Summary
Highlights
Acute pancreatitis is the inflammation of the pancreas due to enzyme-mediated auto-digestion. While 80% of cases are mild, 20% can lead to serious, life-threatening complications. The inflammation can range from mild edema to severe peripancreatic necrosis. Gallstones and ethanol consumption are the most common causes.
The pancreas is an organ located behind the stomach, making contact with the duodenum. It functions as both an exocrine gland, secreting digestive enzymes (proteases, amylase, lipase) through the pancreatic duct into the small intestine, and an endocrine organ, secreting hormones like insulin and glucagon into the blood. In pancreatitis, the pancreatic acinar cells are damaged, releasing digestive enzymes that further damage surrounding tissues.
The causes of acute pancreatitis can be remembered with the acronym GET SMASHED: Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune diseases, Scorpion venom, Hypercalcemia and Hyperlipidemia, ERCP (endoscopic retrograde cholangiopancreatography), and Drugs. Gallstones and ethanol are the most frequent causes.
Acute pancreatitis typically presents with vomiting, severe epigastric central pain that may radiate to the back (in 50% of cases), and relieved by a tripoding position. Tachycardia, jaundice, and fever may also occur.
Investigations include serum amylase and lipase levels (lipase is more specific), ultrasound of the pancreas, and arterial blood gas. Management involves withholding oral intake, administering fluids via cannulation, anti-emetics, pain relief (e.g., morphine), and urinary catheterization to monitor urine output. Daily monitoring of blood count, amylase levels, electrolytes, hourly blood pressure, heart rate, and urinary output is crucial.
Complications include chronic pancreatitis, pancreatic pseudocysts, acute lung injury (due to inflammation spreading from the pancreas below the diaphragm), pancreatic pleural effusions (fistula formation), acute renal failure, infected pancreatic necrosis (associated with 80% of deaths), and fatty necrosis.