Acute pancreatitis

Abstract

Acute pancreatitis is a common disease most frequently caused by gallstone disease or excess alcohol ingestion. Diagnosis is usually based on characteristic symptoms, often in conjunction with elevated serum pancreatic enzymes. Imaging is not always necessary, but may be performed for many reasons, such as to confirm a diagnosis of pancreatitis, rule out other causes of abdominal pain, elucidate the cause of pancreatitis, or to evaluate for complications such as necrosis or pseudocysts. Though the majority of patients will have mild, self‐limiting disease, some will develop severe disease associated with organ failure. These patients are at risk to develop complications from ongoing pancreatic inflammation such as pancreatic necrosis, fluid collections, pseudocysts, and pancreatic duct disruption. Validated scoring systems can help predict the severity of pancreatitis, and thus, guide monitoring and intervention.Treatment of acute pancreatitis involves supportive care with fluid replacement, pain control, and controlled initiation of regular food intake. Prophylactic antibiotics are not recommended in acute pancreatitis if there is no evidence of pancreatic infection. In patients who fail to improve, further evaluation is necessary to assess for complications that require intervention such as pseudocysts or pancreatic necrosis. Endoscopy, including ERCP and EUS, and/or cholecystectomy may be indicated in the appropriate clinical setting. Ultimately, the management of the patient with severe acute pancreatitis will require a multidisciplinary approach. Journal of Hospital Medicine 2010;5:241–250. © 2010 Society of Hospital Medicine.

Clinical profile of patients with pancreatitis

“…10 Mild acute pancreatitis presents with minimal organ dysfunction and an uneventful recovery while severe acute pancreatitis is associated with local and systemic complications and higher mortality, thus it is important to identify patients having severe disease. 7 Categorization of patients based on the type of pancreatitis was made in this study by using ultrasonography which showed 12% cases of chronic pancreatitis, 76% cases of acute pancreatitis and 12% cases of acute on chronic pancreatitis.…”

“…1,7,8 It is a complex process which varies from mild self-limiting inflammation to rapidly deteriorating condition which poses a serious threat to life.…”

“…3,4 The first 12 hours are extremely important to provide appropriate management which will decrease morbidity and mortality. [5][6][7] Nearly 80% of cases of acute pancreatitis worldwide are caused by gall stone obstruction and high alcohol intake. Other causes like hypertriglyceridemia and drugs account for the rest.…”

Hypertriglyceride Induced Acute Pancreatitis

“…Patients should be placed on bowel rest, receive nothing by mouth and undergo aggressive fluid resuscitation due to third space losses 87 . Adequate pain control is essential, often through the use of opioid narcotics [88][89][90] . Some controversy still remains about the potential for medication-induced sphincter of Oddi dysfunction aggravating the clinical picture although low dose transdermal fentanyl patches appear do not to compromise sphincteric function 91,92 .…”

Incidence and Clinical Associations of Childhood Acute Pancreatitis

“…In adults, the most common causes of AP are alcohol and gallstones, 9,10 but in children it is associated with a wide variety of potential aetiologies, including abdominal trauma, drug therapy, infections, systemic diseases and congenital anatomical anomalies. 2,11 Trauma and mumps were the commonest associations reported in the UK in the 1970/80's.…”