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Acute Pancreatitis

Table of Contents

  • Introduction
  • Aetiology
  • Anatomy
  • Pathophysiology
  • Causes
  • Risk Factors
  • Clinical Features
  • History
  • Clinical Examination
  • Complications
  • References
  • Related Notes
  • Test Yourself

Introduction

  • Acute pancreatitis (AP) is acute inflammation of the pancreas.
  • Incidence in UK: ~56 cases per 100,000 annually.
  • Most cases mild (mortality <1%), severe cases carry ~15% mortality.

Aetiology & Anatomy

  • Pancreas: retroperitoneal, lobulated organ with head, neck, body, tail.
  • Functions as exocrine (digestive enzymes secretion) and endocrine (islets of Langerhans).
  • AP caused by hypersecretion or premature activation/backflow of pancreatic enzymes → autodigestion.

Pathophysiology

  • Two types:
  • Interstitial oedematous pancreatitis (most common, better prognosis)
  • Necrotising pancreatitis (5-10%, more severe)
  • Damage is potentially reversible; chronic pancreatitis involves ongoing injury and dysfunction.

Causes

  • Commonest in UK: Gallstones, Alcohol.
  • Mnemonic "I GET SMASHED":
  • Idiopathic
  • Gallstones
  • Ethanol
  • Trauma
  • Steroids
  • Mumps/Malignancy
  • Autoimmune disease
  • Scorpion sting
  • Hypertriglyceridemia/Hypercalcaemia
  • ERCP
  • Drugs (azathioprine, thiazides, septrin, tetracyclines)

Risk Factors

  • Male gender
  • Increasing age
  • Obesity
  • Smoking

Clinical Features

History

  • Severe sudden epigastric pain radiating to back
  • Nausea, vomiting
  • Reduced appetite
  • Past medical: gallstones, biliary disease, previous pancreatitis
  • Past surgical: recent ERCP or other procedures
  • Drug, social, and family history important (esp. alcohol, smoking, hereditary pancreatitis)

Clinical Examination

  • Epigastric tenderness
  • Abdominal distention (from ileus or retroperitoneal inflammation)
  • Reduced bowel sounds (if ileus present)
  • Signs of systemic inflammation and possible organ failure
  • Specific signs: Cullen's sign (periumbilical bruising), Grey-Turner's sign (flank bruising)

Complications

Early

  • Necrotising pancreatitis
  • Infected pancreatic necrosis (requires antibiotics, necrosectomy)
  • Pancreatic abscess
  • Acute respiratory distress syndrome (ARDS) due to SIRS

Late

  • Pancreatic pseudocysts (usually develop within 4 weeks, often require drainage)
  • Portal vein/splenic vein thrombosis
  • Chronic pancreatitis with endocrine/exocrine insufficiency

References

  • International Pancreatic Association/American Pancreatic Association, 2013
  • BMJ Best Practice, 2013
  • Van Brummelen SE et al., 2003
  • Balthazar EJ et al., 1990
  • Banks PA et al., Atlanta classification
  • Kimura Y, JPN Guidelines 2010
  • Way LW, Doherty GM, Curr Surg Diagn Treat, 2003
  • Barrett’s Oesophagus
  • Coeliac Disease
  • Crohn's Disease
  • Hyperlipidaemia
  • Irritable Bowel Syndrome

Test Yourself

  • [Link to practice questions and flashcards on Acute Pancreatitis]

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