Acute Pancreatitis

Question 1

What is acute pancreatitis?

Answer 1

pancreatic inflammation due to autodigestion

Question 2

What percent is self-limiting?

Answer 2

90%

Question 3

10-15% become ______

Answer 3

chronic

Question 4

Where does pancreatic enzymes normally get activated? By what two components?

Answer 4

pancreatic juices move into the duodenum where pancreatic enzymes get activated by BILE and TRYPSIN

Question 5

Is it potentially fatal?

Answer 5

yes

Question 6

How does autodigestion occur?

Answer 6

Autodigestion occur when bile flow outside the duodenum and combines with pancreatic juice activating the digestive enzymes prematurely.

–> activated enzymes break down structure proteins of the pancreas causing self-breakdown and self-digestion

Question 7

Pancreatic enzymes are secreted in an ______ form

Answer 7

inactive

Question 8

Etiology (5)

Answer 8

• alcohol abuse (~70%)
• idiopathic (~10%)
• stones eg gallstones
• injury eg physical trauma or infection
• drugs (inflict injury to pancreas)

Question 9

Pathophysiology: Gallstones

Answer 9

stone obstruct the bile flow causing bile stasis or reflux of bile–> bile flows backwards into ducts and pancreas causing premature activation of enzymes –> prematurely activated enzymes break down structure protein = AUTODIGESTION–> followed by inflm, hemorrhage, and necrosis

Question 10

Why does hemorrhage occur?

Answer 10

blood vessels can be damaged

Question 11

Pathophysiology: alcohol (2 ways)

Answer 11

1. alcohol constricts the Sphincter of Oddi:
   - pancreatic juice cannot enter into duodenum resulting in accum of bile and pancreatic secretion into common bile duct and pancreatic duct and into the pancreas where enzyme get activated prematurely
2. alcohol increases pancreatic secretion:
   - fills up the ducts and back up into the pancreas
   - the constriction of the Sphincter of Oddi causes bile and pancreatic secretion to back into ducts and into pancreas where enzymes are activated prematurely

Question 12

Manifestations

Answer 12

• acute onset
• excessive third spacing
• many others: tachycardia, fever, resp distress

Question 13

Complications

Answer 13

vascular collapse and shock

b/c there are not enough blood in blood vessels

Question 14

What triggers acute onset? Where is the severe pain located and where does it radiates?

Answer 14

• acute onset follows alcohol binge and after a large meal
• epigastric and periumbilical region
• radiates to back, chest, and flank

Question 15

Why does pain follow after alcohol binge and large meal (3)?

Answer 15

• incr. secretion of dig. enzymes
• incr. pancreatic secretions
• incr. bile production

Question 16

Why does excessive 3rd spacing occur?

Answer 16

pancreas is richly vascularized–> inflm leads to hyperemia–> exudate produced –> incr. CHP –> fluid from vessels to interstitial space of pancreas (cavity of pancreas)

Question 17

What are the complication of 3rd spacing?

Answer 17

removing fluid from vasculature can lead to hypovolemia, hypovolemic shock, and vascular collapse

Question 18

Is fever, tachycardia, and respiratory distress linked to pancreas? Fever?

Answer 18

not obviously linked to pancreas but can be present

fever occurs w/ or w/o infection

Question 19

Diagnosis (labs, biomakers, and imaging).

Answer 19

• labs: amylase and lipase–> incr. when pancreas is damaged
• new biomakers: TNF, trypsinogen, and proteases–> decr. levels = recovery is occurring
• U/S and CT scan to determine swelling of pancreas

Question 20

What diagnostic testing reveal more information on severity, sensitivity, and prognosis of acute pancreatitis? New or old?

Answer 20

biomakers: TNF, trypsinogen, and proteases

New.

Question 21

What is TNF

Answer 21

tumor necrosis factor: cytotoxin are proteins that are found in blood d/t cell death

Question 22

What are trypsinogen?

Answer 22

precursor of trypsin (dig. enzymes) that is activated in intestinal mucosa

Question 23

What are proteases?

Answer 23

enzymes found in pancreas that break down proteins

Question 24

What diagnostic testing do not give prognosis or severity of diease?

Answer 24

amylase and lipase–> degree of elevation is not related to degree of damage

Question 25

treatment for mild form (4)

Answer 25

• one week recovery
• NPO b/c ingestion incr. pancreatic secretion and bile
• manage pain
• correct fluid and electrolyte imbalance

Question 26

treatment for severe form

Answer 26

• patient req ICU
• IV opiates
• sx: depending on circumstances eg gallstones

leads to systemic issues:

• renal prob: hypovolemia affects perfusion of kidneys resulting in decr. fxn and fluid imbalance
• circulatory: hypovolemia + hypovolemic shock
• hepatobiliary: gallbladder and liver are affected (b/c all ducts are joined together)
• pulmonary: a complication of acute pancreatitis is acute respiratory distress syndrome (ARDs)