Pancreatitis

Acute Pancreatitis

Features

• Severe abdominal pain often radiating through to the back.
• Nausea, vomiting and loss of appetite.
• Severe illness, sometimes requiring admission to intensive care and sometimes fatal.
• Recovery may be followed by development of pancreatic pseudocyst, pancreatic dysfunction (malabsorption) and diabetes.

Causes

• Gallstones
• Alcohol
• Mumps
• Hypercalcaemia
• Idiopathic (unknown)
• Fat necrosis

Gallstones and alcohol abuse account, in Western countries, for more than 90% of all acute pancreatitis. Gallstones that travel down the common bile duct and which subsequently get stuck in the Ampulla of Vater[?] can cause obstruction in the outflow of pancreatic juices from the pancreas into the duodenum. The backflow of these digestive juices causes lysis[?] of pancreatic cells and subsequent pancreatitis.

Pathogenesis The exocrine pancreas produces a variety of enzymes that breakdown food tissues, such as proteases, lipases and saccharidases. Basically these spill into the blood and digest the patients own tissues.

Diagnosis

• Blood tests (amylase or lipase[?]).
• Xrays (plain Xrays help exclude other causes, CT scan may be useful).

Treatment

• Supportive for shock.
• Pain relief
• Enzyme inhibitors are not proven to work.
• While often severe, the disease is essentially self limiting.