Pancreas diseases
Etiology
- Gallstone Pancreatitis
- Alcohol
- Metabolic: Hyperlipidemia and Hypercalcemia
- Hereditary
- Autoimmune
- Infection (mumps and coxsaki B viral infection)
- Trauma (blunt, penetrating, surgical, ERCP)
- Pancreatic duct obstruction (neoplasm, worms, pancreatic divism)
- Medications (thiazid, steroid, azathioprin)
- Idiopathic
Acute Pancreatitis
Chronic Pancreatitis
Acute Abdomen
CT abdomen Pancreatitis
Although a CT scan may eventually be useful, it will not be as helpful as the other choices at this point. It is best used at 72 hours of illness to assess the degree of pancreatic necrosis in patients with predicted severe disease. A cardiogram and troponin will help to rule in or rule out a myocardial infarction while the serum amylase and lipase will give information about pancreatitis. The gallbladder ultrasound will be important in this patient with a strong family history for cholelithiasis and cholecystitis
Amylase and Lipase in Acute pancreatitis:
- The diagnosis of acute pancreatitis is best supported by a three-fold increase in amylase and lipase.
- The lipase is considered a little more specific than amylase but situations other than pancreatitis can cause lipase elevations.
- Serum amylase may be elevated for many reasons other than acute pancreatitis (eg, mumps, perforated viscus, tubo-ovarian abscess,), as can the serum lipase (eg, intestinal infarction and perforation, severe peptic ulcer disease).
- The severity of pancreatitis does not correlate well with the magnitude of the elevation of the serum amylase or lipase.
- Lipase and amylase levels also do not correlate with recovery or prognosis.
Pancreatitis: Initial Mnagement
All patients with acute pancreatitis should initially be made NPO. If they continue to vomit, nasogastric aspiration may be indicated,. Vigorous hydration with isotonic fluids (Ringer’s lactate or normal saline) is indicated to maintain blood volume, especially in the face of severe pancreatitis in which patients may sequester large amounts of fluids in the retroperitoneal space. Use of IV antibiotics is controversial. In this patient, antibiotics are not indicated, as the severity of the disease has not been established. Immediate IV hyperalimentation is not required, especially in patients with mild pancreatitis.