ACUTE PANCREATITIS

DEFINITION

Acute inflammatory process of the pancreas.

It can be limited to the pancreas but it can
spread to the abdomen and cause systemic
complications

Acute Pancreatitis vs Chronic Pancreatitis

AP= acute abdominal pain +  amylase &

lipase  AP imaging w/o signs of CP
 PATOLOGY
Two different forms:
Interstizial pancreatitis : oedema
(microscopic necrosis)
Resolution in just a few days

Necrotizing pancreatitis:
macroscopic evidence of necrosis
Reparation and pseudocyst
 CAUSES

GALLSTONES (90%) ALCOHOL

IDIOPATHIC
AMPOLLARY DISEASES
METABOLIC
DRUGS
Hyperlipidemia
Hypercalcemia
Azathioprine
POST-TRAUM.
Hyperparathyroidism

ERCP
Surgery VIRUS
 EPIDEMIOLOGY
• Incidence 5-6/100000/year

• Age of onset: 40 - 60 years

• Biliary pancreatitis F>M

• Alcoholic pancreatitis M>F

• Mortality AP: interstizial p. 0%
sterile necrosis 10%
infected necrosis 30%
 CLINICAL PICTURES 1
ABDOMINAL PAIN
Severe and lasts for many hours
Epimesogastric
Radiates to the back (straight or around the abdomen)
Post-prandial onset
Relief with a change of position in bed

NAUSEA & VOMITING

ILEUS
JAUNDICE
 CLINICAL PICTURES 2

FEVER

CARDIOVASCULAR COMPLICATIONS
Hypotension  shock

MULTIORGAN FAILURE
Renal failure, ARDS, stress gastritis  GI
bleeding, DIC, subcutaneous fat necrosis
 LABORATORY TESTS

1. Amylase & Lipase

2. Alkaline phosphatase, gamma-GT, AST, ALT, bilirubin

3. FBC, pO2, glucose, blood urea nitrogen, calcium, LDH, albumine

 IMAGING TESTS
ABDOMINAL US
ABDOMINAL CT (48-72 hours, with
contrast-enhancement):
mild/interstial a.p.
severe/necrotising a.p.
MR CHOLANGIOPANCREATOGRAPHY
ENDOSCOPIC US
ERCP for sphincterotomy
 PROGNOSIS 1

GLASGOW SCORE (48 hours)

Add 1 for each positive value:
WBC > 15000/ml Mild form < 3

PO2 < 60 mmHg

Glucose > 180 mg/dl
Are you happy?
What about amylase and lipase?
BUN > 45 mg/dl No prognostic value!

Calcium < 8 mg/dl

Albumine < 3,2 g/dl
LDH > 600 UI/l
AST >200 UI/l
What about timing?
 PROGNOSIS 2

HEMATOCRIT AT ADMISSION

Hct < 44, mild form

Hct > 50, severe form

 THERAPY
• NBM and iv fluids
• Antibiotics (?)

• Gabexate? (only for severe forms?)

• Endoscopic sphincterotomy in the first 72 hours, in case
of biliary a.p.

• Surgery