12/01/2024
Acute pancreatitis
Acute pancreatitis is an inflammatory condition of the pancreas most commonly caused by biliary tract disease or alcohol abuse.
Damage to the pancreas causes local release of digestive proteolytic enzymes that autodigest pancreatic tissue.
Acute pancreatitis usually presents with epigastric pain radiating to the back, nausea and vomiting, and epigastric tenderness on palpation.
The diagnosis is made based on:
1- Clinical presentation
2- Elevated serum pancreatic enzymes most specific Lipase, most sensitive amylase
3- Findings on imaging (CT, MRI, ultrasound) that suggest acute pancreatitis.
Best screening test is USG abdomen
Investigation of choice is CT scan abdomen with pancreatic protocol
Treatment is mostly supportive and includes bowel rest, fluid resuscitation, antibiotics and pain medication such as initial ketrolac, if not controlled than pethidine , morphine, tramadol.
Enteral feeding is usually quickly resumed once the pain and inflammatory markers begin to subside.
Interventional procedures may be indicated for the treatment of underlying conditions, such as ERCP or cholecystectomy in gallstone pancreatitis.
Localized complications of pancreatitis include necrosis, pancreatic pseudocysts, and abscesses.
Systemic complications involve sepsis, ARDS, organ failure, and shock and are associated with a considerable rise in mortality.
