PANCREATITIS

PANCREATITIS

Pancreatitis is inflammation of the pancreatic parenchyma. For clinical purposes, it is useful to divide pancreatitis into acute, which presents as an emergency , and chronic, which is a prolonged and frequently lifelong disorder resulting from the development of fibrosis within the pancreas. It is possible that acute and chronic pancreatitis are di ff erent phases of the same process. - Acute pancreatitis is defined as an acute condition pre - senting with abdominal pain, a threefold or greater rise in the serum levels of the pancreatic enzymes amylase or lipase and/or characteristic findings of pancreatic inflammation on contrast-enhanced CT . Acute pancreatitis may recur . The underlying mechanism of injury in pancreatitis is thought to be premature activation of pancreatic enzymes - within the pancreas, leading to a process of autodigestion. Anything that injures the acinar cells and impairs the secr e - - tion of zymogen granules or damages the duct epithelium, and thus delays enzymatic secretion, can trigger acute pancreati - tis. Once cellular injury has been initiated, the inflammatory process can lead to pancr eatic oedema, haemorrhage and, eventually , necrosis. As inflammatory mediator s are released - into the circulation, systemic complications can arise, such as haemodynamic instability , bacteraemia (due to translocation of gut flora), acute respiratory distress syndrome and pleural e ff usions, gastrointestinal haemorrhage, renal failure and dis - seminated intravascular coagulation (DIC). Acute pancreatitis may be categorised as mild (interstitial oedematous pancreatitis) or severe (necrotising pancreatitis). The former is characterised by interstitial oedema of the g land and minimal organ dysfunction. The majority of patients will have a mild attack of pancreatitis, the mortality from which is around 1%. Severe acute pancreatitis is seen in 5–10% of patients and is characterised by pancreatic necrosis, a severe In those who have a severe attack of pancreatitis, the mortality varies from 20% to 50%. Acute pancreatitis has an early phase that usually lasts a week. It is characterised by a systemic inflammatory response syndrome (SIRS), which – if severe – can lead to transient or persistent organ failure (deemed persistent if it lasts for over 48 hours). About one-third of deaths occur in the early phase of the attack, from multiple organ failure. The late phase is seen typically in those who su ff er a severe attack and can run from weeks to months. It is characterised by persistent systemic signs of inflammation and/or local complications, particularly fluid collections and peripancreatic sepsis. Deaths occurring after the first week of onset are often due to septic complications. Chronic pancreatitis is defined as a continuing inflamma tory disease of the pancreas characterised by irreversible mor phological change typically causing pain and/or permanent loss of function. Many patients with chronic pancreatitis have painful exacerbations, but the condition may be completely painless.