Clinical Case Database / Category: Patient Management
Management of acute pancreatitis
Heather M Sowden BSc MBChB, Sonia Littlewood MBChB, MRCS
Foundation Years Journal, volume 4, issue 1, p.38 (123Doc Education, London, January 2010)
Acute pancreatitis (AP) is an inflammatory condition of the pancreatic gland whereby pancreatic enzymes autodigest the pancreas. Although the exact mechanisms by which this process occurs is unknown, the presence of gallstones and excessive alcohol consumption are responsible for approximately 75% of attacks in the UK. Individuals typically present with acute epigastric pain that radiates through to the back, nausea and vomiting are also prominent features. The diagnosis is confirmed by a raised serum amylase, however, if individuals present more than 3 days after the onset of pain, the amylase may be normal and serum lipase measurements may be more useful. The majority of people will have mild self-limiting disease that requires supportive care only. However, of those with AP approximately 20% go on to have a severe attack characterised by the systemic inflammatory response syndrome (SIRS), and multi-organ dysfunction (MOD). Identifying early those who are likely to have a severe attack has been the driving force behind the development of scoring systems aimed to predict early those who will develop a serious attack. Those with both local and systemic complications will need to receive their care in a high dependency or intensive care unit environment and ideally be managed by multidisciplinary teams. Mortality from AP has a bimodal distribution with approximately half of the deaths occurring in the first 14 days from SIRS and MOD, which fails to respond to treatment. The second peak occurs at 3 months with MOD secondary to sepsis from infected pancreatic necrosis.
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Heather M Sowden BSc MBChB
FY1 in General Surgery, Dewsbury District Hospital, West Yorkshire
Sonia Littlewood MBChB, MRCS
SpR in General Surgery (Colorectal), Dewsbury District Hospital, West Yorkshire
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