Acute Pancreatitis: Pathogenesis and Clinical Findings
Authors: Yan Yu Reviewers: Laura Craig Noriyah AlAwadhi Ryan Brenneis Maitreyi Raman* * MD at time of publication
Associated signs due to intra- abdominal hemorrhage from an unknown mechanism (classically associated with pancreatitis, but happens in <1% of cases): Note: It is not enough to just diagnose “acute pancreatitis”. Full management requires determining underlying etiology with further work-up. Alcohol ↑ Toxic metabolites within pancreas and Spincter of Oddi Spasms Gallstones Migration to common bile duct blocks Sphincter of Oddi Hypertriglyceridemia Unknown mechanism (rare) Idiopathic Further investigations: CBC: Cell counts elevated, due to sever hypovolemia Serum [Lipase]: Gold Standard Diagnostic Test; rupture of pancreatic cells releases lipase into circulation Pancreatic secretions back up, ↑ pressure within pancreas Hypercalcemia (Rare; Ca2+ depositions in bile ducts block outflow of pancreatic secretions) Since pancreas is retroperitoneal, somatic nerves in the parietal peritoneum are directly stimulated Inflammation triggers cytokine release Inflamed pancreas irritates adjacent intestines, causing ileus Inflamed, more permeable blood vessels leak fluid into pancreas • • Cullen’s sign (bruising in peri-umbilical region) Grey-Turner’s sign (bruises along both flanks) Sudden, severe epigastric pain (with peritoneal signs), radiates to the center of the back Fever, nausea/vomiting (general signs of inflammation) Diminished bowel sounds Profound dehydration (flat JVP, hypotension, tachycardia, oliguria) – may happen, not always 1. Pressure compresses pancreatic blood vessels, causing tissue ischemia. 2. Activation of inactive proteases (zymogens) digesting pancreatic tissue Necrosis (death) of pancreatic cells Inflammation self- perpetuates Massive systemic inflammatory response 2 main complications, usually detected on CT; may happen, but not always 1. Pancreatic pseudocyst (enlargement of the pancreas due to fluid accumulation) 2. Pancreatic necrosis/abscesses (death of a part of the pancreas) Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Re-published September 1, 2019 on thecalgaryguide.com