Al-FARAHDI University

Ministry of higher education

Acute pancreatitis
 INTRODUCTION
The pancreas is a large gland located behind the stomach close to the
first part of the small intestine, and it secretes digestive juices into the
small intestine through a tube known as the pancreatic duct

• Elongated and tapered organ.

• A pale gray gland weighing
about 60 grams and about 12-
15 cm long
• Located hypochondriac regions
of the abdominal cavity in the
epigastric and left
Parts
• Head -the widest right
part of the organ and lies
in the of the curve
duodenum
• Body-tapered left side
extends slightly upward
lies behind stomach.
• Tail- narrowed end part
lies infront of the kidney
and just reaches spleen
 FUNCTIONS

Endocrine functions - Exocrine functions

Islet of Langerhans Pancreatic juice
-Alphacell glucagon -Amylase
(20%)
-Lipase
-Beta cells insulin
(75%) -Trypsin
-Delta cells -Chymotrypsin
somatostatin Carboxypeptidase
Diseases of the Pancreas
Disorders affecting the pancreas include pancreatitis, precancerous
conditions such as PanIN and IPMN, and pancreatic cancer. Each
disorder may exhibit different symptoms and requires different
treatm
 PANCREATITIS

Inflammation in pancreas associated with injury

to exocrine parenchyma.
PANCREAS

Stroma
Primary injury
Endocrine causing
PANCREATITIS
Parenchyma
Involved secondarily
Exocrine or
as a complication
1. Acute: Emergency
condition.

2. Chronic:
Prolonged &
frequently lifelong
disorder resulting
from the
development of
fibrosis within the
pancreas.
Acute Pancreatitis
• Definition:
Acute condition of diffuse pancreatic
inflammation & autodigestion, presents with
abdominal pain, and is usually associated
with
raised pancreatic enzyme levels in the blood
&
urine.
• Reversible inflammation of
the pancreas
• Ranges from mild to severe.
Etiology
• 80% of the cases are due to gallstones & alcohol.
• The remaining 20 % of cases are due to:
1. Congenital: Pancreatic divisum
2. Metabolic: Hyperlipidemia, Hypercalcemia.
3. Toxic: Scorpion venom
4. Infective: Mumps, Coxsackie B, EBV, CMV.
5. Drugs: Azathioprine, Sulfonamides, Steroids, Thiazides,
Estrogens.
6. Vascular: Ischemia, Vasculitis (SLE, PAN).
7. Autoimmune: Hereditary pancreatitis.
8. Traumatic.
9. Miscellaneous: CF, Hypothermia, Periampullary Tumors.
10. Idiopathic.
• Biliary Pancreatitis:
1. Common channel Theory
2. Incompetent sphincter of
Oddi
3. Obstruction of the
pancreatic duct

Alcoholic Pancreatitis:
- Direct toxic effect on the
pancreatic acinar cells
- Stimulation of the pancreatic
secretion
- Constriction of the sphincter
of Oddi
Symptoms
• Upper Abdominal pain, sudden onset, sharp, severe, continuous,
radiates to the back, reduced by leaning forward.
• Generalized abdominal pain, radiates to the shoulder tips.
Patient lies very still.
• Nausea, non-projectile vomiting, retching
• Anorexia, Fever, weakness
Signs
• Distressed, moving continuously, or sitting still
• Pale, diaphoretic. Confusion
• Low grade fever
• Tachycardia, Tachypnea, Mild icterus
• Shallow breathing, Hypotension
• Abdominal distension (Ileus, Ascites)
• Grey Turner’s sign, Cullen’s sign, Fox’s sign
• Rebound tenderness, Rigidity
• Shifting dullness, reduced bowel sounds
Diagnosis
• Diagnosis of Acute Pancreatitis requires at least 2 of 3 from
the following criteria:
- Abdominal pain consistent with acute pancreatitis
- Serum amylase or
lipase greater than 3
times the upper limit
of normal
- Characteristic findings
on abdominal imaging

• CT w / Contrast or MRI
should be reserved for patients in whom the diagnosis in
unclear or fail to improve within 48-72 hours.
Investigations
Blood tests:
• Complete Blood Count
• Serum amylase & lipase
• C-reactive Protein
• Serum electrolytes
• Blood glucose
• Renal Function Tests
• Liver Function Tests
• LDH
• Coagulation profile
• Arterial Blood Gas Analysis
Treatment .

• Percutaneous drainage - for

poor risk patients only
• Open procedures
- Distal pancreatectomy
- Cystogastrostomy
- Cystoduodenostomy
- Roux-en-y cystojejunostomy
- Whipple procedure
• Endoscopic procedures -
stenting Laparoscopic
procedures
Mortality
• Mild acute pancreatitis:
Mortality rate of 1%
• Severe pancreatitis: Mortality
rate of 75-90%
• Overall mortality rate of 15-
20%
• First week of illness -> MODS
• Subsequent weeks ->
infection
References
• Bailey’s & Love’s Short Practice of Surgery, 25th
Edition, Page 1138 – 1146.
• Essential Surgery, Burkitt, 4th Edition, Page 380 –
388.
• Robbins & Cotran Pathologic Basis of Disease, 8th
Edition.
• http://www.aafp.org/afp/2007/0515/p1513.html
• http://www.aafp.org/afp/2000/0701/p164.html