4 Pathogenesis

The exocrine pancreas produces a variety of enzymes, such as proteases, lipases and saccharidases. These enzymes contribute to food digestion by breaking down food tissues. In acute pancreatitis, the worst offender among these enzymes may well be the protease trypsinogen which converts to the active trypsin which is most responsible for auto-digestion of the pancreas which causes the pain and complications of pancreatitis.

5 Diagnosis

Important biochemical markers for pancreatitis are serum amylase and lipase levels. Amylase and lipase levels can rise to more than a hundred times normal levels in cases of acute pancreatitis.

In addition, in predicting the prognosis, there are several factors that are known to impact negatively on survival: the more of these that are present, the graver the patient's condition is (these are known as the Ranson or Imrie criteria):

• age greater than 55 years at admission or diagnosis
• a white blood cell count of > 16,000/µL at admission or diagnosis
• blood glucose > 11 mmol/L (>200 mg/dL) at admission or diagnosis
• serum LDH > 400 IU/L at admission or diagnosis
• serum AST >256 IU/L at admission or diagnosis
• fall in hematocrit by more than 10 percent in the first 48 hours of admission
• fluid deficit of > 4 L in the first 48 hours of admission
• hypocalcemia (serum calcium < 1.0 mmol/L (<8.0 mg/dL) in the first 48 hours of admission
• hypoxemia (P_O2 < 60 mmHg in the first 48 hours of admission
• increase in BUN to >1.98 mmol/L (>5 mg/dL) after IV fluid hydration in the first 48 hours of admission
• hypoalbuminemia (albuminm <32 g/L (<3.2 g/dL) in the first 48 hours of admission
• Acute physiology and chronic health evaluation (APACHE II) score > 12 points
• hemorrhagic peritoneal fluid
• obesity
• indicators of organ failure
• hypotension (SBP <90 mmHG) or tachycardia > 130 bpm
• P_O2 <60 mmHg
• Oliguria (<50 mL?h) or increasing BUN and creatinine
• serum calcium < 1.90 mmol/L (<8.0 mg/dL) or serum albumin <33 g/L (<3.2.g/dL)>

6 Classification by severity

Acute pancreatitis can be further divided in mild and severe pancreatitis. Mostly the Atlanta classification (1992) is used. In severe pancreatitis serious amount of necrosis determine the further clinical outcome. About 20% of the acute pancreatitis are severe with a mortality of about 20%. This is an important classification as severe pancreatits will need intensive care therapy whereas mild pancreatits can be treated on the common ward.

Necrosis will be followed by an systemic inflammation response syndrom (SIRS) and will determine the immediate clinical course. The further clinical course is then determined by bacterial infection. SIRS is the cause bacterial translocation from the patients colon.

There are several ways to help distinguish between these two forms. One is the above mentioned Ranson Score.

7 Treatment

• Supportive for shock.
• Pain relief
• Enzyme inhibitors are not proven to work.
• While often severe, the disease is essentially self limiting.

In the management of acute pancreatitis, the treatment is to stop feeding the patient, giving him or her nothing by mouth, giving intravenous fluids to prevent dehydration. As the pancreas is stimulated to secrete enzymes by the presence of food in the stomach, having no food pass through the system allows the pancreas to rest.

8 See also

• Chronic pancreatitis

Health science - Medicine - Gastroenterology

Diseases of the esophagus - stomach

Halitosis - Nausea - Vomiting - GERD - Achalasia - Esophageal cancer - Esophageal varices - Peptic ulcer - Abdominal pain - Stomach cancer - Functional dyspepsia

Diseases of the liver - pancreas - gallbladder - biliary tree

Hepatitis - Cirrhosis - NASH - Budd-Chiari syndrome - Hepatocellular carcinoma - Pancreatitis - Pancreatic cancer - Gallstones - Cholecystitis

Diseases of the small intestine

Peptic ulcer - Malabsorption (e.g. celiac disease, lactose intolerance, fructose malabsorption, Whipple's disease) - Lymphoma

Diseases of the colon

Diarrhea - Appendicitis - Diverticulitis - Diverticulosis - IBD ( Crohn's disease and Ulcerative colitis) - Irritable bowel syndrome - Constipation - Colorectal cancer - Hirschsprung's disease - Pseudomembranous colitis

Medical emergencies Gastroenterology Surgery

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