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Chapter-21 Acute Pancreatitis

BOOK TITLE: Common Surgical Emergencies

Author
1. Parikh Deval A
2. Parikh Amarish J
ISBN
9788184486537
DOI
10.5005/jp/books/10158_21
Edition
2/e
Publishing Year
2009
Pages
36
Author Affiliations
1. Jagmohan Hospital, Ahmedabad, Gujarat, India
2. Jagmohan Hospital, Ahmedabad, Gujarat, India
Chapter keywords

Abstract

In India there has been a steady increase in the incidence of acute pancreatitis, both as a result of changing life style and increasing consumption of fatty foods and alcohol. Acute pancreatitis is defined as an acute inflammatory process of pancreas with variable involvement of other regional tissues or remote organ systems. Initial episode can be classified as acute pancreatitis whatever the underlying condition of pancreas. For a clinician mild acute pancreatitis is defined as a condition associated with minimal or no organ dysfunction and ultimately uneventful recovery. Acute pancreatitis is considered severe when there is evidence of organ failure or local complications such as pseudocyst, abscess or necrosis. Acute fluid collection is defined as a collection of fluid that occurs early in the course of acute pancreatitis, is located in or near pancreas and lacks wall of granulation or fibrous tissues. It occurs in 30 to 50 percent of patients. If it persists for 4 to 6 weeks and becomes capsulated, it is termed a pseudocyst. Pancreatic necrosis is characterized by focal or diffuse areas of nonviable pancreatic parenchyma and is usually associated with peripancreatic fat necrosis. Dynamic contrast enhanced CT scan can help to distinguish oedematous and necrotizing pancreatitis. Acute pancreatitis causes rapid onset of epigastric pain which radiates to the back, left shoulder, both iliac fossa and whole of abdomen. Some times attack follows a heavy meal or heavy drinking. Pain is severe, persistent and patient may find comfort in sitting up in bed and bending forward. Ultrasonography is abnormal in 30-50 percent of patients with acute pancreatitis, the major limitation being that the pancreas cannot be adequately visualized in large number of patients because intra-abdominal gas or excess body fat obscure tissue planes. CT is of great benefit in case of patients with acute pancreatitis. Spiral CT is the most common technique currently used in evalu­a­tion of acute pancreatitis. Enhanced CT scan with half cm cuts over pancreatic region defines the extent of disease and involvement of nearby organs, blood vessels and liver, spleen and kidneys. Grading of severity is of critical importance in providing appropriate therapy in acute pancreatitis. It is important to make this distinction as early as possible during the illness to maximize therapy and to prevent or minimize organ dysfunction and local complications, medical treatment of pancreatitis has been primarily supportive, with close attention to fluid resuscitation, careful pulmonary care and general treatment in intensive care unit. Major goals are to reduce morbidity and mortality, limit systemic complications, prevent pancreatic necrosis, and prevent pancreatic infection in fluid collection or necrosis. Major systemic complications are hypotension, respiratory failure and renal failure. There is no single operative treatment and probably no operation that cures pancreatitis. The role of surgery is mainly reactive and responsive to complications as they arise in minority of patients. Surgery is also helpful in eliminating the cause so that relapse could be prevented. Surgical approach to specific complications of acute pancreatitis, pancreatic pseudocyst, hemorrhage, pancreatic abscess.

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