Epidemiology
Incidence
An incidence of 5% has been reported in the West which is higher (25%) in some countries (e.g., Scandinavian countries) because of variations in alcohol consumption as well as early detection.[1]
Mortality
The mortality rate is between 10% and 20% depending on many factors including pathology, clinical presentation and diagnostic capability.[2]
Etiology
Gall stones obstructing the pancreatic duct (30%) and chronic alcohol abuse (15%) represent the common causes. Infections such as mumps and coxackie B. hereditary genetic mutations, hypercalcemia, pancreatic tumors and drugs such as azathioprine, oestrogens, corticosteroids. Iatrogenic causes include postsurgical acute pancreatitis and endoscopic retrograde cholangeiopancreatography (ERCP). Hyperlipidemias (hypertriglyceridemia, hyperchylomicronemia) have also been known to be complicated by pancreatitis.[1]
Clinical suspicion
Clinical picture is suggestive with severe agonizing epigastric pain which may radiate in a band like manner to the back accompanied by nausea and vomiting. This pain lasts for days and may be relieved by leaning forwards and is accompanied by epigastric tenderness. However there are 3 cardinal manifestations.
- Pain.
- Vomiting.
- Shock (especially in fulminant cases).
Diagnosis
A serum amylase raised more than 4 times greater than the upper limit of normal confirms the diagnosis. In doubtful cases serum lipase, and serum trypsin levels will be elevated in acute pancreatitis.
Prognosis
Modified Ranson's criteria
These are features which when present during the first 48 hours indicate severe pancreatitis and poor prognosis.
Age >55 years, leucocytosis >16000, LDH >400 IU/L + hypocalcemia
liver cell failure, respiratory failure, diabetes.
Treatment
Rest to the pancreas: All oral feeding is stopped and nasogastric suction is used to reduce vomiting & abdominal distension. Pethidine 100mg IM every 3-4 hours. Morphine is contraindicated because it causes spasm of the sphincter of Oddi. Water and electrolyte replacement and treatment of complications.
In severely ill patients where the cause is a stone obstructing the common bile duct and endoscopic sphincterotomy may be useful.
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