Pancreatitis

Definition

• Inflammation of the pancreas

Etiology

• Gallstones
• Ethanol
• Tumour/Trauma
• Scorpion sting (Trinidadian)
• Microbiological
  • Viral
    • Mumps
    • Rubella
    • Varicella
    • Viral hepatitis
    • CMV/EBV/HIV
    • Coxsackie virus/Echovirus/Adenovirus
  • Bacterial
    • Mycoplasma
    • Campylobacter
    • Mycobacterium tuberculosis
    • Mycobacterium avium intracellular
    • Legionella
    • Leptospirosis
  • Parasitological
    • Ascariasis
    • Clonorchiasis
    • Echinococcus
• Autoimmune
  • SLE
  • Polyarteritis nodosa
  • Crohn's disease
• Surgery: ERCP
• Hyperlipidemia
• Hypercalcemia
• Hypothermia
• Emboli/Ischemia
• Drugs
  • Steroids
  • Azathioprine
  • Furosemide
  • Mercaptopurine
  • Estrogen
  • Methyldopa
  • H2 blockers
  • Valproic acid
  • Antibiotics
  • Acetaminophen
  • Salicylates
  • Methanol
  • Organophosphates

Clinical Presentation

• Acute abdominal pain, usually epigastric, sometimes radiating to the back
• Nausea, vomiting
• Fevers
• Dyspnea

Management

Pancreatic necrosis

• Two forms
  • Acute necrotizing pancreatitis, which is present at the start, and is usually phlegmonous
  • Walled-off necrosis, which develops over the course of illness, and is usually an organized collection
• Both are sterile and both can become infected
• No antibiotics warranted in acute necrotizing pancreatitis
• Infection usually develops after about 10 days
• If necrosectomy is indicated, it should be delayed by at least 4 weeks

Splenic vein thrombosis

• Monitor

Prognosis

Ranson's criteria

• On presentation
  • Sugar > 10
  • WBC > 16k
  • Elderly > 55 years
  • LDH > 350
  • AST > 250
• After 48h
  • Hct drop >10% from admission
  • BUN increase >5 mg/dL (>1.79 mmol/L) from admission
  • Ca <8 mg/dL (<2 mmol/L) within 48 hours
  • Arterial pO2 <60 mmHg within 48 hours
  • Base deficit (24 - HCO3) >4 mg/dL within 48 hours
  • Fluid needs > 6L within 48 hours

BISAP

• BUN > 8.9
• Impaired LOC
• SIRS
• Age > 60
• Pleural effusion