Information about the inflammation of the pancreas

1. Pancreatitis
Dr Robert Zulu
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2. Introduction
• Definition
- Inflammation of the exocrine pancrease
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3. Anatomy
.
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4. Causes
• Alcohol
- 80% in Zambia,
- France
- Actual pathogenesis not known well
• Gallstone
- Common cause in Europe
- Causes obstructive of the common pancreatic duct
• Trauma
- Seat belt, post Endoscopic Retrograde Cholangio-
Pancreatogram
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5. Causes
• Drugs
- Thiazide diuretic, ACE-Inhibitors,
oestrogen
• Viral
- mumps, Epstein-Barr virus,
cytomegalovirus, coxsackie virus
• Hyperparathyroidism
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6. Causes
• Parasites
- Ascaris lumbricoides
• Idiopathic
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7. Pathogenesis
• Release of proteolytic enzymes from
exocrine (trypsin)
• This triggers local inflammation and
systemic inflammation
• Process is self limiting but in 15-20%, the
process runs a fulminating cause
• Leads to fat necrosis and eventually
pancreatic abcess
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8. Pathogensis
• Discolouration of the flank seen in acute
pancreatitis- Grey turner’s sign
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9. Diagnosis
• Acute abdomen
- Acute pancreatitis
- Acute peptic ulcer disease
- Ruptured Abdominal Aortic Aneurysm
- Pneumonia
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10. Diagnosis
• Serum amylase
• Urine amylase
• Alkaline phosphatase
• Ultrasound to look for gall stone
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11. Assessment of severity
Modified Glasgow criteria (Imrie)
• Age >55 years
• White cell count > 15-1091
• Blood glucose 10 mmol/1
• Urea >16 mmol 1
• Arterial oxygen partial pressure 8.0 kPa
• Albumin <32 gl
• Calcium 2.0 mrnoH
• Lactate dehydrogenase>600 U 1
• Severe disease is present if ::':3 factors detected within 48
hours
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12. Classification
• Mild pancreatitis
• Acute pancreatitis
• Severe pancreatitis
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13. Management
• Mild pancreatitis
- Admit
- Nil orally
- Intravenous fluids
- Nasogastric aspiration
- Find the cause and treat accordingly
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14. Management
• Acute pancreatitis
- Admit to high dependency/Intensive care
unit
- Investigate the cause
- May require surgical intervention if there is
pancreatic abscess, necrosis
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15. Management
• Severe pancreatitis
- As for acute pancreatitis
- May need organ support
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16. Prognosis
• Mild pancreatitis 5% mortality
• Acute pancreatitis 10-15% mortality
• Severe pancreatitis 20-25% mortality
Prognosis has not changed over the past
20years even in good centers
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