Details Descriptions About :: Pancreatitis

 Pancreatitis, inflammation of the pancreas, occurs in acute and chronic forms and may be due to edema, necrosis, or hemorrhage. In men, this disease is commonly associated with alcoholism, trauma, or peptic ulcer and carries a poor prognosis. In women, it’s associated with biliary tract disease and has a good prognosis. Mortality in pancreatitis with necrosis and hemorrhage is as high as 60%.

Causes for Pancreatitis

Causes Biliary tract disease Alcoholism Abnormal organ structure Metabolic or endocrine disorders, such as high cholesterol levels or overactive thyroid Pancreatic cysts or tumors Penetrating peptic ulcers Blunt trauma, surgical trauma Drugs, such as glucocorticoids, sulfonamides, thiazides, hormonal contraceptives, nonsteroidal anti-inflammatory drugs Kidney failure or transplantation Endoscopic examination of bile ducts and pancreas

Pathophysiology Pancreatitis

Pathophysiology Acute pancreatitis occurs in two forms: edematous (interstitial) and necrotizing. Edematous pancreatitis causes fluid accumulation and swelling. Necrotizing pancreatitis causes cell death and tissue damage. In both types, inappropriate activation of enzymes causes tissue damage. Normally, the acini in the pancreas secrete enzymes in an inactive form. Two theories suggest why enzymes become prematurely activated: A toxic agent such as alcohol may alter the way the pancreas secretes enzymes. Alcohol probably increases pancreatic secretion, alters the metabolism of the acinar cells, and encourages duct obstruction by causing pancreatic secretory proteins to precipitate. Autodigestion may occur when duodenal contents containing activated enzymes reflux into the pancreatic duct, activating other enzymes and setting up a cycle of more pancreatic damage. In chronic pancreatitis, persistent inflammation produces irreversible changes in the structure and function of the pancreas. It sometimes follows an episode of acute pancreatitis. Protein precipitates block the pancreatic duct and eventually harden or calcify. Structural changes lead to fibrosis and atrophy of the glands. Growths called pseudocysts contain pancreatic enzymes and tissue debris. An abscess results if pseudocysts become infected. If pancreatitis damages the islets of Langerhans, diabetes mellitus may result. Sudden severe pancreatitis causes massive hemorrhage and total destruction of the pancreas, manifested as diabetic acidosis, shock, or coma.

Signs and symptoms Pancreatitis

Signs and symptoms Epigastric pain Mottled skin Tachycardia Low-grade fever Cold, sweaty extremities Restlessness Left pleural effusion Basilar crackles Abdominal distension Vomiting Weight loss Jaundice Dyspnea, orthopnea Cullen’s sign Turner’s sign Steatorrhea In a severe attack: persistent vomiting, abdominal distention, diminished bowel activity, crackles at lung bases, left pleural effusion Extreme malaise (in chronic pancreatitis)

Diagnostic Lab Test results

Diagnostic test results Serum amylase and lipase levels are elevated. Blood and urine glucose tests reveal transient glucose in urine and hyperglycemia. In chronic pancreatitis, serum glucose levels may be transiently elevated. White blood cell count is elevated. Serum bilirubin levels are elevated in both acute and chronic pancreatitis. Blood calcium levels may be decreased. Stool analysis shows elevated lipid and trypsin levels in chronic pancreatitis. Abdominal and chest X-rays detect pleural effusions and differentiate pancreatitis from diseases that cause similar symptoms; may detect pancreatic calculi. Computed tomography scan and ultrasonography show enlarged pancreas with cysts and pseudocysts. Endoscopic retrograde cholangiopancreatography identifies ductal system abnormalities, such as calcification or strictures; helps differentiate pancreatitis from other disorders such as pancreatic cancer.

Treatment for Pancreatitis

Treatment Nothing by mouth; I.V. fluids, protein, and electrolytes Blood transfusions Nasogastric suctioning Pain medication such as I.V. morphine Antacids, histamine antagonists Antibiotics Anticholinergics Insulin Surgical drainage Supplemental oxygen, mechanical ventilation Laparotomy if biliary tract obstruction causes acute pancreatitis

 

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