Acute Pancreatitis
Acute pancreatitis is pancreatic inflammation with local and systemic inflammatory consequences; diagnose it clinically and biochemically, treat early with monitored supportive care and enteral nutrition, and prevent recurrence by addressing the cause.
Definition
Acute pancreatitis is acute inflammation of the pancreas. Diagnosis requires at least two of characteristic acute upper-abdominal pain, serum amylase or lipase more than three times the upper limit of normal, or characteristic imaging. Severity is defined by local/systemic complications and organ failure, especially persistent organ failure beyond 48 hours.
First principles
Premature enzyme activation causes pancreatic and peripancreatic inflammation
Acinar-cell injury leads to premature intracellular activation of digestive enzymes and an inflammatory cascade. The result is pancreatic oedema, fat necrosis, fluid shifts and sometimes haemorrhage. Gallstones usually cause transient ampullary or biliary obstruction, while alcohol can injure acinar cells directly; other metabolic, drug-related, structural, hereditary and autoimmune causes must be considered when these are not found.
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