Acute Pancreatitis

EPIDEMIOLOGY
• Worldwide, the incidence of acute pancreatitis ranges
between 5 and 80 per 100,000 population, with the highest
incidence recorded in the United States and Finland.
• Acute pancreatitis affects males more often than females
• Age-related demographics
Alcohol-related - 39 years
Biliary tract–related - 69 years
Trauma-related - 66 years
Drug-induced etiology - 42 years
AIDS-related - 31 years
 ETIOLOGY
• Biliary tract
• Alcohol
• Trauma
• Drugs
PATHOPHYSIOLOGY
 SIGN AND SYMPTOMS
• Abdominal pain (cardinal symptom):
Characteristically dull, boring, and steady;
usually sudden in onset and gradually
becoming more severe until reaching a
constant ache; most often located in the upper
abdomen and may radiate directly through to
the back
• Nausea and vomiting, sometimes with
anorexia
 SIGN AND SYMPTOMS
The following physical findings may be noted, varying with the severity
of the disease:
• Fever (76%) and tachycardia (65%); hypotension
• Abdominal tenderness, muscular guarding (68%), and distention
(65%); diminished or absent bowel sounds
• Jaundice (28%)
• Dyspnea (10%); tachypnea; basilar rales, especially in the left lung
• In severe cases, hemodynamic instability (10%) and hematemesis or
melena (5%); pale, diaphoretic, and listless appearance
• Occasionally, extremity muscular spasms secondary to hypocalcemia
 SIGN AND SYMPTOMS
The following uncommon physical findings are
associated with severe necrotizing pancreatitis:
• Cullen sign (bluish discoloration around the
umbilicus resulting from hemoperitoneum)
• Grey-Turner sign (reddish-brown discoloration along
the flanks resulting from retroperitoneal blood
dissecting along tissue planes
• Erythematous skin nodules, usually no larger than 1
cm and typically located on extensor skin surfaces
 DIAGNOSIS
• Serum amylase (25-125 U/L)
 >200 U/L for 24-72 hours
starts to rise 2-6 hr after onset of pain
Peaks @ 24 hours
Return to normal @ 72 hr

• Serum lipase (3-19 U/dL)

used with amylase; rises later than amylase (48 hours)
return to normal 5-7 days
 SUPPORTING INVESTIGATION
• Abdominal and chest films
• CT scan
• Ultrasound
• Aspiration biopsy
• Peritoneal lavage
• Endoscopic Retrograde Cholangio-
pancreatography (ERCP)
 MANAGEMENT
“Rest” the pancreas & GI tract
– NPO
– NG tube to suction
– parenteral vs. enteral nutrition
– drug therapy
Manage Pain
– morphine
– H2 antagonists
– PPI
 MANAGEMENT
Conditions that should be monitored
•  K,  Ca  dysrhythmias
•  Ca  neurologic changes
•  FBS  hyperosmolar diuresis, electrolyte
shifts
•  BUN, Creatinine indicates renal damage
from  perfusion
• Amylase, lipase for return to normal
 COMPLICATIONS
• Pulmonary
• Cardiovascular
• Coagulation
• Renal
• Imunological
 PROGNOSIS
• The overall mortality in patients with acute
pancreatitis is 10-15%.
• Patients with biliary pancreatitis tend to have
a higher mortality than patients with alcoholic
pancreatitis.