Acute pancreatitis:-Causes, Pathogenesis, Anatomy and diagnosis of pancreatitis скачать в хорошем качестве

Acute pancreatitis:-Causes, Pathogenesis, Anatomy and diagnosis of pancreatitis

Acute pancreatitis is a syndrome of inflammation of the pancreatic gland initiated by an acute injury. In the western world, gallstones and alcohol account for the vast majority of episodes. Alcohol also causes chronic pancreatitis. The severity of the pancreatitis may range from mild and self-limiting to extremely severe, with extensive pancreatic and peripancreatic necrosis as well as haemorrhage. In the most severe form the mortality is between 40% and 50%. acute pancreatitis is a process that occurs on the background of a previously normal pancreas and can return to normal after resolution of the episode. In chronic pancreatitis there is continuing inflammation with irreversible structural changes. Pancreas anatomy The pancreas, is a 12-15–cm long J-shaped, soft, lobulated, retroperitoneal organ. It lies transversely, although a bit obliquely, on the posterior abdominal wall behind the stomach, across the lumbar (L1-2) spine. it has both an endocrine and a digestive exocrine function. As an endocrine gland, it functions mostly to regulate blood sugar levels, secreting the hormones insulin, glucagon, somatostatin, and pancreatic polypeptide. As a part of the digestive system, it functions as an exocrine gland secreting pancreatic juice into the duodenum through the pancreatic duct. This juice contains bicarbonate, which neutralizes acid entering the duodenum from the stomach; and digestive enzymes, which break down carbohydrates, proteins, and fats in food entering the duodenum from the stomach. Pathogenesis The pancreatic inflammatory response is secondary to the premature and exaggerated activation of digestive enzymes within the pancreas itself. An acute rise in intracellular calcium may be the initiating mechanism, leading to early activation of trypsinogen to trypsin and impairment of trypsin degradation by chymotrypsin C. It is these activated enzymes which are responsible for cellular necrosis. In the case of gallstonerelated pancreatitis it is believed that stones occlude the pancreatic drainage at the level of the ampulla leading to pancreatic ductular hypertension. Causes for acute pancreatitis include, Gallstones that goes and block the pancreatic duct, Alcohol, Tropical Infections like mumps, Coxsackie B infection, Hereditary Pancreatic tumours, Trypsinogen and inhibitory protein defects, Drugs like azathioprine, oestrogens, corticosteroids, didanosine, Cystic fibrosis, Iatrogenic like post-surgical, post-ERCP, Idiopathic, Hyperlipidemias, Trauma, Hypercalcaemia. Lest see what are the Clinical features of a patient with acute pancretitis, Acute pancreatitis is a differential diagnosis in any patient with upper abdominal pain. The pain usually begins in the epigastrium accompanied by nausea and vomiting. As inflammation spreads throughout the peritoneal cavity, the pain becomes more intense. Involvement of the retroperitoneum frequently leads to back pain. The patient may give a history of previous similar episodes or be known to have gallstones. An attack may follow an alcoholic binge. However, in many cases there are no obvious aetiological factors. In severe disease, the patient has a tachycardia, hypotension and is oliguric. Abdominal examination may show widespread tenderness with guarding as well as reduced or absent bowel sounds. Specific clinical signs that support a diagnosis of severe necrotizing pancreatitis include periumbilical (Cullen’s sign) and flank bruising (Grey Turner’s sign). In patients with a gallstone aetiology, the clinical picture may also include the features of jaundice or cholangitis.