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Pancreatitis

Acute Pancreatitis

Features

  • Severe abdominal pain often radiating through to the back.
  • Nausea, vomiting and loss of appetite.
  • Severe illness, sometimes requiring admission to intensive care and sometimes fatal.
  • Recovery may be followed by development of pancreatic pseudocyst, pancreatic dysfunction (malabsorption) and diabetes.

Causes

  • Gallstones
  • Alcohol
  • Mumps
  • Hypercalcaemia
  • Idiopathic (unknown)
  • Fat necrosis

Gallstones and alcohol abuse account, in Western countries, for more than 90% of all acute pancreatitis. Gallstones that travel down the common bile duct and which subsequently get stuck in the Ampulla of Vater[?] can cause obstruction in the outflow of pancreatic juices from the pancreas into the duodenum. The backflow of these digestive juices causes lysis[?] of pancreatic cells and subsequent pancreatitis.

Pathogenesis The exocrine pancreas produces a variety of enzymes that breakdown food tissues, such as proteases, lipases and saccharidases. Basically these spill into the blood and digest the patients own tissues.

Diagnosis

  • Blood tests (amylase or lipase[?]).
  • Xrays (plain Xrays help exclude other causes, CT scan may be useful).

Treatment

  • Supportive for shock.
  • Pain relief
  • Enzyme inhibitors are not proven to work.
  • While often severe, the disease is essentially self limiting.



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