The Horrible Boys

Acute Pancreatitis

Aguirre, Lucas
Galligani, Guido
Gorostiaga, Marcos
Kreutzer, Gustavo
What is Acute Pancreatitis?
Sudden Inflammation and/or Hemorrhaging of the
Pancreas due to Autodigestin.

Mild/Severe Diagnose/Treat
Functions

Endocrine Role
(insulin and glucagon)

Exocrine Roles
(digestive enzymes)
Malfunction - Autodigestion
Zymogens
Early activation.
Any injury to the acinar cells OR anything that prevents
the normal secretion of the zymogens into the duodenum
can cause acute pancreatitis,
for example, the two leading causes of acute pancreatitis like
alcohol abuse and gallstones.
 Alcohol increased secretion of acinar cells

protein plug blocking the duct

chaotic membrane trafficking

digestive enzyme activation,
inflammatory cytokines, neutrophils

autodigestion of the pancreas
(similarly, Gall Stones blocks the
release of pancreatic juices)
Symptoms
The predominant symptom is ABDOMINAL PAIN.

Pain may vary depending on certain factors:

Pain after drinking or eating food

Pain spreading from your abdomen to your back or
left shoulder blade area (Belt-like pain)
Pain that lasts for several days at a time
Pain when you lie on your back, more so than when
sitting up or in the mohammedan prayer position
Symptoms
Other symptoms can also increase the pain and discomfort.

Fever
Nausea
Vomiting
Sweating
Jaundice (yellowing of the skin)
Diarrhea
Anorexia
When any of these symptoms are accompanied by abdominal pain, you should seek immediate medical care.
Physical Examination
Common sings:
Fever (76%)
Tachycardia (65%)
Hypotension
Abdominal tenderness, muscular guarding (68%), and distention (65%)
Diminished or absent bowel sounds.
Jaundice (28%)
Dyspnea (10%); tachypnea; basilar rales, especially in the left lung
Physical Examination
In severe cases:

Hemodynamic instability (10%)

Hematemesis (5%)
Melena (5%)
Pale, diaphoretic
Listless appearance
Extremity muscular spasms secondary to hypocalcemia
Physical Examination
The following uncommon physical findings are associated with severe necrotizing
pancreatitis:

Cullen sign (bluish discoloration around the umbilicus resulting from hemoperitoneum)
Grey-Turner sign (reddish-brown discoloration along the flanks resulting from
retroperitoneal blood dissecting along tissue planes); more commonly, patients may have a
ruddy erythema in the flanks secondary to extravasated pancreatic exudate)
Erythematous skin nodules, usually no larger than 1 cm and typically
located on extensor skin surfaces; polyarthritis
Pleural effusions
Exams and Tests
Biochemical:

Increased blood amylase levels

Increased serum blood lipase level
Increased urine amylase and lipase level
Increased levels of calcium
Increased levels of lipids

Amylase is widely available and provides acceptable accuracy of diagnosis, where

lipase is available it is preferred for the diagnosis.
Computed tomography
Intrapancreatic: diffuse or segmental enlargement, edema,
gas bubbles, pancreatic pseudocysts and abscesses
Peripancreatic: irregular pancreatic outline, obliterated
peripancreatic fat, retroperitoneal edema,
Regional: Gerota's fascia sign (Inflamation that becomes
visible), pancreatic ascites, pleural effusion (seen on basal
cuts of the pleural cavity), adynamic ileus, etc
Echography
Gallstones are found in almost half of patients with acute pancreatitis, so
abdominal ultrasound is indicated in all cases, within 24 hours of admission, to
look for stones in the gallbladder.

Early detection helps plan the definitive treatment of gallstones (usually by

cholecystectomy) and prevent future pancreatitis attacks.

Endoscopic Echography and MRCP are requested only after patients have
already recovered from the acute phase and after a detailed history and
repeated ultrasound have failed to identify a cause.
The main aim of the treatment is to stabilize the patient and prevent the further
development of the pancreatitis.

It differs on whether the patient presents a severe or a mild pancreatitis.

Initial management

The first steps of the treatment are:

Absolute suspension of diet

Nasogastric intubation, and the removal of remaining gastric juices
Endovenous hydration
Pain management
Pain control and treatment
Patients with acute pancreatitis experience severe pain. The pharmacological
agents used to treat pain are:

NSAIDS
Opioids such as buprenorphine or meperidine
Nutrition
Patient resumes his normal diet once there is clinical evidence that the
paralytic ileus has resolved and the pain is controlled.
Patients with severe pancreatitis may need to wait longer to resume normal
nutrition, hence it may be necessary to use a nasojejunal tube.
If the ileus persist, parenteral nutrition can be used
Complications
It is important to do a careful follow up of the patient due to the frequent
complications they may present

Acute liquid collections

Pancreatic pseudocyst
Abscess