(Surgery)

Overview

• A disorder of the exocrine pancreas, and is associated with acinar cell injury with local and systemic inflammatory responses.
• Inflammatory condition of the pancreas → damage to pancreas causes local release of digestive proteolytic enzymes that autodigest pancreatic tissue
• Peak Age → 60 years old
• Causes (I GET SMASHED) ⇒ Idiopathic, Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune, Scorpion poison, Hypercalcemia, Hypertriglyceridemia, ERCP (eg. for cholangitis), and Drugs (Sodium Valproate, Steriods, Thiazides, Azathioprine, Mesalazine)
  • Gallstones ⇒ more common in females
  • Alcohol ⇒ more common in males

Making Diagnosis

Clinical Features:

• Constant, severe epigastric pain that radiates towards the back → usually sudden onset, described as 'being stabbed with knife', worse with movement
• N&V → leads to dehydration, electrolyte abnormalities & hypokalaemic metabolic alkalosis
• Signs of Shock → hypovolaemia (dry mucous membrane, decreased skin turgor, sweating), hypotension, tachycardia
• Fever, decreased appetite (Anorexia), signs of pleural effusion
• Severe Pancreatitis → Cullen's Sign (periumbilical bruising) & Grey-Turner Sign (flank bruising)

Investigations:

• Serum Lipase (more sensitive and specific than amylase, and has longer half-life hence remains elevated for longer) → 3x the upper limit