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Acute Pancreatitis (Clinical Presentation (Fever, Jaundice, Tachycardia,…
Acute Pancreatitis
Clinical Presentation
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Anorexia, nausea and vomiting
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Gradual or sudden severe epigastric or central abdominal pain that radiates to the back - sitting forward may relieve
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Periumbilical ecchymosis (skin discolouration due to blood under skin due to bruising) - Cullen's sign
Left flank bruising (skin discolouration due to blood under skin due to bruising) - Grey Turner's sign
Pathophysiology
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These prematurely activate enzymes & cause leaky vessels. This causes oedema, inflammation and hypovolaemia
Gallstone pancreatitis
Accumulation of enzyme-rich fluid WITHIN the pancreas due to OBSTRUCTION of the pancreatic duct by gallstones
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In this situation, trypsinogen is cleaved to trypsin. A build up of trypsin occurs, thus increased enzymatic digestion of the pancreas and inflammation leading to extensive acinar damage
Destruction of the adjacent islets of Langerhans can result in hyperglycaemia as beta cells will be destroyed resulting in less insulin
There are many mechanisms by which this can occur, with the majority being caused by gallstones and alcohol
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Acute pancreatitis is caused by the destructive effect of premature activation of pancreatic enzymes which causes self-perpetuating pancreatic inflammation by enzyme-mediated AUTOdigestion
Lipolytic enzymes causes fat necrosis, which can result, if extensive and involving the anterior abdominal wall, in skin discolouration
The released fatty acids bind to Ca2+ ions, forming white precipitates in the necrotic fat
If this is very severe, it can result in hypocalcaemia - presenting with tetany
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Main Causes
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- Idiopathic
- Gallstones (majority - 60%)
- Ethanol (i.e. alcohol - 30%)
- Trauma
- Steroids
- Mumps
- Autoimmune
- Scorpion venom
- Hyperlipidaemia
- ERCP
- Drugs
Also pregnancy and neoplasia
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Process that occurs on the background of a previously normal pancreas and can return to normal after resolution of the episode