Pancreatitis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Associate Editor(s)-in-Chief: ; Iqra Qamar M.D.[2]
Overview
Overview
Pancreatitis is an inflammatory disease of the pancreas characterized by reversible or irreversible changes in pancreatic structure and function leading to inflammation and fibrosis. The concept of pancreas and pancreatic duct was first described by Johannes Wirsung of Padua in 1642. Pancreatitis may be classified as acute pancreatitis, chronic pancreatitis, autoimmune pancreatitis, and hereditary pancreatitis. Common causes of pancreatitis may include gallstones, hypertriglyceridemia, alcohol, drugs, genetic, autoimmune, iatrogenic, trauma, infection, surgical causes, and obstruction. Acute pancreatitis usually presents with fever, sharp abdominal pain, nausea and vomiting. Patients with chronic pancreatitis present with dull abdominal pain, steatorrhea, pancreatic diabetes, nausea, weight loss, pseudocyst and pancreatic cancer.
Causes
Causes
| Type of pancreatitis | Causes |
|---|---|
| Acute pancreatitis |
|
| Chronic pancreatitis |
|
| Autoimmune pancreatitis |
|
| Hereditary pancreatitis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Vidit Bhargava, M.B.B.S [2]
Overview
Common causes of pancreatitis include alcoholism, gallstones, hypertriglyceridemia, ERCP, pancreatic tumors, and medications such as 5-Mercaptopurine and Azathioprine.
Causes
Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. Acute pancreatitis is a life-threatening condition, especially if it progresses to necrotizing pancreatitis, and should be treated as such irrespective of the cause.
Common Causes
- Gallstones 35-40% [2]
- Hypertriglyceridemia 1-4% cases [3]
- Medication such as 5-mercaptopurine, azathioprine, Diphenoxylate hydrochloride and atropine sulfate, 5-DDI[4]
Causes by Organ System
Causes in Alphabetical Order
References
- ↑ Yang, AL.; Vadhavkar, S.; Singh, G.; Omary, MB. (2008). “Epidemiology of alcohol-related liver and pancreatic disease in the United States”. Arch Intern Med. 168 (6): 649–56. doi:10.1001/archinte.168.6.649. PMID 18362258. Unknown parameter
|month=ignored (help) - ↑ Forsmark, CE.; Baillie, J. (2007). “AGA Institute technical review on acute pancreatitis”. Gastroenterology. 132 (5): 2022–44. doi:10.1053/j.gastro.2007.03.065. PMID 17484894. Unknown parameter
|month=ignored (help) - ↑ Fortson, MR.; Freedman, SN.; Webster, PD. (1995). “Clinical assessment of hyperlipidemic pancreatitis”. Am J Gastroenterol. 90 (12): 2134–9. PMID 8540502. Unknown parameter
|month=ignored (help) - ↑ Yi, GC.; Yoon, KH.; Hwang, JB. (2012). “Acute Pancreatitis Induced by Azathioprine and 6-mercaptopurine Proven by Single and Low Dose Challenge Testing in a Child with Crohn Disease”. Pediatr Gastroenterol Hepatol Nutr. 15 (4): 272–5. doi:10.5223/pghn.2012.15.4.272. PMID 24010098. Unknown parameter
|month=ignored (help) - ↑ Köhler, H.; Lankisch, PG. (1987). “Acute pancreatitis and hyperamylasaemia in pancreatic carcinoma”. Pancreas. 2 (1): 117–9. PMID 2437571.
Classification
Classification
Pancreatitis may be classified as:
| Pancreatitis | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Acute pancreatitis | Chronic pancreatitis | Autoimmune pancreatitis | Hereditary pancreatitis | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Based on the duration of symptoms, pancreatitis may be classified into either acute or chronic.
Classification
1. Acute Pancreatitis
Subtypes:
- Interstitial edematous pancreatitis
- Necrotizing pancreatitis
- Hemorrhagic pancreatitis
Acute pancreatitis is a rapidly-onset inflammation of the pancreas. Depending on its severity, it can have severe complications and high mortality despite treatment. While mild cases are often successfully treated with conservative measures, such asNPO (abstaining from any oral intake) and IV fluid rehydration, severe cases may require admission to the ICU or even surgery (often more than one intervention) to deal with complications of the disease process.
2. Chronic Pancreatitis
- Chronic pancreatitis is a long-standing inflammatory disease of the pancreas characterized by irreversible change to pancreatic structure and function related to inflammation and fibrosis.
- Chronic pancreatitis presents as a complex of pain and poor quality of life[1] and, as it advances, develops symptoms related to exocrine and endocrine insufficiency, manifesting as malabsorption or diabetes.[2]
3. Hereditary Pancreatitis
- Hereditary pancreatitis is a genetic disease affecting enzyme production in the pancreas.
4. Gall stone pancreatitis
5. Autoimmune pancreatitis
6. Emphysematous pancreatitis
7. Ascaris-induced pancreatitis
8. Tropical pancreatitis
9. Pancreatitis associated with cystic fibrosis
10. Segmental pancreatitis
- Paraduodenal pancreatitis
11. Post-ERCP pancreatitis
Subtypes of Pancreatitis
- Interstitial Edematous Pancreatitis
- ▸ Acute inflammation of the pancreatic parenchyma and peripancreatic tissues, but without recognizable tissue necrosis
- CECT criteria
- ▸ Pancreatic parenchyma enhancement by intravenous contrast agent.
- ▸ No findings of peripancreatic necrosis.
- Necrotizing Pancreatitis
- ▸ Inflammation associated with pancreatic parenchymal necrosis and/or peripancreatic necrosis
- CECT criteria
- ▸ Lack of pancreatic parenchymal enhancement by intravenous contrast agent
- ▸ Presence of findings of peripancreatic necrosis.
- Infected Pancreatic Necrosis:
- ▸ It should be considered in patients with necrotizing pancreatitis who deteriorate or fail to improve after 7–10 days of hospitalization.[3]
- ▸ It may be presumed by the presence of extraluminal gas on CECT or when fine-needle aspiration is positive for bacteria and/or fungi on Gram stain and culture.[4]
- ▸ Antibiotics are able to penetrate pancreatic necrosis (such as carbapenems, quinolones, and metronidazole) and may be useful in delaying or sometimes totally avoiding intervention.[5][6]
References
- ↑ Pezilli et al. Pancreatectomy for Pancreatic Disease and Quality of Life. JOP. J Pancreas (Online) 2007; 8(1 Suppl.):118-131.
- ↑ Ammann RW. A clinically based classification system for alcoholic chronic pancreatitis: summary of an international workshop on chronic pancreatitis. Pancreas 1997; 14: 215–21.
- ↑ Banks, PA.; Bollen, TL.; Dervenis, C.; Gooszen, HG.; Johnson, CD.; Sarr, MG.; Tsiotos, GG.; Vege, SS.; Acosta, JM. (2013). “Classification of acute pancreatitis–2012: revision of the Atlanta classification and definitions by international consensus”. Gut. 62 (1): 102–11. doi:10.1136/gutjnl-2012-302779. PMID 23100216. Unknown parameter
|month=ignored (help) - ↑ Banks, PA.; Gerzof, SG.; Langevin, RE.; Silverman, SG.; Sica, GT.; Hughes, MD. (1995). “CT-guided aspiration of suspected pancreatic infection: bacteriology and clinical outcome”. Int J Pancreatol. 18 (3): 265–70. doi:10.1007/BF02784951. PMID 8708399. Unknown parameter
|month=ignored (help) - ↑ Petrov, MS.; Shanbhag, S.; Chakraborty, M.; Phillips, AR.; Windsor, JA. (2010). “Organ failure and infection of pancreatic necrosis as determinants of mortality in patients with acute pancreatitis”. Gastroenterology. 139 (3): 813–20. doi:10.1053/j.gastro.2010.06.010. PMID 20540942. Unknown parameter
|month=ignored (help) - ↑ van Santvoort, HC.; Bakker, OJ.; Bollen, TL.; Besselink, MG.; Ahmed Ali, U.; Schrijver, AM.; Boermeester, MA.; van Goor, H.; Dejong, CH. (2011). “A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome”. Gastroenterology. 141 (4): 1254–63. doi:10.1053/j.gastro.2011.06.073. PMID 21741922. Unknown parameter
|month=ignored (help)
Differential Diagnosis
Differential Diagnosis
Differentiating pancreatitis from other diseases on the basis of abdominal pain and weight loss:
Pancreatitis presents most commonly with abdominal pain. Pancreatitis must be differentiated from various disease which present with abdominal pain and weight loss such as peptic ulcer disease, pancreatic carcinoma, gastritis, and inflammatory bowel disease.
Abbreviations: RUQ= Right upper quadrant of the abdomen, LUQ= Left upper quadrant, LLQ= Left lower quadrant, RLQ= Right lower quadrant, LFT= Liver function test, SIRS= Systemic inflammatory response syndrome, ERCP= Endoscopic retrograde cholangiopancreatography, IV= Intravenous, N= Normal, AMA= Anti mitochondrial antibodies, LDH= Lactate dehydrogenase, GI= Gastrointestinal, CXR= Chest X ray, IgA= Immunoglobulin A, IgG= Immunoglobulin G, IgM= Immunoglobulin M, CT= Computed tomography, PMN= Polymorphonuclear cells, ESR= Erythrocyte sedimentation rate, CRP= C-reactive protein, TS= Transferrin saturation, SF= Serum Ferritin, SMA= Superior mesenteric artery, SMV= Superior mesenteric vein, ECG= Electrocardiogram
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