Acute Pancreatitis Overview

Acute inflammation of the pancreas, leading to tissue damage.

Epigastric pain radiating to the back, nausea, and vomiting.

Hemorrhage under the skin near the umbilicus (belly button).

Hemorrhage under the skin in the flank area.

Gallstones and alcohol consumption are common triggers.

Enzymes produced by the pancreas that aid digestion.

Blocked flow of pancreatic enzymes, leading to their activation and autodigestion of the pancreas.

A pancreatic enzyme that activates other digestive enzymes, including itself.

Inactive form of the enzyme trypsin, produced by the pancreas.

Enzyme in the small intestine that activates trypsin.

A series of reactions where trypsin activates other enzymes.

Digestion of the pancreas by its own enzymes.

Blood tests used to detect pancreatic damage or inflammation.

Pancreatic enzyme more specific for pancreatic damage than amylase.

Hard deposits in the gallbladder, common cause of pancreatitis.

Obstruction of bile flow, affecting liver function tests.

Enlargement of the bile duct, often seen with gallstones.

Swelling of the pancreas, common finding in acute pancreatitis found on imaging.

Death of pancreatic tissue, usually severe pancreatitis.

Requires at least 2 of: epigastric pain, elevated serum amylase/lipase, and abnormal pancreatic imaging.

Heavy alcohol use, potential cause of acute pancreatitis.

Acute pancreatitis with no identifiable cause.

The pancreas is located behind the peritoneum, making it less vulnerable to direct trauma.

Blunt or penetrating trauma can damage the pancreas, leading to acute pancreatitis.

Restrained children can experience pancreatic trauma due to seatbelt force.

Mumps is a classic viral infection that can cause acute pancreatitis.

Drugs like Exenatide and Liraglutide, used for diabetes, can rarely cause pancreatitis.

Some sulfa medications can trigger acute pancreatitis.

Venom from some arachnids and reptiles can lead to acute pancreatitis.

The Gila monster's venom can cause pancreatitis.

A rare condition with recurrent pancreatitis, elevated IgG4 levels, and a large pancreas.

High levels of calcium in the blood can rarely trigger pancreatitis.

High levels of triglycerides, over 1000, can lead to acute pancreatitis.

Large lipid particles carrying triglycerides, implicated in pancreatitis due to hypertriglyceridemia.

Endoscopic retrograde cholangiopancreatography, a procedure involving endoscopy and fluoroscopy to visualize the bile ducts.

Pancreatitis can occur as a complication of ERCP due to pancreatic duct irritation.

Nil per os, meaning no food or liquid intake. This helps rest the pancreas by preventing stimulation from gastric contents.

To compensate for significant fluid loss due to pancreatic edema and vascular leak.

Epigastric pain, often radiating to the back.

Systemic Inflammatory Response Syndrome, a clinical syndrome of dysregulated inflammation.

Elevated temperature (above 38.3 Celsius or below 36), elevated heart rate (above 90), elevated respiratory rate (above 20), and elevated white blood cell count (above 12,000).

SIRS plus an infection.

Indicates a patient with more severe disease, potentially becoming sicker.

Clinical features present at admission or 48 hours later, predicting the severity of acute pancreatitis with points assigned for each criterion.

Higher Ranson's score indicates a worse prognosis and higher mortality risk.

Prolonged PT and PTT, low platelet count, microangiopathic hemolytic anemia, bleeding.

White, fluffy infiltrates in both lung fields, often mistaken for other causes of pulmonary edema.

Capillary and alveolar damage, protein leakage into the lung tissues.

Disseminated Intravascular Coagulation (DIC), a life-threatening blood clotting disorder.

Acute Respiratory Distress Syndrome (ARDS), characterized by severe lung damage leading to respiratory failure.

In ARDS, the pulmonary capillary wedge pressure is normal, indicating the fluid leakage is not due to high heart pressure but a leaky vascular endothelium.

ARDS in acute pancreatitis can be due to inflammation from pancreatitis itself, leading to leakage in the lungs.

ARDS, a complication of acute pancreatitis, requires ventilation due to impaired gas exchange in the lungs.

A pseudocyst is a walled-off collection of edema and fluid in the pancreas, lacking epithelial lining.

Pseudocyst contains mostly edema and fluid, while walled-off pancreatic necrosis contains necrotic pancreatic cells.

Pseudocysts take about 4 weeks to develop, requiring granulation and fibrous tissue formation around the fluid collection.

Pseudocysts are often diagnosed by imaging, like CT scan or MRI, and may be asymptomatic.

The most common location for a pseudocyst is in the lesser sac of the abdomen, behind the stomach and in front of the pancreas.

Most pseudocysts resolve without intervention. Larger cysts might require drainage.

Rupture of a pseudocyst can lead to peritonitis, inflammation of the abdominal lining.

A pancreatic abscess is an infection of a pancreatic pseudocyst, occurring about 10 days into acute pancreatitis.

Fat necrosis is when pancreatic inflammation affects fat surrounding the pancreas, leading to low calcium and magnesium levels.

Pancreatic lipase releases fatty acids that bind calcium and magnesium, reducing their levels in the blood (saponification).

Low calcium suggests severe pancreatitis extending to surrounding fat, indicating a poor prognosis.

Severe acute pancreatitis can lead to multi-organ failure and death, requiring intensive care and life-support.

Acute pancreatitis is a sudden inflammation of the pancreas, leading to tissue damage due to activated enzymes digesting the organ itself.

The hallmark symptoms are severe epigastric pain that radiates to the back, accompanied by nausea and vomiting.

Cullen's sign is bruising around the belly button, while Grey Turner's sign is bruising in the flank area.

The main cause is the activation of digestive enzymes within the pancreas itself, leading to autodigestion.

Common triggers include gallstones and alcohol consumption.

Trypsin is a pancreatic enzyme that activates other digestive enzymes, including itself, causing a domino effect of damage.

Serum amylase and lipase levels are elevated in acute pancreatitis, indicating pancreatic damage.

Severe cases can lead to organ failure and death, requiring intensive care to manage complications like infection and fluid loss.

Trypsinogen is the inactive form of the powerful digestive enzyme trypsin, produced by the pancreas.

Enterokinase, an enzyme in the small intestine, activates trypsinogen to trypsin.

Activated trypsin activates other pancreatic enzymes like chymotrypsin, elastase, and carboxypeptidase.

Auto-activation of trypsin inside the pancreas can lead to auto-digestion, where the pancreas is digested by its own enzymes.

Epigastric pain (upper abdominal pain), nausea, and vomiting.

Lipase is more specific than amylase in indicating pancreatic damage because it is less likely to be elevated in other conditions.

Gallstones and alcohol consumption.

Gallstones can block the common bile duct, which also obstructs the flow of pancreatic enzymes, leading to their activation within the pancreas.

Ultrasound may show gallstones, while CT scan shows pancreatic edema and necrosis.

At least two of the following: epigastric pain, increased amylase/lipase, and abnormal pancreatic imaging.

Idiopathic (unknown cause), trauma, viral infections, medications, venom, autoimmune disorders, hypercalcemia, and hypertriglyceridemia.

To rest the pancreas by preventing stimulation from gastric contents.

Obstruction of the pancreatic duct leads to accumulation of activated pancreatic enzymes. This leads to autodigestion of the pancreas, resulting in inflammation, edema, and necrosis.

Blunt or penetrating trauma can damage the pancreas and cause acute pancreatitis.

The pancreas is located in the retroperitoneal space, making it less vulnerable to direct trauma.

Mumps, a viral infection, can cause inflammation of the parotid gland and lead to acute pancreatitis.

Drugs like GLP-1 agonists (Exenatide, Liraglutide), sulfa drugs, and 6-Mercaptopurine can trigger acute pancreatitis.

Venom from brown recluse spiders, scorpions, and Gila monster lizards can trigger acute pancreatitis.

It causes chronic abdominal pain, recurrent attacks of acute pancreatitis, IgG4 plasma cells, and elevated serum IgG4 levels.

High calcium levels can deposit in the pancreatic ducts, leading to trypsinogen activation and autodigestion.

Hypertriglyceridemia with levels over 1000 can cause acute pancreatitis.

Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure to image the bile ducts and biliary tree.

ERCP can irritate the pancreatic duct, obstructing the flow of pancreatic enzymes and causing post-ERCP pancreatitis.

Idiopathic pancreatitis refers to acute pancreatitis with no identifiable cause.

Chylomicrons are large lipid particles that carry triglycerides, potentially implicated in hypertriglyceridemia-induced pancreatitis.

High triglycerides may obstruct capillaries, leading to ischemia and exposure of triglycerides to pancreatic lipases, generating free fatty acids and tissue injury.

ERCP is a common procedure for bile duct issues, and post-ERCP pancreatitis is a potential complication.

Severe lung damage caused by inflammation from pancreatitis, leading to respiratory failure. Characterized by normal pulmonary capillary wedge pressure, indicating fluid leakage not due to heart issues, but a leaky vascular endothelium.

Pseudocyst is a walled-off collection of edema and fluid in the pancreas, lacking epithelial lining. Walled-off pancreatic necrosis contains necrotic pancreatic cells.

Pseudocysts develop over 4 weeks as granulation and fibrous tissue surround edema and fluid.

Pseudocysts are usually diagnosed by imaging (CT or MRI) and are often asymptomatic.

The most common location for a pseudocyst is the lesser sac of the abdomen, behind the stomach and in front of the pancreas.

Most pseudocysts resolve without intervention. Large cysts might require drainage.

The feared complication is rupture, leading to peritonitis (inflammation of abdominal lining). Other issues include fistulas and bowel obstruction.

An infection of a pancreatic pseudocyst, typically occurring around 10 days into acute pancreatitis. Caused by intestinal bacteria entering the cyst.

Pancreatic inflammation affects surrounding fat, leading to low calcium and magnesium levels in the blood.

Pancreatic enzymes release fatty acids that bind calcium and magnesium, reducing their levels in the blood.

Low calcium suggests severe pancreatitis affecting surrounding fat, a poor prognostic indicator.

Severe pancreatitis can lead to multi-organ failure and death, requiring intensive care and life support.

A sudden inflammation of the pancreas caused by activated enzymes digesting the organ itself. Characterized by severe epigastric pain radiating to the back, nausea, vomiting, elevated serum amylase/lipase, and potential complications like ARDS, pseudocysts, and fat necrosis.

A rare cause of acute pancreatitis where a duodenal ulcer ruptures and irritates the nearby pancreas.

No food or liquid intake, prescribed for acute pancreatitis to rest the pancreas and reduce stimulation from gastric contents.

Administered to replace fluids lost due to pancreatic edema and vascular leak, keeping blood pressure and kidney function stable.

Essential for managing the intense epigastric pain, a major symptom of acute pancreatitis.

Four criteria: fever (above 38.3°C or below 36°C), rapid heart rate (above 90 bpm), fast breathing (above 20 breaths per minute), and elevated white blood cell count (above 12,000).

SIRS with the presence of infection.

Shows white, fluffy infiltrates in both lung fields, mimicking other causes of pulmonary edema.

Can be severe and life-threatening, including DIC, ARDS, pancreatic pseudocysts, and abscesses.

A fluid-filled sac in the pancreas, formed from inflammation and tissue damage, often resolving without intervention.