Acute Pancreatitis

 

  • inflammation of pancreas
  • can cause autodigestion
  • can have severe complications and high mortality despite treatment.
  • Mild cases are often successfully treated with conservative measures, such as NPO and IV fluid rehydration
  • Severe cases may require admission to the ICU or even surgery (often requiring more than one intervention) to deal with complications of the disease process.

 

Etiology

  • alcohol – 70%
  • gallstones
  • hyperlipidemia
  • pancreatic trauma
  • drugs
  • idiopathic – 10%

 

Pathophysiology

  • enzymes activated in presence of bile (normally in duodenum)
  • bile elsewhere will also cause enzyme activation
  • may occur is bile flow is obstructed
  • bile leaks out of gallbladder or flows backwards upon meeting obstruction within the gall bladder into ducts around the pancreas
  • fat necrosis, vascular damage when severe leads to potentially lethal hemorrhage

 

Mechanism of alcohol induced pancreatitis:

  • increases the secretion of pancreatic enzymes
  • sphincter of oddi controls bile flow
  • alcohol causes constriction of the spincter of oddi
  • bile and pancreatic juices mix – autodigestion occurs within the pancreas itself
  • recovery or development of chronic pancreatitis

 

Manifestations:

  • triggered by heavy meal or alcohol binge
  • abdominal pain
  • severe epigastic pain
  • pain radiating towards back
  • hyperemia
  • third spacing occurs
  • edema
  • hypovolemic shock due to extensive third spacing

 

 

  • Lipase – produced by pancreas, diagnositic – blood levels
  • hyperlipidemia occurs with pancreatitis
  • enzymes released into blood occurs as with cell damage

 

Diagnostics

  1. serum lipase
  2. serum amylase

enzymes enter blood stream upon cellular damage

if only one diagnostic can be performed, measure serum lipase as it is produced only in the pancreas

amylase if produce in the mouth as well.

Tx

  1. pain management
  2. patient on NPO status – to decrease enzyme level production
  3. Address etiology eg. Alcohol abuse
  4. Prevent hypovolemic shock due to third spacing – fluid and electrolyte balanceing – IV fluids
  5. Sx for duct blockage
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