ACUTE PANCREATITIS -A minority of patients exhibit jaundice (28%).
Introduction -Some patients experience dyspnea (10%), which may be
Principal function of the pancreas is to make food-digesting caused by irritation of the diaphragm (resulting from
enzymes (exocrine) and Insulin (endocrine). The pancreas, inflammation) or by a more serious condition, such as
comprising only 0.1% of total body weight, has 13 times the respiratory distress syndrome.
protein-producing capacity of the liver and reticulo -In severe cases, hemodynamic instability is evident (10%)
endothelial system combined, which make up 4% of total and hematemesis or melena sometimes develops (5%).
body weight. -A few uncommon physical findings are associated with
Several mechanisms enable the pancreas to avoid digesting severe necrotizing pancreatitis.
itself. First, proteins are translated into an inactive form The Cullen sign is a bluish discoloration around the
called pro enzymes. The pro enzymes are packaged in a para- umbilicus resulting from hemoperitoneum.
crystalline arrangement with protease inhibitors The Grey-Turner sign is a reddish-brown
Zymogen granules have an acidic pH and a low calcium discoloration along the flanks resulting from
concentration, which are factors that guard against premature retroperitoneal blood dissecting along tissue planes.
activation Erythematous skin nodules may result from focal
Under various conditions, these protective mechanisms are subcutaneous fat necrosis.
disrupted, resulting in intracellular enzyme activation and Rarely, abnormalities on funduscopic examination
pancreatic auto digestion, a condition called acute may be seen in severe pancreatitis. Purtscher
pancreatitis. This condition typically causes abdominal pain, retinopathy, this ischemic injury to the retina
usually associated with elevated pancreatic enzyme levels in appears to be caused by activation of complement
the blood and inflammation of the pancreas. and agglutination of blood cells within retinal
Mortality/Morbidity: vessels. It may cause temporary or permanent
The overall mortality rate of patients with acute pancreatitis blindness.
is 10-15%. Causes: Although pancreatitis has numerous etiologies,
In patients with severe disease, the mortality rate is alcohol dependence and biliary tract disease cause most
approximately 30%. cases. In 10-30% of cases, the cause is unknown, and careful
In the first week of illness, most deaths result from evaluation may identify a rare etiology in 10% of cases.
multiorgan system failure. In subsequent weeks, infection 1. Biliary tract disease (approximately 38%)
plays a more significant role, but organ failure still The most common cause of acute pancreatitis is gallstones
constitutes a major cause of mortality. passing into the bile duct and temporarily lodging at the
Sex: sphincter of Oddi. The risk of a stone causing pancreatitis is
In general, acute pancreatitis affects males more often than inversely proportional to its size.
females. Abnormal anatomy (eg, choledochal cysts, juxtapapillary
The etiology in males is more often related to alcohol; in diverticula) is also associated with acute pancreatitis.
females, to biliary tract disease. 2. Alcohol (approximately 35%)
History: Alcohol abuse is a major cause of pancreatitis, evidence
The cardinal symptom of acute pancreatitis is abdominal shows that alcohol may cause acute pancreatitis in the
pain, which is characteristically dull, boring, and steady. absence of chronic disease.
Most often, it is located in the upper abdomen, usually in the 3. Post-ERCP (approximately 4%)
epigastric region, but it may be perceived more on the left or 4. Trauma (~1.5%)
right side, depending on which portion of the pancreas is Abdominal trauma causes an elevation of amylase and lipase
involved. levels in 17% of cases and clinical pancreatitis in 5% of
The pain radiates to the back in approximately half of cases. cases.
The duration of pain varies but typically lasts more than a 5. Drugs (~1.4%)drug-induced pancreatitis is usually mild.
day. Drugs definitely associated with acute pancreatitis include
The pain may be aggravated by eating or lying supine and it azathioprine, sulfonamides, sulindac, tetracycline, valproic
may be alleviated by fasting or lying on the left side with the acid, didanosine, methyldopa, estrogens, furosemide, 6-
knees and hips flexed. mercaptopurine, pentamidine, 5-aminosalicylic acid
Associated symptoms (eg, anorexia, nausea, vomiting) are compounds, corticosteroids, and octreotide.
common, and some patients experience diarrhea due to 6. Infection (<1%) )Viral causes include mumps, Epstein-
indigestion. Barr, coxsackievirus, echovirus, varicella-zoster, and
Avulsion to fatty foods may be reported. measles.
Physical: Bacterial causes include Mycoplasma pneumoniae,
The following physical examination findings vary with the Salmonella, Campylobacter, and Mycobacterium
severity of the disease. tuberculosis.
1.Fever (76%) and tachycardia (65%) are common abnormal Worldwide, ascariasis is a recognized cause of pancreatitis
vital signs. resulting from the migration of worms in and out of the
2. Abdominal tenderness, muscular guarding (68%), and duodenal papillae.
distension (65%) are observed in most patients. Bowel
sounds are often hypoactive.
Imaging
1.Abdominal radiography
