Acute pancreatitis (AP) is a sudden inflammation of the pancreas. Causes, in order of frequency, include: a gallstone impacted in the common bile duct beyond the point where the pancreatic duct joins it; heavy alcohol use; systemic disease; trauma; and, in minors, mumps. Acute pancreatitis may be a single event; it may be recurrent; or it may progress to chronic pancreatitis.
Mild cases are usually successfully treated with conservative measures: hospitalization, pain control, nothing by mouth, intravenous nutritional support, and intravenous fluid rehydration. Severe cases often require admission to an intensive care unit to monitor and manage complications of the disease. Complications are associated with a high mortality, even with optimal management. For people with this condition, the pancreas will begin to secrete active enzymes such as Trypsin, chymotrypsin and carboxypeptidase instead of their inactive forms. Damage to the pancreatic ducts can occur as a result of this.
Signs and symptoms
Common
severe epigastric pain (upper abdominal pain) radiating to the back in 50% of cases nausea vomiting loss of appetite fever chills (shivering) hemodynamic instability, including shock tachycardia (rapid heartbeat) respiratory distress peritonitis hiccup Although these are common symptoms, frequently they are not all present; and epigastric pain may be the only symptom.
Uncommon
The following are associated with severe disease: Grey-Turner's sign (hemorrhagic discoloration of the flanks) Cullen's sign (hemorrhagic discoloration of the umbilicus) Pleural effusions (fluid in the bases of the pleural cavity) Grünwald sign (appearance of ecchymosis, large bruise, around the umbilicus due to local toxic lesion of the vessels) Körte's sign (pain or resistance in the zone where the head of pancreas is located (in epigastrium, 6–7 cm above the umbilicus)) Kamenchik's sign (pain with pressure under the xiphoid process) Mayo-Robson's sign (pain while pressing at the top of the angle lateral to the erector spinae muscles and below the left 12th rib (left costovertebral angle (CVA)) Mayo-Robson's point – a point on border of inner 2/3 with the external 1/3 of the line that represents the bisection of the left upper abdominal quadrant, where tenderness on pressure exists in disease of the pancreas. At this point the tail of pancreas is projected on the abdominal wall.
Complications
Locoregional complications include pancreatic pseudocyst (most common, occurring in up to 25% of all cases, typically after 4–6 weeks) and phlegmon/abscess formation, splenic artery pseudoaneurysms, hemorrhage from erosions into splenic artery and vein, thrombosis of the splenic vein, superior mesenteric vein and portal veins (in descending order of frequency), duodenal obstruction, common bile duct obstruction, progression to chronic pancreatitis, pancreatic ascites, pleural effusion, sterile/infected pancreatic necrosis.
Systemic complications include acute respiratory distress syndrome (ARDS), multiple organ dysfunction syndrome, disseminated intravascular coagulation (DIC), hypocalcemia (from fat saponification), hyperglycemia and insulin dependent diabetes mellitus (from pancreatic insulin-producing beta cell damage), malabsorption due to exocrine failure Metabolic Hypocalcemia, hyperglycemia, hypertriglyceridemia Respiratory Hypoxemia, atelectasis, effusion, pneumonitis, acute respiratory distress syndrome Renal Renal artery or vein thrombosis Kidney failure Circulatory Arrhythmias Hypovolemia and shock Myocardial infarction Pericardial effusion Vascular thrombosis Gastrointestinal Gastrointestinal hemorrhage from stress ulceration Gastric varices (secondary to splenic vein thrombosis) Gastrointestinal obstruction Hepatobiliary Jaundice Portal vein thrombosis Neurologic Psychosis or encephalopathy (confusion, delusion and coma) Cerebral Embolism Blindness (angiopathic retinopathy with hemorrhage) Hematologic Anemia Disseminated intravascular coagulation Leucocytosis Dermatologic Painful subcutaneous fat necrosis Miscellaneous Subcutaneous fat necrosis Arthalgia