Overview Pancreatitis: Inflammation of the pancreas. Commonly due to alcohol or gallstones. Characterised by autodigestion of pancreatic tissue by its enzymes, resulting in necrosis. What are the most common causes of pancreatitis? Gallstones Alcohol Medications (e.g., azathioprine, thiazide diuretics). Trauma. Metabolic disorders (e.g., hypercalcaemia). Viral infections (e.g., mumps). Types Acute Pancreatitis (AP): Sudden inflammation, which often resolves with treatment. Chronic Pancreatitis (CP): Persistent inflammation, causing irreversible damage. Clinical Presentation Abdominal pain: Severe epigastric pain, often radiating to the back. Commonly accompanied by vomiting. Examination may show epigastric tenderness, ileus, and a low-grade fever. Rare signs include periumbilical discolouration (Cullen’s sign) and flank discolouration (Grey-Turner’s sign). Rarely, ischaemic (Purtscher) retinopathy may occur, leading to temporary or permanent blindness. Investigations Serum amylase: Elevated in about 75% of patients; typically >3 times the upper limit of normal. However, its level does not correlate with severity. Specificity for pancreatitis is around 90%. Other conditions causing raised amylase include pancreatic pseudocyst, mesenteric infarct, perforated viscus, acute cholecystitis, and diabetic ketoacidosis. Serum lipase: More sensitive and specific than amylase. Useful for late presentations (>24 hours) due to its longer half-life. Imaging: Diagnosis can be confirmed without imaging if there’s characteristic pain and amylase/lipase is >3 times the normal level. However, early ultrasound is crucial to determine the cause, especially for gallstones/biliary obstruction. Other options include contrast-enhanced CT. Scoring Systems Used to identify severe cases: Ranson score, Glasgow score, APACHE II, etc. Indicators of severe pancreatitis include: age >55 years, hypocalcaemia, hyperglycaemia, hypoxia, neutrophilia, and elevated LDH & AST. Note: amylase level is not of prognostic value. What are some complications of pancreatitis? Pseudocyst: Fluid-filled cyst-like cavities. Haemorrhage or infection. Organ failure, especially respiratory. Chronic pancreatitis can lead to malabsorption and diabetes. Treatment Supportive care: Fluid resuscitation, pain relief. Nutritional support: Initial fasting followed by a low-fat diet. Alcohol cessation, if alcohol-induced. Addressing the underlying cause, e.g., gallstone removal. Surgery for severe cases or complications. Prognosis Most cases of acute pancreatitis recover completely. Chronic cases can lead to lasting damage and need long-term management.
