Acute pancreatitis:
Complications
Inflammation causes vasodilation and vasculature leakage
Mild, (85%):
Interstitial edematous pancreatitis
Local accumulation of fluid in the pancreas
<2 weeks after onset Acute peripancreatic fluid collection (not encapsulated) Walled off by fibrous & granulation tissue >2 weeks after onset
Pancreatic pseudocyst
(completely encapsulated)
Peritoneal irritation à pain
Large cyst can (very rarely) compress surrounding bowel
Acute Pancreatitis
Inflammatory cytokines are released from damaged pancreas
If recurrentàchronic pancreatitis (see relevant slide)
Inflammation damages pancreatic exocrine
cellsàInappropriate release of pancreatic enzymes into surrounding tissue & vasculature àdigesting pancreatic parenchyma
Authors: Nissi Wei, *Yan Yu Reviewers: Dean Percy, Miles Mannas, Varun Suresh, Brandon Hisey, *Kerri Novak, *Sylvain Coderre * MD at time of publication
complete resolution (most cases)
Necrotic tissue is vulnerable to
infection (esp. Gram neg GI bacteria)
inflammation & necrosis activate cytokine cascade
Severe, necrosis (15%): Necrotizing pancreatitis
Local infection
Severe pancreatic inflammation shifts body fluid into retroperitoneal spaceàintravascular volume depletion
Systemic Inflammatory Response Syndrome (SIRS) (see relevant slide)
Organ failure (may be sole feature on presentation)
Stagnant fluid can more easily become infected
Infection spreads to bloodstream
Cardiac failure Hypovolemic shock Renal failure
Local accumulation of fluid & necrosis in the pancreas
< 4 weeks after onset: Acute necrotic collection (not encapsulated) Walled off by fibrous & granulation tissue > 4 weeks after onset
walled-off necrosis
(completely encapsulated)
When treated with excess fluid resuscitation:
Intra- abdominal hypertension
Respiratory failure (ARDS)
Disseminated intravascular coagulation (DIC)
Bowel obstruction Gastric outlet (see relevant slide) obstruction
Infected pancreatic necrosis
Legend:
Pathophysiology
Mechanism
Sign/Symptom/Lab Finding
Complications
Published September 20, 2016, updated September 7, 2020 on www.thecalgaryguide.com