Acute Pancreatitis
Epidemiology and Etiology:
- 80% are caused by:
- biliary tract disease
- alcoholism
- etiologies:
- metabolic:
- alcohol
- hyperlipoproteinemia
- hypercalcemia
- drugs
- thiazide
diuretics
- azathioprine
- estrogens
- sulfonamides
- furosemide
- methyldopa
- pentamidine
- procainamide
- hereditary
- cationic
trypsinogen (PRSS1) mutation
- trypsin
inhibitor (SPINK1) mutation
- mechanical
- trauma
- gallstones
- iatrogenic
injury
- perioperative
- endoscopic
- vascular:
- shock
- atheroembolism
- vasculitis
- polyarteritis nodosa
- SLE
- Henoch-Schonlein
- infectious:
- Mumps
- Coxsackievirus
- Mycoplasma pneumoniae
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Common sites:
Gross features:
- hemorrhagic
- yellow-white,
chalky fat necrosis
Histologic features:
- edema
- fat necrosis with
calcification (lipolytic enzymes)
- acute inflammation
- destruction of
pancreatic parenchyma (proteolytic)
- blood vessel
destruction with interstitial hemorrhage (may be pronounced in severe /
hemorrhagic pancreatitis)
Immunophenotype:
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Marker:
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Sensitivity:
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Specificity:
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Molecular features:
Other features:
- elevated plasma
amylase and lipase
- complications
(release of toxic enzymes, cytokines, and other mediators into the
circulation):
- systemic
organ failure
- shock
(peripheral vascular collapse)
- ARDS
- Acute
renal failure
- Hemolysis
- Disseminated
intravascular coagulation (DIC)
- Pancreatic
abscess
- Pancreatic
pseudocyst
- Duodenal
obstruction
References: