October 12, 2017

Acute Pancreatitis Background:

Definition: Acute inflammatory process of the pancreas; a retroperitoneal organ with endocrine and exocrine function.

Epidimiology (Rosen’s 2018)

  • US Incidence: 5 - 40/100,000
  • Mortality: 4-7%
  • Progression to severe disease: 10-15% of cases (mortality in this subset 20-50%)

Etiology:

  • Alcohol (~ 35% of cases)
  • Gallstones (~ 45% of cases)
  • Medications/toxins
  • Hypertriglyceridemia
  • Non-gallstone Obstruction (i.e. strictures, masses)
  • Trauma
  • Infectious

Pathophysiology:

  • Phase 1: Local inflammation
    • Results from obstruction of the pancreatic or bile ducts or direct toxicity to pancreatic cells
    • Inflammation results in pancreatic enzyme activation within the pancreas and ducts
    • Premature enzyme activation leads to pancreatic autodigestion
  • Phase 2
    • Enzyme digestion leads to necrosis of the pancreas
    • Erosion into vascular structures can occur as well leading to hemorrhage
  • Phase 3
    • Release of systemic inflammatory mediators
    • systemic immune response syndrome and multisystem organ dysfunction (i.e. acute renal failure, cardiac dysfunction, ARDS, disseminated intravascular coagulation)
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