- Inflammatory disease of the pancreas characterized by abdominal pain and elevated serum amylase and lipase.
- Leakage of pancreatic enzymes into the peri-pancreatic tissue
- Often secondary to gallstones or alcoholism
- 85% self-limiting
- Other causes include: trauma, drugs, hyperlipidemia, and genetics, post-surgery (ECRP), infection, hypercalcemia, pancreatic tumor.
PERTINENT HISTORICAL FINDINGS/ CLINICAL SYMPTOMS
- Abrupt constant epigastric pain often radiating to the back
- Nausea, vomiting
PERTINENT PHYSICAL EXAM FINDINGS
- Fever and shock (hypotension when severe)
- Pain aggravated by walking and lyin
- Improved by sitting and leaning forward
- If associated with severe necrotizing pancreatitis, flank discoloration (Gray-Turner sign) may be present
- Gall stones
- Perforated duodenal ulcers
- Chronic pancreatitis
- Leaking aortic aneurysm
- Mesenteric ischemia
DIAGNOSTIC EVALUATIONS Cancer
- Elevated amylase
- Elevated lipase, remains elevated longer than amylase
- Decreased Ca if very severe
- CT is useful in diagnosis
- Plain abdominal x-rays may show signs of obstruction due to Ileus, “sentinel loop” or “colon cutoff”
- U/S not helpful
- Subsides spontaneously in a few days
- Remove offending agent (alcohol or stones (ERCP))
- Supportive care: IV fluids, Pain control, Nutritional support, May require respiratory support
- Pain control
- Surgical referral for severe acute pancreatitis
- Surgical correction may be beneficial in necrotizing pancreatitis, clinical deterioration with multi-organ failure.
- Surgical drainage of a potential abscess may be necessary
- Surgical referral for severe acute pancreatitis.
- If pancreatic infection, Imipenem 500 mg every 8 hours intravenously
PATIENT EDUCATION/ MAINTENANCE – PREVENTION
- Remove offending agent (alcohol if cause)
- Oral feedings should be initiated once the patient’s pain and anorexia resolve
- Close follow-up (~ 7 – 10 days)
Contrast-enhanced axial computed tomographic section of the upper abdomen showing peripancreatic and retroperitoneal edema (large arrows) and stranding. The pancreas itself (small arrow) appears relatively normal.
Dr. Zachary Lahlou