Acute pancreatitis

Acute pancreatitis
Updated: 03/25/2019
© Jun Wang, MD, PhD

General features
  • Clinical emergency
  • More common in women, in African Americans
  • Commonly associated with biliary tract disease in women, alcoholism in men
  • Overall mortality: 10% if edematous vs. 50% if hemorrhagic/necrotic, higher in biliary pancreatitis, most deaths due to failure of multiple organ system in the first week, and infections in subsequent weeks
Etiology
  • Metabolic: Alcoholism; hyperlipoproteinemia, hypercalcemia; certain drugs (e.g., azathioprine); cigarette smoking
  • Genetic: Mutation of trypsin, trypsin regulators, or calcium metabolism regulators
  • Mechanical: Bile duct obstruction (increase intrapancreatic ductal pressure and leads to the accumulation of enzyme-rich fluid in the interstitium); trauma; iatrogenic injury including perative injury/Endoscopic procedures with dye injection
  • Toxins: Such as scorpion bite in Trinidad
  • Vascular: Shock; atheroembolism; vasculitis
  • Infectious: Mumps
Pathogenesis
  • Destruction of pancreatic tissue due to inappropriate release and activation of pancreatic enzymes
  • Activation of systemic inflammatory response
  • Alcohol effects:
Sphincter of Oddi spasm
Abnormal blood flow and glandular secretion
Toxic metabolics: Non-oxidative and oxidative
CCK and secretin release
CCK sensitization
Clinical presentations
  • Persistent epigastric abdominal pain, radiating to back
  • Epigastric tenderness to palpation
  • Fever, tachypnea, hypoxemia, hypotension, etc
  • Severity and outcome predictor: Ranson criteria, APACHE II score, etc
Key laboratory findings
  • Elevated amylase and lipase, diagnostic if at least 3 times above normal range, glycosuria  and hypocalcemia
  • Elevated trypsinogen activation peptide (TAP)
  • Leukocytosis
  • Signs of DIC
  • Acute renal tubular necrosis
  • Hypocalcemia
  • Hyperglycemia
Key pathological features
  • Swollen, indurated, edematous or hemorrhagic/necrotic, yellow chalky nodules of fat necrosis in pancreas, mesenteric and peritoneal fat
  • Acute interstitial type: Acute inflammatory cell infiltrate admixed with edema and fibrinous exudate
  • Acute hemorrhagic types: Patchy necrosis, periductal or perilobular; interstitial edema, fat necrosis, neutrophils, acinar and blood vessel destruction, interstitial hemorrhage
Radiologic findings
Diagnosis
  • Two of the three criteria
Acute onset of persistent, severe, epigastric pain often radiating to the back
Elevation in serum lipase or amylase to three times or greater than the upper limit of normal
Characteristic findings of acute pancreatitis on imaging
Severity prediction
Treatment
  • Supportive, antibiotics for infection
  • Surgery for gallstone, pancreatic duct disruption, pseudocysts, etc


Back to exocrine pancreas pathology
Back to contents

Comments

Post a Comment

Popular posts from this blog

Contents

Pathology notes Jun Wang, MD, PhD 1. General information Frequently discussed syndromes Terms of dermatology Terms of hematology 2. Primary immunodeficiency disorders 3. Hemodynamic abnormalities Shock Thrombosis and embolism Bleeding disorders 4.  Benign blood cell disorders Anemia Benign white cell disorders 5. Hematopoietic neoplasms Lymphoid neoplasms Myeloid neoplasms Histiocytic neoplasms: Langerhans cell histiocytosis 6. Cardiovascular system Pulmonary hypertension Cardiovascular system tumors 7. Respiratory tract tumors 8. Gastrointestinal tract Congenital disorders Infectious gastroenteritis Oral cavity Esophagus Stomach Intestinal tumors Salivary glands Exocrine pancreas and gallbladder 9. Urinary system Kidney masses Lower urinary tract 10. Male reproductive system 11. Female genital tract 12. Breast 13. Endocrine organs Pituitary gland Adrenal gland Thyroid gland Parathyroid gland Endocrine pancreas...
Read more

Anemia

Anemia Updated: 07/13/2024 © Jun Wang, MD, PhD   General features Decrease in red cell mass Hemoglobin: Levels of hemoglobin in a specific volume of whole blood Hematocrit: Fraction of whole blood composed of red blood cells Red cell count: Quantity of red cell in a specific volume of whole blood Three major groups based on RBC sizes Microcytic Normocytic Macrocytic Three major causes Blood loss: acute or chronic Increased red cell destruction: hemolysis Reduced production: marrow failure due to genetic abnormality or nutritional deficiency Etiology Genetic abnormality Hemoglobinopathies RBC cytoskeletal abomorlities Enzyme abnormalities Fanconi anemia Nutritional deficiencies: iron, VB12, folate, general malnutrition Physical etiologies: trauma, burns, frostbite, prosthetic valves, etc Chronic diseases: chronic infections, neoplasia, autoimmune disorders, kidney or liver diseases, etc Infectious diseases: hepatitis, sepsis , malaria, e...
Read more

Lymphoid neoplasms

Lymphocytic neoplasms Updated: 05/17/2020 © Jun Wang, MD, PhD Terminology Lymphoma : Proliferations forming discrete tissue masses Leukemia : Widespread involvement of the bone marrow and usually the peripheral blood Any "lymphoma" can present with or evolve to a leukemic picture, and any "leukemia" can occasionally present with a mass lesion Other hematology terms Important risk factors Immunodeficiency (primary or secondary) Autoimmune disorders Viruses (HIV, KSHV/HHV8, HTLV-1) H. pylori infection Radiation Chemotherapy Diagnostic approaches Complete history, especially those with possible epidemic characters, such as Burkitt lymphoma CBC, Bone marrow Morphology/immunohistochemistry Immunofluorescence flow cytometry Cytogenetic studies Molecular studies Commonly used markers All lymphomas: CD45 B-cell neoplasms: CD5, CD10, CD19, CD20, CD79a, CD23, bcl2, bcl6, cyclin D1, light chai...
Read more