| General Info |
HPI/Physical |
| The
two most common causes of acute pancreatitis are alcohol and
gallstones. Other causes include pancreatic trauma, hypercalcemia,
hypertriglyceridemia, and ERCP. Acute pancreatitis occurs when there is an injury leading to dysfunction of enzymatic secretion. Trypsinogen goes to trypsin causing activation of the enzymatic cascade within the pancreas and an increase in pancreatic vascular permeability. This causes edema and inflammation or pancreatitis. Systemic complications include acute respiratory distress syndrome, pleural effusions, gastrointestinal hemorrhage, renal failure, and shock. There are >200,000 cases a year, males > females. The mortality is 10% with biliary causes having a worse prognosis. With severe pancreatitis it is closer to 30%, so it is important to be able to distinguish and identify severe cases from mild. |
History: Presents
with abdominal pain, dull, aching, constant often sudden in onset
lasting more than a day, it improves when patient supine. Pain is
usually located in the epigastrium, but also LUQ and RUQ. The pain
often radiates to the back. Other complaints include nausea, vomiting
and diarrhea. Symptoms: Fever, tachycardia, abdominal tenderness, abdominal guarding, abdominal distension, hypoactive bowel sounds, jaundice Signs of severe pancreatitis: Dyspnea, respiratory failure secondary to ARDS, shock, pallor, diaphoresis, hematemesis Signs: Cullen sign, Grey-Turner sign |
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