Pancreatitis is inflammation of the pancreas. It is a serious disorder. Pancreatitis is commonly described as autodigestion of the pancreas. It is believed that the pancreatic duct becomes temporarily obstructed, accompanied by hypersecretion of the exocrine enzymes of the pancreas. These enzymes enter the bile duct, where they are activated and, together with bile, back up (reflux) into the pancreatic duct, causing pancreatitis.
Acute Pancreatitis ranges from a mild, self-limited disorder to a severe, rapidly fatal disease that does not respond to any treatment. Mild acute pancreatitis is characterized by edema and inflammation confined to the pancreas. Minimal organ dysfunction is present, and return to normal function usually occurs within 6 months.
Signs and Symptoms / clinical manifestations:
- Severe abdominal pain
- Abdominal pain and tenderness and back pain result from irritation and edema of the inflamed pancreas. Increased tension on the pancreatic capsule and obstruction of the pancreatic ducts also contribute to the pain.
- Pain usually occurs 24-48 hours after a heavy meal or alcohol ingestion and is unrelieved by antacids.
- Abdominal distention
- Palpable abdominal mass
- Decreased peristalsis
- Nausea and vomiting. – may be bile stained emesis.
- Ecchymosis in the flank or around the umbilicus may indicate severe pancreatitis.
LABS and Imaging:
- Serum Amylase – Enzyme produced by pancreas that aids digestion of complex carbohydrates. Normal 23-85 units/L)
- Serum calcium (necrosis of fat from release of pancreatic enzymes leads to binding of free calcium. (normal: 8.2-10.2 mg/dl)
- Serum lipase- enzyme that aids in digestion of fat. Begins to elevate within two hours of inflammation because it is released into the serum when there is cell damage or necrosis. (normal 3-73 units/L)
- Serum glucose – interference with insulin release and B sell injury leads to hyperglycemia in some patients.
- CT scans – inflammation, necrosis, swelling, fluid collection changes the configuration of the pancreas.
Medical treatment:
The immediate goal of therapy is to control and decrease inflammation of the pancreas. The fluid lost into the retroperitoneal space can be as much as 4-12 L. with severe disease. This patient had no free fluid found on CT. Volume replacement with fluids with Lactated Ringers or human serum albumin is used to restore blood volume and prevent hypovolemic shock. Albumin is used if serum protein if levels lead to loss of osmotic pressure.
Treatment of pain is important. Meperidine is preferred over morphine because of the greater spastic effect of morphine on the sphincter of Oddi
Antibiotics can be used for microorganisms causing biliary pancreatitis and acute necrotizing pancreatitis., Therapy is based of the idea that enteric anaerobic and aerobic gram negative bacilli microorganisms are often the cause of pancreatitic infections.
NPO Status is indicated for complete rest of digestive system.
Surgical Treatment: Surgical intervention maybe be indicated for managing the complications associated with pancreatic necrosis. The procedures include pancreatic drainage, pancreatic resection or debridement and removal of obstructions (bilary stones)
