Acute pancreatitis

Clinical presentation
• Interstitial edematous acute pancreatitis:
Acute inflammation of the pancreatic parenchyma
and peripancreatic tissues, which usually is self limited and
associated with mild transitory clinical manifestations

• Necrotizing acute pancreatitis:

Inflammation and pancreatic parenchymal necrosis,
which is associated with a much higher morbidity and a
substantial mortality rate

• Acute hemorrhagic pancreatitis:

Pancreatic parenchymal hemorrhage
Diagnosis

2/3 criteria

• Abdominal pain( acute, epigastric, severe, radiating to

back)

• S. Amylase, lipase > 3 times ULN

• Characteristic findings on abdominal imaging

Bimodal distribution of organ failure in pancreatitis
Case 1
52 year old male, chronic alcoholic, complains of abdominal
pain which is sudden onset, continuous dull aching diffuse
pain for 2 days, unrelated to food intake, moderate to severe
intensity pain radiating to the back. Pain decreases on bending
forward.
Associated with 4 episodes of non bilious, non projectile, non
blood stained vomiting. Vomitus contains food particles.
Pt is a k/c/o T2DM, on metformin.
O/E:
Hydration status is fair, moderately built and moderately
nourished, no pallor, no icterus.
vitals
RR: 20/ min, Spo2: 96% RA, BP: 140/ 80 mmHg,
PR: 100/ min

PA, no discoloration around the umbilicus, flanks or the

inguinal region, tenderness present in the epigastric region,
no guarding, no rigidity.
Case 2
48 year old male, epigastric pain and vomiting for 2 days
following alcohol binge.
O/E: PR- 110/min, BP- 100/60 mmHg, RR- 20/min
PA: tenderness and guarding in epigastrium
Admitted in ICU with provisional diagnosis- Acute pancreatitis

TLC -16000/cmm
CRP- 200 mg/l
S. Amylase- 1400 U/L
S. Lipase- 812 U/L
Initial management:
• NBM/ NG tube placement
• IV fluids
• Urine output monitoring
After 48 hours:
• Dropping of urine output
• Tachycardia 130/ min
• Hypotension 80/60 mmHg
• Abdominal distension, high volume bilious NG aspirate
TLC- 23000/cmm
CRP- 340 mg/l
S. Creatinine 1.3mg/dl

CT pancreatic protocol, dilated edematous bowel loop with

pancreatic necrosis and extensive fat stranding
• Acute necrotizing pancreatitis
Case 3
38 year old female k/c/o biliary calculi had undergone
ERCP now c/o abdominal pain radiating to back, h/o
vomiting.
THANK YOU