Acute pancreatitis

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Inflammatory process ranges from mild oedema to necrosis of pancreas & peripancreatic tissues.  Clinically it presents as abrupt onset of epigastric pain, frequently with back pain, nausea and vomiting.  Diagnosis is confirmed by elevated Serum or Urinary Amylase.

Causes:

  • Gallstones in 40% of cases.
  • Alcohol in 40 % of cases.
  • Drugs e.g. INH, isoniazid, estrogens, & thiazides in 10% cases.
  • Hyperlipidemias.
  • Hypercalcemia.
  • Infectious diseases e.g. mumps, orchitis, hepatitis A & B.
  • Tumors.
  • Trauma.

Symptoms:

  • Usually presentation is of shock with cold, clammy skin; low B.P.; rapid low volume pulse
  • Severe central abdominal pain radiating directly to the back
  • Vomiting

Signs:

  • Abdomen diffusely tender, rigidity not as marked as in other causes of peritonitis.
  • Discoloration around umbilicus & in flanks may be present.
  • Bowel sounds absent.
  • Hypoxemia & renal failure may be the only presenting features.

Investigations:

 

  1. CBC, leukocytosis.
  2. Serum amylase > 300 IU.
  3. Serum lipase is elevated.  It is more specific and returns to normal after 3-5 days
  4. Serum Ca++ is low in very severe cases.
  5. Hyperglycemia.

Radiological:

  • Plain X-Ray Abdomen & chest to;
  • Rule out duodenal perforation as a differential diagnosis.
  • Pancreatic calcification.
  • Ultrasonography may reveal cholelithiasis, acute cholecystitis, or a swollen pancreas.
  • C.T. Scan with I/V contrast

Management

  1. Treatment of shock including O2 therapy
  2. Inj. Nalbufin 10 mg to relieve pain, then repeats according to response and Maxolon for vomiting.
  3. Give I/V fluids.  During treatment, over-infusion is avoided by monitoring the JVP & auscultation of the chest (basal crepts).
  4. Nasogastric tube for gastric decompression if patient vomiting.
  5. (Prophylactic antibiotics) Inj. Meropenam I/V 50mg BD for five days.
  6. Calcium gluconate (10%) 10 ml is given 1/V.
  7. Insulin if marked hyperglycemia.
  8. Injection cimetidine 200 mg I/V 6 hourly
  9. Blood transfusion in case of severe haemorrhagic shock.
  10. Patients with hypoxia require oxygen therapy or assisted ventilation
  11. Look out for complications i.e. ARDS, pseudopancreatic cyst or pancreatic abscess etc.
  12. Consider standostatin

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