Acute Pancreatitis

Definition

Acute pancreatitis is the sudden onset of reversible inflammation of pancreatic parenchyma.

Etiology

Mnemonic: I GET SMASHED

  • Idiopathic
  • Gallstones
  • Ethanol abuse
  • Trauma
  • Steroid use
  • Mumps infection
  • Autoimmune
  • Scorpion stings
  • Hypertriglyceridemia, Hypercalcemia, Hyperparathyroidism
  • Endoscopic Retrograde Cholangiopancreatography (ERCP) use
  • Drug-induced
Clinical Features
  • Intense Pain
    • At umbilical and/or epigastric region
    • Radiates posteriorly (straight through to the back)
    • Palpable tender mass
    • Associated with nausea ± vomit
  • Loss of appetite
  • Diarrhoea
  • Positive Cullen’s sign (Periumbilical region bruising)
  • Positive Grey Turner’s sign (Flank bruising)
Investigations
  • Imaging
    • Ultrasound if suspect presence of gallstone
    • CT scan to visualise pancreatic inflammation or necrosis or presence of pseudocyst
  • Blood test
    • Lower calcium (due to fat necrosis consuming calcium)
    • Elevated phosphate, amylase, lipase, CRP and ALT
Management

Only supportive treatments in most cases:

  • Pain management
  • Fluids rehydration
  • Antiemetics
  • Antibiotics (if infective pancreatic necrosis or abscess present)
Author