Acute Pancreatitis

Excerpt

Acute pancreatitis is a common disease and is the leading cause of hospitalization among gastrointestinal disorders in the United States. It involves the acute inflammation of the pancreas. The severity of acute pancreatitis varies widely, from mild conditions needing conservative treatment to severe and complicated diseases with high morbidity and mortality. The mortality of acute pancreas ranges from 3% in patients with mild edematous pancreatitis to as high as 20% in patients with pancreatic necrosis. The diagnosis of acute presentation is simple, but the major challenge is predicting the progression of the disease course and outcome. The duration of the disease is essential in determining the level of care.

The Atlanta classification broadly classifies acute pancreatitis into two categories. These are:

1. Interstitial edematous acute pancreatitis is characterized by the acute inflammation of the pancreatic parenchyma and surrounding peri-pancreatic tissue.

2. Necrotizing acute pancreatitis is characterized by necrosis of pancreatic parenchyma and peri-pancreatic tissue.

Based on the severity of the disease, acute pancreatitis is divided into the following types;

1. In mild acute pancreatitis, there is the absence of local or systemic complications and organ failure.

2. In moderately severe acute pancreatitis are local complications with or without organic failure for less than 48 hours.

3. In severe acute pancreatitis, there is persistent organ failure for more than 48 hours with the involvement of one or more than one organs.

The pancreas is a digestive gland organ and is found in front of the bodies of vertebra L1 and L2 on the posterior abdominal wall. The pancreas lies between the duodenum on the right and the spleen on the left transversely. It is divided into four parts: the head, neck, body, and tail. The head of the pancreas lies on the inferior vena cava and the right renal vein and is surrounded by the loop of the duodenum. The tail of the pancreas extends up to the splenic hilum. The primary function of the pancreas can be divided into exocrine and endocrine secretions. The exocrine secretion (pancreatic juice from the acinar cells) enters the duodenum through the main and accessory pancreatic ducts, and endocrine secretions (glucagon and insulin from the pancreatic islets of Langerhans) enter the blood.