Acute Pancreatitis: Diagnosis and Treatment

Abstract

Acute pancreatitis is a common indication for hospital admission, increasing in incidence, including in children, pregnancy and the elderly. Moderately severe acute pancreatitis with fluid and/or necrotic collections causes substantial morbidity, and severe disease with persistent organ failure causes significant mortality. The diagnosis requires two of upper abdominal pain, amylase/lipase ≥ 3 ×upper limit of normal, and/or cross-sectional imaging findings. Gallstones and ethanol predominate while hypertriglyceridaemia and drugs are notable among many causes. Serum triglycerides, full blood count, renal and liver function tests, glucose, calcium, transabdominal ultrasound, and chest imaging are indicated, with abdominal crosssectional imaging if there is diagnostic uncertainty. Subsequent imaging is undertaken to detect complications, for example, if C-reactive protein exceeds 150 mg/L, or rarer aetiologies. Pancreatic intracellular calcium overload, mitochondrial impairment, and inflammatory responses are critical in pathogenesis, targeted in current treatment trials, which are crucially important as there is no internationally licenced drug to treat acute pancreatitis and prevent complications. Initial priorities are intravenous fluid resuscitation, analgesia, and enteral nutrition, and when necessary, critical care and organ support, parenteral nutrition, antibiotics, pancreatic exocrine and endocrine replacement therapy; all may have adverse effects. Patients with local complications should be referred to specialist tertiary centres to guide further management, which may include drainage and/or necrosectomy. The impact of acute pancreatitis can be devastating, so prevention or reduction of the risk of recurrence and progression to chronic pancreatitis with an increased risk of pancreas cancer requires proactive management that should be long term for some patients.

Impact of multiple drug-resistant Gram-negative bacterial bacteraemia on infected pancreatic necrosis patients

“…Acute pancreatitis (AP) is an unpredictable and potentially lethal disease of the gastrointestinal system with increasing occurrence within the past decade ( Boxhoorn et al., 2020 ; Szatmary et al., 2022 ). Approximately 30% of AP patients will develop severe acute pancreatitis (SAP) and infected pancreatic necrosis (IPN), which are respectively the major causes for the first and second peaks of mortality in AP ( Brown et al., 2014 ; Werge et al., 2016 ; Baron et al., 2020 ).…”

Azathioprine-Induced Pancreatitis in a Patient With Systemic Lupus Erythematosus

“…Various drugs such as didanosine, valproic acid, thiazides, furosemide, pentamidine, chemotherapeutics, dexamethasone, prednisolone, estrogen, opiates, mesalamine/sulfasalazine, azathioprine, tetracycline, metronidazole, isoniazid, and rifampin have been implicated in drug-induced pancreatitis (DIP) [ 10 ]. These drugs are further classified based on their weight of evidence as the cause of pancreatitis [ 5 , 11 ].…”

“…The most common causes of acute pancreatitis are gallstones and alcohol, accounting for about two-thirds of cases [ 4 ]. Other causes include various etiologies such as hyperlipidemia, hypercalcemia, drugs, viral infections, toxins, trauma, iatrogenic injury during surgery or endoscopic retrograde cholangiopancreatography (ERCP), vasculitis, ischemia, periampullary lesions, anatomical variants, and genetic mutations [ 5 ].…”

Circulating monocytes in acute pancreatitis

“…Patients present with very acute onset of severe abdominal pain often necessitating urgent hospital admission ( 2 ), an event which is thought to coincide with the time of initial pancreatic injury. After the initial insult by pancreatitis toxins, injured pancreatic acinar cells release cytokines, chemokines, cellular components, and neuropeptides to promote inflammation ( 3 – 5 ). Immune cells are closely related with the systemic response to pancreatic injury, thereby contributing substantially to disease severity ( 6 – 9 ).…”