acute pancreatitis


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Related to acute pancreatitis: Chronic pancreatitis

acute pancreatitis

Inflammation of the pancreas of abrupt onset, often accompanied by gallstones and alcohol ingestion.
 
Epidemiology
15-fold increase from 1960s to present, possibly due to widened diagnostic criteria, with 40 admissions/105/year.
 
Aetiology
See table.

Clinical findings
Abdominal pain, nausea, vomiting, hypotension.

Diagnosis
Contrast-enhanced CT (method of choice), ultrasonography.

Lab
Increased amylase, increased lipase.

Management
Supportive bowel rest with parenteral nutrition.
 
Prognotic instruments
Ranson’s criteria, modified Glasgow criteria, APACHE II.
 
Prognosis
25% have complications; 9% die of pancreatitis, sepsis, pulmonary failure, etc.

Acute pancreatitis aetiology
• Acute ischaemia—thrombosis, embolism, vasculitis, shock.
• Alcohol.
• Drugs—thiazide diuretics, azathioprine, oestrogens, sulfonamides, furosemide, methyldopa, pentamidine, procainamide.
• Gallstones—biliary tract disease.
• Genetic—defective genes encoding critical enzymes or proteins.
• Infection—mumps, coxsackieviruses, Mycoplasma pneumoniae.
• Metabolic defects—hypertriglyceridemia, hyperparathyroidism, hypercalcaemia.
• Obstruction—ampullary tumours, congenital defects of pancreas or biliary tree, parasites.
• Toxins—scorpion bites.
• Trauma—blunt, iatrogenic injury during heart surgery or ERCP.
• Vascular defects.
• Idiopathic.

Pathogenesis
Autodigestion of pancreas by inappropriately activated pancreatic enzymes—e.g., trypsin from trypsinogen—which activates other proenzymes. Possible pathways of enzyme activation:
(1) Pancreatic duct obstruction
Increased intrapancreatic ductal pressure results in accumulation of enzyme-rich interstitial fluid; lipase (one of the few enzymes secreted in activated form) results in fat necrosis, while injured tissues release cytokines, leading to local inflammation, oedema.
(2) Primary acinar cell injury—e.g., mumps, other viral infections, drugs, trauma, ischaemia, shock.
(3) Defective intracellular transport of proenzymes—aberrant cell packaging of enzymes has been shown to occur in alcohol and duct obstruction.

acute pancreatitis

Inflammation of the pancreas of abrupt onset, often with gallstones and alcohol ingestion Epidemiology 109,000 hospitalizations, 2251 deaths–US; 10-fold ↑ from 1960s to 1980s–reason unclear;
? alcohol abuse; ? widened diagnostic criteria; ± 250 admissions/106 population/yr, higher in certain populations–eg, 4-22% in AIDS Pts Etiology Obstruction, toxins or drugs, trauma, metabolic defects, infection, vascular defects, idiopathic Diagnosis Abdominal pain, ↑ amylase, ↑ lipase, ultrasonography, contrast-enhanced CT Management Supportive, bowel rest with parenteral nutrition Prognosis Ranson's criteria, modified Glasgow criteria, APACHE II Prognosis 25% have complications, 9% die of pancreatitis, sepsis, pulmonary failure, etc. See Chronic pancreatitis.

a·cute pan·cre·a·ti·tis

(ă-kyūt' pan'krē-ă-tī'tis)
Inflammation of the pancreas, frequently involving destruction of tissue by pancreatic enzymes. When severe, may lead to local necrosis, hemorrhage, and shock.

Fitz,

Reginald Heber, U.S. physician, 1843-1913.
Fitz syndrome - Synonym(s): acute pancreatitis
References in periodicals archive ?
If results prove to be in favor of BISAP score than it can help in early diagnosis of severe acute pancreatitis, preventing complications and overall mortality can be reduced.
Briefly, we selected patients with pancreatitis as the diagnosis on an electronic medical record (CUMNAVI, Core Create System, Miyazaki, Japan) and biological information management system (PrimeGaia, Nihon Kohden, Tokyo, Japan), and those who received treatment for severe acute pancreatitis in the ICU were selected according to details from the medical information.
Acute pancreatitis is most often linked to gallstones and drinking too much alcohol, but sometimes the cause is unknown.
The present study was a cross sectional study hospital based carried out among 50 indoor cases of acute pancreatitis admitted under department of general medicine in a tertiary healthcare teaching institute in Maharashtra during February 2018 to April 2018.
Literature has recorded numerous information on drug-induced pancreatitis (Table 1), and case reports of acute pancreatitis in patients with chronic valproic acid treatment, including acute necrotizing pancreatitis (4).
Drug-induced acute pancreatitis related to medications commonly used in gastroenterology.
This Phase 2a clinical study is intended to provide safety and tolerability data on CM4620 in acute pancreatitis patients with accompanying systemic inflammatory response syndrome (SIRS), as well as provide potential indications of beneficial effects.
In acute pancreatitis, a fever may occur, and symptoms typically resolve in a few days.
(3) However, there are few studies that have investigated the relationship between gallbladder polyps and acute pancreatitis. These studies have reported conflicting results, suggesting that the question of whether gallbladder polyps can cause acute pancreatitis is still unknown.

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