Acute pancreatitis overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]
Overview
Acute pancreatitis is a rapidly-onset inflammation of the pancreas. Depending on its severity, it can have severe complications and high mortality despite treatment. While mild cases are often successfully treated with conservative measures, such as NPO (abstaining from any oral intake) and IV fluid rehydration, severe cases may require admission to the ICU or even surgery (often more than one intervention) to deal with complications of the disease process.
Historical Perspective
Dutch physician and anatomist, Nicholaes Tulp in the year 1652 gave the first clear description of acute pancreatitis. The first systemic analysis of acute pancreatitis was presented by Reginald Huber Fitz in 1889. During the 20th century many theories were proposed with regards to whether surgery is to be preferred as the initial approach to the treatment of acute pancreatitis. Hans Chiari in 1896 proposed that the basic mechanism of the disease was autodigestion of pancreas. The father of modern anatomical pathology, Giovanni Battista Morgagni gave the first description of pancreatic pseudocysts.
Classification
Acute pancreatitis can either be classified according to its phase (early or late), or according to its level of severity.
Epidemiology and Demographics
Annual incidence in the U.S. is 18 per 100,000 population. In a European cross-sectional study, incidence of acute pancreatits increased from 12.4 to 15.9 per 100,000 annually from 1985 to 1995; however, mortality remained stable as a result of better outcomes.[1] Another study showed a lower incidence of 9.8 per 100,000 but a similar worsening trend (increasing from 4.9 in 1963-74) over time.[2]
Diagnosis
History and Symptoms
Severe upper abdominal pain, with radiation through to the back, is the hallmark of acute pancreatitis. Nausea and vomiting (emesis) are prominent symptoms.
CT
Although ultrasound imaging and CT scanning of the abdomen can be used to confirm the diagnosis of pancreatitis, neither is usually necessary as a primary diagnostic modality[3] . In addition, CT contrast may exacerbate pancreatitis,[4] although this is disputed.[5]
Ultrasound
Although ultrasound imaging and CT scanning of the abdomen can be used to confirm the diagnosis of pancreatitis, neither is usually necessary as a primary diagnostic modality[3]
References
- ↑ Eland IA, Sturkenboom MJ, Wilson JH, Stricker BH (2000). "Incidence and mortality of acute pancreatitis between 1985 and 1995". Scand. J. Gastroenterol. 35 (10): 1110–6. PMID 11099067.
- ↑ Goldacre MJ, Roberts SE (2004). "Hospital admission for acute pancreatitis in an English population, 1963-98: database study of incidence and mortality". BMJ. 328 (7454): 1466–9. doi:10.1136/bmj.328.7454.1466. PMID 15205290.
- ↑ 3.0 3.1 Fleszler F, Friedenberg F, Krevsky B, Friedel D, Braitman L (2003). "Abdominal computed tomography prolongs length of stay and is frequently unnecessary in the evaluation of acute pancreatitis". Am J Med Sci. 325 (5): 251–5. PMID 12792243.
- ↑ McMenamin D, Gates L (1996). "A retrospective analysis of the effect of contrast-enhanced CT on the outcome of acute pancreatitis". Am J Gastroenterol. 91 (7): 1384–7. PMID 8678000.
- ↑ Hwang T, Chang K, Ho Y (2000). "Contrast-enhanced dynamic computed tomography does not aggravate the clinical severity of patients with severe acute pancreatitis: reevaluation of the effect of intravenous contrast medium on the severity of acute pancreatitis". Arch Surg. 135 (3): 287–90. PMID 10722029.