ACUTE PANCREATITIS

Acute inflammation of the normally

existing pancreas.
Most common cause is Gall stone
disease, alcohol misuse and obesity.

CAUSES

TOXIC
GENETIC
METABOLIC
OBSTRUCTION

STONE
STRICTURE
NEOPLASM
INFECTON
ANATOMICAL
DUODENAL OBSTRUCTION
CONGENITAL ANOMALY

INFLAMMATORY
PHYSIOLOGICAL

PATHOGENESIS

SPASM OF SPHINCTER/ INCREASED PANCREATIC ENZYME SECRETION

CLINICAL FEATURES

PAIN Constant, severe, agonizing pain in

epigastrium radiating to back.
Nausea, vomiting, fever, retching often present.
Signs of Guarding, rigidity, tenderness present.
JAUNDICE.
Systemic disturbance of

TACHYCARDIA
TACHYPNOEA
HYPOTENSION

Rare signs of Grey Turner, Cullen sign, Fox sign

SIRS & MODS

INVESTIGATIONS

BLOOD

Complete Blood Count

S. amylase & S. lipase
Liver function test & Renal function test
Blood glucose
S. Electrolytes & S. calcium
Others S. lactescence, S. trypsin,
Trypsinogen activation Polypeptide,
Phospholipase A2, LDH.

Imaging

X- ray Abdomen Erect, CXR

USG
CT scan Balthazar scoring system
CT

grade + Necrosis score

ERCP

PROGNOSTIC SCORES

Modified Glascow Criteria

MANAGEMENT

CONSERVATIVE

P Pain relief
A Antibiotics
N Nutritional support and NG tube
C CVP monitoring & Calcium gluconate
R Rehydration, Respiratory support
E Electrolyte management
A Antacids (PPI, H2 receptor antagonists)
S Somatostatin analogues

Goals

Pain relief
Fluid resuscitation
Suppression of pancreatic function
Prevention of infection
Inhibition of inflammatory response
Nutritional support

Endoscopic treatment
Surgical treatment

COMPLICATIONS

Infected Pancreatic necrosis

Pancreatic pseudocyst
Pancreatic abscess
Progressive jaundice
Persistent duodenal ileus
Gastro intestinal bleeding
Gastrointestinal ischemia/ fistulae

THANK YOU