Overview
Definition
Sudden inflammation of the pancreas resulting from premature intracellular activation of digestive enzymes (trypsin), leading to pancreatic autodigestion.
Epidemiology
One of the most common GI causes for hospital admission.
Etiology & Risk Factors
- Gallstones (most common cause globally, blocking the Ampulla of Vater)
- Alcohol abuse (second most common)
- Hypertriglyceridemia (usually > 1000 mg/dL)
- ERCP (post-procedure complication)
- Medications (e.g., Azathioprine, Thiazides, Valproic acid)
- Hypercalcemia
- Trauma or Scorpion sting (rare)
Clinical Symptoms
- Severe, sudden-onset epigastric pain that radiates directly to the back
- Nausea and profuse vomiting
- Pain improves when leaning forward
- Cullen's sign (periumbilical bruising) or Grey Turner's sign (flank bruising) in hemorrhagic pancreatitis
Clinical Approach
Diagnosis
- Requires 2 of 3 criteria: (1) Classic epigastric pain, (2) Serum Lipase or Amylase > 3x the upper limit of normal, (3) Characteristic findings on CT abdomen (pancreatic edema/necrosis)
- Note: Lipase is much more specific and sensitive than Amylase
Management
- AGGRESSIVE IV fluid resuscitation (Lactated Ringer's preferred) within the first 12-24 hours (most critical step)
- Pain control (Opioids)
- Bowel rest initially, but early enteral nutrition (within 24-48h) is recommended to prevent gut bacterial translocation
- Treat underlying cause (e.g., Cholecystectomy for gallstone pancreatitis once recovered)
Complications
- Pancreatic necrosis (can become infected)
- Pancreatic pseudocyst (fluid collection taking >4 weeks to form)
- ARDS and Systemic Inflammatory Response Syndrome (SIRS)
- Hypocalcemia (due to fat saponification)