Acute Pancreatitis

Question 1

What is acute pancreatitis?

Answer 1

life-threatening inflammation of the pancreas

Question 2

Use one word to describe the underlying problem involved in acute pancreatitis.

Answer 2

auto-digestion

Question 3

What causes acute pancreatitis?

Answer 3

• mostly alcohol abuse (70%)
• gallstones
• idiopathic (10%)
• others (pancreatic trauma like infection, drugs)

Question 4

Normally, how is it that pancreatic enzymes do not auto-digest the pancreas?

Answer 4

normally, the enzymes are secreted in an inactive form, they are activated by bile in the duodenum

Question 5

What is the pathology of acute pancreatitis caused by gallstones?

Answer 5

• bile flow is obstructed by gallstone, it cannot enter the duodenum and instead flows up the pancreatic duct to the pancreas
• enzymes are activated by the bile
• there is auto-digestion which damages the pancreas
• this causes necrosis, bleeding, hemorrhage

Question 6

What is the pathology of acute pancreatitis caused by alcohol abuse?

Answer 6

• alcohol increases pancreatic secretions
• alcohol also constricts the hepato-pancreatic ampulla, this obstructs the flow of bile and pancreatic secretions
• bile will mix with the pancreatic enzymes and back up along the pancreatic duct
• activated enzymes autodigest the pancreas
• damage, necrosis, bleeding, hemorrhage follow

Question 7

What might precipitate acute pancreatitis?

Answer 7

• a large meal or alcohol binge

Question 8

What are the manifestations of acute pancreatitis?

Answer 8

acute onset of:

- severe abdominal/epigastric pain that can radiate to the back or chest

Question 9

In addition to history and presentation, how might you diagnose acute pancreatitis?

Answer 9

• an increase in blood amylase and lipase (because damaged cells release their contents)
• lipase is more specific to the pancreas (amylase also made in by salivary glands)

Question 10

What is a complication of acute pancreatitis?

Answer 10

inflammation causing 3rd spacing, which can cause vascular collapse, hypovolemic shock

Question 11

How is acute pancreatitis treated?

Answer 11

it is largely self-limiting, so it is based on severity:

if mild - can recover in one week

• NPO (eating will stimulate enzymes and auto-digestion)
• treat pain
• provide fluids and electrolytes to correct 3rd spacing
• correct metabolic abnormalities (damage to pancreas will affect insulin and glucagon production)

if severe - patient will be in ICU

• renal, circulatory, hepatobiliary support
• use IV opiates for severe pain
• may require surgery to fix hemorrhage or remove stones