Pancreatitis

Pancreatitis
Presentation lecture by:Brad Brough, DO

Acute pancreatitis
* Pathophys- insult leads to leakage of pancreatic enzymes into pancreatic and peripancreatic tissue leading to acute inflammatory reaction
* Etiologies
o Idiopathic
o Gallstones (or other obstructive lesions)
o EtOH
o Trauma
o Steroids
o Mumps (& other viruses: CMV, EBV)
o Autoimmune (SLE, polyarteritis nodosa)
o Scorpion sting
o Hyper Ca, TG
o ERCP (5-10% of pts undergoing procedure)
o Drugs (thiazides, sulfonamides, ACE-I, NSAIDS, azathioprine)

“Less Common” causes
* Pancreas divisum
* Chinese liver fluke
* Ischemia (bypass surgery)
* Cystic fibrosis

Trivia
Signs & Symptoms
* Grey Turner sign
* Cullen’s sign
Differential
* Not all inclusive, but may include:
o Biliary disease
o Intestinal obstruction
o Mesenteric Ischemia
o MI (inferior)
o AAA
o Distal aortic dissection
o PUD
Evaluation

* amylase…Nonspecific
* lipase
* Other inflammatory markers will be elevated
* Depending on severity may see:

Radiographic Evaluation

* AXR - “sentinel loop” or small bowel ileus
* US or CT may show enlarged pancreas with stranding, abscess, fluid collections, hemorrhage, necrosis or pseudocyst
* MRI/MRCP newest “fad”
o Decreased nephrotoxicity from gadolinium
o Better visualization of fluid collections
o MRCP allows visualization of bile ducts for stones
# Does not allow stone extraction or stent insertion
* Endoscopic US (even newer but used less)
o Useful in obese patients

CT Scan of acute pancreatitis
Gall stone pancreatitis by ERCP
Prognosis
Ranson Criteria
CT Severity Index
* CT Grade
* Necrosis score)
* TOTAL SCORE
Therapy
Complications
Prognosis
Chronic pancreatitis
* Pathophys - irreversible parenchymal destruction leading to pancreatic dysfunction
* Persistent, recurrent episodes of severe pain
* Anorexia, nausea
* Constipation, flatulence
* Steatorrhea
* Diabetes

Evaluation
CT - chronic pancreatitis
Complications
Conclusion
References

Pancreatitis.ppt