Necrotizing Pancreatitis: Pathophysiology, Diagnosis, and Acute Care Management

Abstract

Severe acute necrotizing pancreatitis is a disease that is caused by premature activation of pancreatic enzymes. Cytokine release contributes to systemic manifestations such as systemic inflammatory response syndrome (SIRS), multiple organ dysfunction syndrome (MODS), adult respiratory distress syndrome (ARDS), and sepsis. Diagnosis is based on a history of abdominal pain, laboratory values such as serum amylase and lipase levels, and CT scan. Medical management focuses on fluid and electrolyte balance, antibiotic therapy, pain control, and decreasing systemic complications. Surgery is indicated when infectious pancreatic necrosis has been identified. This article addresses incidence and etiology; pathophysiology; clinical manifestations; diagnostics; and medical and surgical patient care management.

Sudden unexplained death during sleep occurred commonly in the general population in the Philippines: a sub study of the National Nutrition and Health Survey

“…None of the respondents reported this. Hence, in this survey there was no pattern of premorbid abdominal pain observed and this seems to be inconsistent with the typical presentation of severe pancreatitis where a more protracted course with prominent abdominal pain is expected [17,18].…”

Factors Influencing Mortality in Acute Pancreatitis

“…123 Both abscesses and pseudocysts are late complications of severe AP and compared with infected pancreatic necrosis are associated with a more benign clinical course. 119,129 The diagnosis of pancreatic necrosis can involve several modalities. Sterile necrosis usually indicates areas of necrosis that have a negative bacterial culture.…”

Free intraperitoneal air in infected pancreatic necrosis with intraperitoneal rupture: A rare presentation of a complex diseases

“… 4 Pancreatic necrosis follows the same pathogenesis of acute pancreatitis, with both mechanical ductal obstruction and enzymatic destruction causing progressive damage to the pancreatic and peripancreatic parenchyma, eventually leading to a saponified, devascularized area that is prone to infection. 5 Close to a third of patients with pancreatic necrosis will develop infection of the necrotic pancreatic and peripancreatic tissue at some point over the course of their illness. 6 Gastrointestinal bacterial translocation is the source of bacteria for infected pancreatic necrosis.…”

“…Although the most patients with the disease have a predictably mild course, about a fifth of patients face local and systemic complications, most common of which is acute pancreatic necrosis 4 . Pancreatic necrosis follows the same pathogenesis of acute pancreatitis, with both mechanical ductal obstruction and enzymatic destruction causing progressive damage to the pancreatic and peripancreatic parenchyma, eventually leading to a saponified, devascularized area that is prone to infection 5 . Close to a third of patients with pancreatic necrosis will develop infection of the necrotic pancreatic and peripancreatic tissue at some point over the course of their illness 6 .…”