Acute Pancreatitis

Acute pancreatitis is an inflammatory condition of the pancreas that is painful and at times deadly. Despite the great advances in critical care medicine over the past 20 years, the mortality rate of acute pancreatitis has remained at about 10%. Inflammation of the pancreatic tissue can be divided into chronic and acute inflammation depending on the degree of resolution of the tissue inflammation. Over 80% of all cases of acute pancreatitis are due togallstones or the alcohol abuse. Severe abdominal pain is the hallmark symptom of patients suffering from acute pancreatitis as well as of chronic pancreatitis. The successful treatment of patients with acute pancreatitis has three prerequisites:

1) an adequate and early fluid resuscitation,

2) proper nutritional support and

3) an adequate pain management.

An effective treatment of pain in acute pancreatitis ranges from the administration of simpleanalgesic drugs, which might be sufficient for patients with mild acute pancreatitis, up to the administration of potent opioid drugs, high doses of antibiotics for infected pancreatic necrosis and even to surgical or interventional procedures in cases of severe acute pancreatitis

Various Diagnostic modalities employed are:

1) Abdominal radiography: Kidneys-ureters-bladder (KUB) radiography with the patient upright is primarily performed to detect free air in the abdomen.

2) Abdominal ultrasonography (most useful initial test in determining the etiology, and is the technique of choice for detecting gallstones)

3) Endoscopic ultrasonography (EUS) (used mainly for detection of microlithiasis and periampullary lesions not easily revealed by other methods)

4) Abdominal computed tomography (CT) scanning (generally not indicated for patients with mild pancreatitis but always indicated for those with severe acute pancreatitis)

5) Endoscopic retrograde cholangiopancreatography (ERCP); to be used with extreme caution in this disease and never as a first-line diagnostic tool

6) Magnetic resonance cholangiopancreatography (MRCP) (not as sensitive as ERCP but safer and non-invasive)

  • Necrosis
  •  intravenous fluid rehydration
  • Fluid replacement
  • Bowel rest
  • Nutritional support
  • Tachycardia
  • Respiratory distress
  • Gallstones
  • Autoimmune Pancreatitis

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