Acute pancreatitis K85.90

Authors: Prof. Dr. med. Peter Altmeyer, Prof. Dr. med. Guido Gerken

Co-Autor: Mag. Angelika Dahmane

All authors of this article

Last updated on: 29.10.2020

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Synonym(s)

Acute pancreatitis

Definition
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Acute pancreatitis is a sudden inflammation of the pancreas that is not primarily infectious.

Occurrence/Epidemiology
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Incidence: 10-20/100,000 inhabitants/year; in USA and Finland higher incidences; m>w;

Etiopathogenesis
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Acute pancreatitis can have multiple causes:

Biliary tract diseases (approx. 55%) such as choledocholiths, stenosis of the papilla vateri

Alcohol abuse (approx. 35 %)

Medication (approx. 10%) such as: beta blockers, diuretics, ACE inhibitors, methyldopa, oestrogens, glucocorticosteroids, antibiotics - erythromycin, rifampicin, tetracyclines, antivirals, anticonvulsants, NSAIDs; melsalazine, ciclosporin, cytostatics and immunosuppressants (e.g. Imurek)

Other less frequent causes are:

Heredity: hereditary pancreatitis (rare, autosomal dominant inheritance with mutations in the trypsinogen gene PRSS1 and in the SPINK1 gene); Note: both mutations can also lead to chronic pancreatitis.

Infections: Viral infections (mumps, AIDS, viral hepatitis)

Other:

  • Duodenal diverticula
  • Hypertrigyzeridemia
  • Autoimmune Pancreatitis
  • Worm infestation with ascarids in the bile ducts
  • Pancreas divisum.

Clinical features
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Marked symptoms of acute pancreatitis are pain in the upper abdomen, which is accompanied by an increase in pancreatic enzymes. Other symptoms are nausea and vomiting, meteorism, ascites, fever, hypotension and jaundice.

These are classified as follows:

  • Acute interstitial (edematous) pancreatitis, most common form with 85% (lethality = 0%)
  • Acute necrotising pancreatitis, with partial necrosis, 10-15% (lethality approx. 15%)
  • Acute necrotizing pancreatitis, with total necrosis (lethality > 50%)

Laboratory
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Pancreatic enzyme diagnostics
:The levels of lipase and elastase in serum are pancreas-specific, amylase going is not pancreas-specific.

Adverse laboratory values that may indicate necrotising pancreatitis are leukocytosis (> 16,000/µl), serum calcium concentration (< 2 mmol/l), Hkt (> 50%), lactate hydrogenase (> 350 U/l), hyperglycaemia, hypoxaemia, creatinine increase, BMI > 30, age > 55 years.

Diagnosis
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To diagnose acute pancreatitis, a medical history, clinic, sonography and clarification of the lipase level are performed.

Differential diagnosis
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The following diseases must be diagnosed differentially: An acute abdomen, including ureteral and/or renal colic, biliary colic, perforations of the stomach, intestine and gall bladder, mechanical ileus, acute appendicitis, mesenteric ischemia, an incarcerated abdominal wall hernia. Other diseases are myocardial infarction, pulmonary embolism and aneurysm dissecans.

Complication(s)
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Acute pancreatitis can lead to bacterial infections, acute renal failure, circulatory shock, a pancreatic abscess, thrombosis and post-acute pancreatic pseudocysts.

Therapy
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Conservative therapy is carried out on an in-patient basis with close monitoring, parenteral volume, electrolyte and glucose substitution, thromboembolism prophylaxis, administration of analgesics and antibiotics as required, and treatment of any complications that arise.
The minimally invasive therapy removes choledochocytes, pancreatic pseudocytes and necroses and pancreatic abscesses. Surgical therapy is used after an unsuccessful application of minimally invasive therapy.

Progression/forecast
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The first stage of pancreatitis is pancreatic edema or necrosis. This results in an increase in pancreatic enzymes, CRP and leucocytes. In the second stage they heal. In the third stage there is an inflammation of the necroses including sepsis and abscess with a renewed increase in CRP and leukocytes.

The course of acute pancreatitis is difficult to predict. However, it is important to have a close, in-patient control in order to be able to detect and treat necrotizing pancreatitis early enough.

Incoming links (3)

Acute pancreatitis; Pethidine; Prss1;

Outgoing links (3)

Pancreatitis chronic; Prss1; Spink1 gene;

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.