Pancreatitis

Basics

Description

  • Inflammation of pancreas due to activation, interstitial liberation, and digestion of gland by its own enzymes
  • Acute pancreatitis:
    • Exocrine and endocrine function of gland impaired for weeks to months
    • Glandular function will return to normal
  • Chronic pancreatitis:
    • Exocrine and endocrine functions progressively deteriorate with resultant steatorrhea and malabsorption
    • Dysfunction progressive and irreversible
  • Pancreatic pseudocyst:
    • Cystic collection of fluid with high content of pancreatic enzymes surrounded by a wall of fibrous tissue lacking a true epithelial lining
    • Localized in parenchyma of pancreas or adjacent abdominal spaces (lesser peritoneal sac)
    • Requires 4–6 wk to form from onset of acute pancreatitis

Etiology

  • Gallstones and alcohol abuse most common causes of acute pancreatitis (75–80%)
  • Alcohol abuse accounts for 70–80% of chronic pancreatitis
  • Acute:
    • Biliary tract disease
    • Chronic alcoholism
    • Obstruction of pancreatic duct
    • Ischemia
    • Medications
    • Infectious
    • Postoperative
    • Post-ERCP
    • Metabolic diseases
    • Trauma
    • Scorpion venom
    • Penetrating peptic ulcer
    • Hereditary
  • Chronic:
    • Chronic alcoholism
    • Obstruction pancreatic duct
    • Tropical
    • Hereditary
    • Shwachman disease
    • Enzyme deficiency
    • Idiopathic
    • Hyperlipidemia
    • Hypercalcemia
  • Pancreatic pseudocyst:
    • Complication in 5–16% of acute pancreatitis; 20–40% of chronic pancreatitis

Pediatric Considerations
Causes mainly viral, trauma, medications, anatomic abnormalities

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