Acute Pancreatitis

Introduction

This is an acute inflammatory process involving the pancreas and other retroperitoneal tissues. Liters of extracellular fluid (ECF) get trapped in the gut, peritoneal cavity and retro peritoneum. The pancreas may show any change from mild oedema to one of hemorrhagic necrotizing pancreatitis. Death may occur from shock, renal failure, sepsis or respiratory failure

Common causes

Gallstones, alcohol, idiopathic.

Rare causes: Trauma, mumps, steroids, polyarteritis nodosa, hyperlipidemia, obstructed pancreatic ducts

Clinical Features

Symptoms Central abdominal pain radiating to back with vomiting.

Signs

• Shock

Abdominal rigidity

Local tenderness (epigastric)

• Shifting dullness

Cullen’s and Grey Turner’s sign may be positive in hemorrhagic pancreatitis.

Diagnosis

• Serum amylase: >1000 U/ml

Plain X-ray abdomen: Absent psoas shadow. Ground glass appearance, “sentinel” loop sign.

Management

In most cases—management is conservative

• Plasma and N. Saline given till vital signs are satisfactory and urine output is 30 ml/hr.
• Sedatives, nasogastric suction, antibiotics
• Monitor: BP, pulse, urine output
• Investigation: Blood count, urea, S,Electrolytes, S,Calcium, blood glucose level
• In severe cases, consider peritoneal lavage and glucagon (1 mg/hr.)IV.
• Quite often diagnosis is made only at laparotomy. All that is done is closure of abdomen with a drain in lesser sac and peritoneal cavity.