence of pancreatitis secondary to obstruction.

Chronic pancreatitis can lead to pancreatic insufficiency as a result of the replacement of acinar tissue with fibrous tissue. Because the acini secrete pancreatic enzymes necessary for the digestion of proteins, carbohydrates, and fats, dysfunction of acinar tissue results in malabsorption of nutrients from the small intestine. The patient may complain of bulky, fatty, foul-smelling stools, weight loss, fever, malaise, and nausea and vomiting. There also can be a negative nitrogen balance resulting in wasting of the muscles, and malabsorption of the fat-soluble vitamins resulting in easy bruising and bleeding from mild injury. Inadequate absorption of calcium and vitamin B12 also can occur. Glucose intolerance due to insulin lack resulting from degeneration of the islets of Langerhans is a late manifestation of chronic pancreatitis.

Treatment is chiefly substitutive and palliative. Pancreatic insufficiency can be treated with the administration of pancreatic extract with each meal. Relief of pain is not so easily accomplished and often necessitates the use of addictive narcotic analgesics such as codeine, morphine, and meperidine. Symptomatic relief can make the patient more comfortable and substitutive therapy can help maintain adequate nutrition and strengthen the patient's resources so that he can continue most everyday activities of living, but there is no cure for chronic pancreatitis and the long-term prognosis is not good.

Pancreatectomy and islet cell autotransplantation are being done experimentally as an alternative mode of therapy for patients who continue to have chronic pancreatitis. Oral replacement of digestive enzymes and management of diabetes mellitus are necessary after the pancreas is removed. Transplantation of pancreatic islet cells is an attempt to overcome the problem of insulin deficit and diabetes.
acute hemorrhagic pancreatitis a condition due to autolysis of pancreatic tissue caused by escape of enzymes into the substance, resulting in hemorrhage into the parenchyma and surrounding tissues.
chronic calcifying pancreatitis a form accompanying chronic hepatitis and precipitated by chronic alcohol abuse.

a·cute hem·or·rhag·ic pan·cre·a·ti·tis

an acute inflammation of the pancreas accompanied by the formation of necrotic areas and hemorrhage into the substance of the gland; clinically marked by sudden severe abdominal pain, nausea, fever, and leukocytosis; areas of fat necrosis are present on the surface of the pancreas and in the omentum because of the action of the escaped pancreatic enzyme (trypsin and lipase).

acute hemorrhagic pancreatitis

Etymology: Gk, haima, blood, rhegnynei, to gush, pan, all, kreas, flesh
a potentially fatal inflammation of the pancreas characterized by bleeding, necrosis, and paralysis of the digestive tract.

a·cute hem·or·rhag·ic pan·cre·a·ti·tis

(ă-kyūt' hem'ŏr-aj'ik pan'krē-ă-tī'tis)
An acute inflammation of the pancreas accompanied by the formation of necrotic areas and hemorrhages into the substance of the gland; clinically marked by sudden severe abdominal pain, nausea, fever, and leukocytosis; areas of fat necrosis are present on the surface of the pancreas and in the omentum due to the action of escaped pancreatic enzymes (trypsin and lipase).
Synonym(s): acute haemorrhagic pancreatitis.

pancreatitis

inflammation of the pancreas.

acute hemorrhagic pancreatitis
a condition due to autolysis of pancreatic tissue caused by escape of enzymes into the substance, resulting in hemorrhage into the parenchyma and surrounding tissues. Seen most commonly in dogs, rarely in horses and pigs. Clinical signs include abdominal pain that may be severe and associated with cardiovascular shock, vomiting and diarrhea. Fatalities are not uncommon. In the longer term, the process may be slowly progressive, appearing clinically to be relapsing, often with eventual destruction of the islets of Langerhans that leads to diabetes mellitus. Called also acute pancreatic necrosis.
chronic pancreatitis
relapsing or continuing acute pancreatic necrosis. Called also relapsing pancreatitis.
focal pancreatitis
focal lesions discovered incidentally in patients dying of other disease, e.g. canine distemper, foot and mouth disease.
interstitial pancreatitis
inflammation of the interstitial tissue; may be acute or chronic.
necrotizing pancreatitis
see acute hemorrhagic pancreatitis (above).
relapsing pancreatitis
see chronic pancreatitis (see above).
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