Acute Pancreatitis

Aetiology
Most alcohol consumption
gallstones
common causes are or excessive

become severe to + treat

quickly
'

usually quite
mild but can
quickly NB
diagnose

pathophysiology :

Auto
digestion of the pancreas due to
digestion by its own
enzymes
→
leading
to
haemorrhage ing +
inflammation .

Pancreas cells contain the macromolecules which its exocrine

enzymes normally digest Therefore to protect itself , it produces inactive
forms of these
enzymes
-

,
.

These inactive
enzymes
are called
zymogen
which are activated
by proteases ,
by cleaving a
polypeptide chain .

They are also kept away from delicate tissues

by being stored in
zymogen granules
.

They are
packaged with protease inhibitors , which prevent them from doing damage if they are
prematurely activated .

To
digest a meal → pancreatic duct → small intestine + activated
by the protease
trypsin .

Trypsin →
initially the
zymogen tripsinogen ( activated when cleaved
by enter peptidases in the duodenum ) .

If Trysinogen is activated
early it can cause Acute Pancreatitis

might happen
→
due to
injury to acinar cells

→
Impaired Secreation of pro -

enzymes
into the duodenum
 Alcohol induced :

Alcohol increases release from Acini cells 1-

zymogen

Decreases fluid + bicarbonate secreation

from ductal epithelial cells .

potentially forming
Pancreatic Juices become thick that block the duct
plug
+ viscous a can .

↳
Pancreatic juice backs up

leading to ↑
pressure + distension of the duct itself .

↳ membrane trafficking becomes chaotic

↳
may fuse
contact with
Zymogen granules
in
come
lysosomes + .

↳ becomes active
This
brings trypsinogen with
lysomae enzymes then
trypsin
in contact which

↳ Activates
other enzymes +
begins auto
digestion .

of the pancreas .

Alcohol Also !

which
→ Gets Acinar cells to release
inflammatory cytokines produces a
strong immune reaction .

→ Neutrophils arrive + release super oxides + other proteases which continue to the problem .

sufficient oxidative metabolism of alcohol ROS overwhelm

Also ,
ingestion +
may produce enough to
damage + cells -

Gallstones :

→
Get
lodged + block the sphincter of . Oddi which blocks the duct + Slows the flow of pancreatic juice which is similar to the alcohol induced
plug
.

" "

Other Mnemonic I Get smashed

'

causes are varied . =

I =
Idiopathic

G- =
Gallstones .

E = Ethanol abuse

T = Trauma

S =
steroids

M =
Mumps virus

A = Auto -
immune diseases

s scorpion stings
=

H =

Hypertñglycendemia +
Hypercalcemia
E =
ERCP

D=
Drugs
=
sulfa , RTI + PIS
 Acute Pancreatitis involves pancreatic tissue -

destruction
from lipases .

which
inflammatory swelling
'

The response ,
causes blood vessels to leak and rupture causes .

Extra fluid oedema the capsule of the to swell activation

of Lipases that
pen pancreatic fat
'

causes pancreas and

+
, destroy .

This process can

liquefy the pancreatic tissue
,
in a
process called

Liquefactive Haemorrhagic Necrosis

Complications :

-
Formation of a Pseudo cyst

where
fibrotic tissue
forms around the
liquefactive neurosis

Fibrous tissue
develops a
cavity that
fills with panicle juice .

cause
May
:

→ Abdominal pain

→ Loss of appetite

→
A palpable mass -

following a bout of acute

pancreatitis .

Serum :
amylase
Lipase .

Bilirubin be elevated
may

CT
imaging ( Abdominal scan
) =
best

As pseudo cysts
grow
in size
they can rupture leading to a massive
inflammatory response as
enzymes
are released into the abdominal

cavity
.

into
Pseudo
cyst can also
get inf-ekoften.by E. coli + turn a
very dangerous pancreatic Geass .

Presents similar -

to a
pseudo cyst with Fever + ↑ Wcc
 Other complications : ÷

→
Haemhorrhage from damaged blood vessels which can become :

Shock
Hypovoleamic

→
Disseminated Intravascular
coagulation Cbi c)

eder
Tiny Blood clots form throughout the
body using up all the
coagulation factors ,
which
paradoxically make it to bleed .

Can
damage vital
organs
distress
→ Acute
Respiratory gndreme
NB
,
leading cause
of death
among people with acute pancreatitis

↳ hid
massive inflammation leads to
leaky blood vessels
throughout the
body making it to breathe

Signs +
Symptoms
Diagnostic Criteria : 2 out of 3

General
symptoms : of following must be met

→ nausea ① Clinical : upper abdominal pain

→
vomiting

② habs ( serum amylase

or lipase >

3 ULN
)
Distinctive
Signs :

Hypocalcemia
→
Particuraly if a lot
of fat necrosis as uses a lot of calcium ③ Imaging CCT , MR
,
Us )

Bruising around
bellybutton =
Cullen 's
sign

Grey Turner 's

sign
=

Bruising at the
flank
-

These
signs happen as
necrostisrng haemorrhaging Spreads to the
soft tissue of these
body areas .

Diagnosis
:

radiating back
to
epigastric
: Intense pain in the the
Clinically region

t more specific
halos : ↑
Amylase +
Lipase FBC : TW CC + Heaematocn't 244% =
poor prognosis
= ↑ Risk of necrotizing
pancreatitis
p not needed for diagnoses
CT scan :
inflammation CRP : > 200 =
associated with pancreatic neurosis

neurosis UTE :
area 27.14 or creatinine ≥ 2 =
renal failure
Pseudo
cyst Pulse
oximetry
: As
high risk of hypoxia
show LFTS : ALT 73 ULN
us
May Gallstones Gallstones
suggested cause
=
:

CXR Ca
" :
Hypercalcemia cause
=
rare
 Treatment :

A Ibuprofen 1ˢᵗ line

→ Pain control Consider : Anti emetics

-

→ Fluids +
electrolytes .

Replace Thiamine , Folic acid + Biz in alcoholics

→ Rest the Bowels nil

by nourishment fluids Alcohol withdrawal referral for alcohol
=
mouth Iv
+ via
therapy +
counselling

Treat complications :

→ Antibiotics + 02