Acute pancreatitis
- Self perpetuating pancreatic inflammation
- Extracellular fluid is trapped in the gut, peritoneum and retroperitoneum
- There may be rapid progression from mild oedema to necrotising pancreatitis
- In fulminating cases the pancreas is replaced by black fluid
- Contributory factors include protease induced activation of complement, kinin, fibrinolytic and coagulation cascades
Signs
- May be mild in severe disease
- Tachycardia
- Fever
- Jaundice
- Shock
- Ileus
- Rigid abdomen
- Local/generalised tenderness
- Periumbilical discolouration - Cullen’s sign
- Bruising of the flanks - Grey-Turner’s sign
Tests
- Raised serum amylase - excreted renally so renal failure results in raised levels
- Serum lipase is more sensitive and more specific
- ABG to monitor oxygenation and acid-base status
- AXR - no psoas shadow. Sentinal loop of proximal jejunum (solitary air filled dilation)
- Erect CXR can help exclude other causes e.g. perforation
- CT
- US
Management
- IV fluids
- Analgesia - pethidine or morphine
- Hourly obs
- If worsening ITU
- Keep patient NBM and pass an NG tube
Complications
- Early
- Shock
- ARDS
- Renal failure
- DIC
- Sepsis
- Low calcium
- Raised glucose
- Late
- Pancreatic necrosis and pseudosyst (fluid in the lesser sac)
- Abscess
- Bleeding
- Thrombosis
Severity assessed by Glasgow criteria - PANCREAS
- Based on;
- PaO2
- Age
- Neutrophils
- Calcium
- Renal function
- Enzymes (LDH, AST)
- Albumin
- Sugar