20/04/2025
# # # **Pancreatitis: Overview and Management**
# # # # **Definition**
Pancreatitis is inflammation of the pancreas, classified as:
1. **Acute Pancreatitis** – Sudden onset, reversible inflammation.
2. **Chronic Pancreatitis** – Persistent inflammation leading to irreversible damage and fibrosis.
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# # # **Causes**
# # # # **Acute Pancreatitis**
- **Gallstones** (most common, ~40-70%)
- **Alcohol** (second most common)
- **Hypertriglyceridemia** (>1000 mg/dL)
- **Hypercalcemia**
- **Drugs** (e.g., azathioprine, diuretics, valproate)
- **ERCP** (iatrogenic)
- **Trauma/infection**
# # # # **Chronic Pancreatitis**
- **Long-term alcohol abuse** (~70% of cases)
- **Recurrent acute pancreatitis**
- **Genetic factors** (e.g., CFTR mutations, SPINK1)
- **Autoimmune pancreatitis**
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# # # **Clinical Features**
# # # # **Acute Pancreatitis**
- **Severe epigastric pain** (radiating to back)
- **Nausea/vomiting**
- **Tenderness, guarding**
- **Fever, tachycardia**
- **Complications:**
- **Local:** Necrosis, pseudocyst, abscess
- **Systemic:** Shock, ARDS, AKI, DIC
# # # # **Chronic Pancreatitis**
- **Recurrent abdominal pain** (relieved by leaning forward)
- **Steatorrhea** (fat malabsorption)
- **Weight loss, malnutrition**
- **Diabetes mellitus** (late complication)
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# # # **Diagnosis**
# # # # **Laboratory Tests**
- **↑ Serum amylase/lipase** (≥3x upper limit; lipase more specific)
- **CBC** (leukocytosis), **LFTs** (gallstone pancreatitis → ↑ bilirubin/ALP)
- **Calcium, triglycerides** (if etiology unclear)
# # # # **Imaging**
- **Abdominal ultrasound** (1st-line for gallstones)
- **Contrast-enhanced CT** (if severe/complicated; assess necrosis)
- **MRI/MRCP** (for ductal anatomy, chronic pancreatitis)
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# # # **Management**
# # # # **Acute Pancreatitis**
1. **Supportive Care**
- **NPO** (initially), then **early oral feeding** (within 24-48 hrs if mild)
- **IV fluids** (Lactated Ringer’s preferred, aggressive hydration)
- **Pain control** (IV acetaminophen, opioids like morphine)
- **Antiemetics** (ondansetron)
2. **Treat Underlying Cause**
- **Gallstones:** ERCP if cholangitis/obstruction
- **Hypertriglyceridemia:** Insulin + heparin (if severe), plasmapheresis
- **Alcohol cessation counseling**
3. **Severe Cases (ICU Care)**
- **Antibiotics** (only for infected necrosis, e.g., carbapenems)
- **Nutritional support** (enteral > parenteral)
- **Drainage/debridement** (for infected necrosis)
# # # # **Chronic Pancreatitis**
- **Pain management:**
- **Pancreatic enzymes** (e.g., pancrelipase)
- **Antioxidants** (limited evidence)
- **Nerve blocks** (celiac plexus) if refractory
- **Malabsorption:**
- **Pancreatic enzyme replacement (PERT)** + **fat-soluble vitamins**
- **Diabetes management:** Insulin (avoid oral agents due to malnutrition)
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# # # **Complications**
- **Pseudocyst** (drain if symptomatic)
- **Pancreatic necrosis** (antibiotics ± drainage)
- **Pancreatic cancer** (in chronic pancreatitis)
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# # # **Prognosis**
- **Mild acute pancreatitis:** Good recovery
- **Severe acute pancreatitis:** High mortality (10-30%)
- **Chronic pancreatitis:** Progressive, requires long-term management
# # # # **Prevention**
- **Alcohol cessation**
- **Low-fat diet** (if hyperlipidemia)
- **Cholecystectomy** (if gallstone-related)
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# # # **Summary**
- **Diagnose** with lipase/amylase + imaging.
- **Treat** supportively (fluids, pain control, early feeding).
- **Address underlying cause** (gallstones, alcohol, hypertriglyceridemia).
- **Chronic pancreatitis** requires enzyme replacement and diabetes management.
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