Acute pancreatitis (summary)

Dr Jeremy Jones et al.

Acute pancreatitis refers to acute inflammation of the pancreas and is a potentially life-threatening condition.

Reference article

This is a summary article; read more in our article on acute pancreatitis.

  • epidemiology
    • epidemiology is dependent on the cause of pancreatitis
      • gallstones, idiopathic, alcohol, malignancy, metabolic conditions
  • presentation
    • acute onset, severe central abdominal pain
    • radiation through to the back
    • raised lipase and amylase
  • pathophysiology
    • obstruction of the pancreatic ducts is common
    • pancreatic enzyme activation results in inflammation
    • inflammation of the pancreas causes in interstitial oedema and swelling
    • continued inflammation results in necrosis, and in some cases haemorrhage
  • investigation
    • not required for diagnosis, but may help
    • very useful for assessment of complications
  • treatment
    • largely supportive, often requiring ICU care in severe cases
    • respiratory and cardiovascular support
    • careful management of glucose, calcium, and fluid balance
  • prognosis
    • dependant on the severity of disease and rapidity of treatment
    • complication include necrosis and cyst formation
  • clarify the diagnosis when the clinical picture is confusing
  • assess severity and determine prognosis
  • detect complications
  • determine possible causes

Imaging studies of acute pancreatitis may be normal in mild cases. Contrast-enhanced CT provides the most comprehensive initial assessment, typically with a dual phase (arterial and portal venous) protocol. 

CT

Abnormalities that may be seen in the pancreas include:

  • typical findings
    • focal or diffuse parenchymal enlargement
    • changes in density because of oedema
    • indistinct pancreatic margins owing to inflammation
    • surrounding retroperitoneal fat stranding
  • necrosis of pancreatic parenchyma
    • lack of parenchymal enhancement
  • infected necrosis
    • difficult to distinguish from aseptic liquefactive necrosis
    • the presence of gas is helpful
  • abscess formation
    • circumscribed fluid collection
    • little or no necrotic tissues
  • haemorrhage
    • high-attenuation fluid in the retroperitoneum or peripancreatic tissues
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Cases and figures

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    Acute necrotising pancreatitis: gross pathology
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    Case 1: acute pancreatitis
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    Case 2: acute pancreatitis
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    Case 3: with head/body necrosis
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