Pancreatitis

Definition/Etiology:

Acute and chronic pancreatitis are not separate. It is a continuum. Recurrent, severe acute pancreatitis can progress to chronic due to fibrosis and necrosis, as well as continued use of tobacco and alcohol.

Risk factors:

• Alcohol
• Tobacco
• Hypertriglyceridemia (esp >1000)
• Genetic
• Autoimmune
• Abdominal radiation
• Ischemic injury
• Obstructive (stones, scars, tumors, cysts)
• Trauma (blunt, penetrating, post-ERCP)
• Infection (viral, bacterial, parasitic, fungal)

Pathophysiology:

• Gallstones can cause a reflux of bile into the pancreatic duct, and this may be the cause of gallstone pancreatitis (autodigestion).
• Alcohol may increase the level of digestive enzymes, but this is unclear.
• Tobacco use may be dose-dependent in its contribution to risk.

Clinical Presentation:

• LUQ and epigastric pain
• Can radiate to back
• Nausea / vomiting
• More abrupt onset with gallstone pancreatitis
• More gradual onset with hereditary or alcoholic
• Can get shocky
• Jaundice can occur
• May have s/s alcoholism

Collaborative Management:

• Labs: lipase, amylase (3x normal or greater), fasting lipids
• CXR: in severe cases, can develop pleural effusions, atelectasis, ARDS
• Abdominal ultrasound
• Abdominal CT with contrast
• MRI if contrast allergy

Evaluation | Patient Monitoring | Education:

• Monitor for SIRS/sepsis.
• Serial lipase, amylase, CMP, CBC, lactate.
• Alcohol / tobacco cessation.
• Treatment of hypertriglyceridemia with diet, exercise, and medications.

Linchpins: (Key Points)

• Pancreatitis can cause sepsis and multiorgan failure.
• Lifestyle modifications can help (diet, exercise, smoking/tobacco cessation).
• Pain can be severe.