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Pancreatitis

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Pathophysiology of Pancreatitis
The pancreas contains enzymes which have potential to cause extensive tissue damage. Under normal circumstances several mechanisms protect the pancreas from damage by these enzymes; however, inappropriate activation of the enzyme systems leads to extensive damage by auto digestion. Some proposed mechanisms by which auto digestion begins are: reflux of duodenal contents, reflux of bile into pancreatic duct when CBD blocked, and activation of complement system and overstimulation of pancreatic secretions.

Epidemiology
Acute pancreatitis is a potentially lethal disease that is increasing in incidence. Its mortality has improved as a result of a better understanding of the natural history of the disease and improvement of critical care. Approximately 210,000 patients are admitted to hospitals each year with acute pancreatitis with approximately 20% meeting criteria for severe pancreatitis alone in the US. Alcoholic pancreatitis is seen more frequently in men.

Manifestation
Acute pancreatitis is an important cause of acute upper abdominal pain. Because its manifestations are similar to a number of other acute illnesses, it is difficult to base a diagnosis only on symptoms and signs. The two most common causes of acute pancreatitis in adults are gallstones and alcoholism.

Treatment
The main goal of initial treatment is to prevent complications of severe pancreatitis by reducing pancreatic secretory stimuli. Initially, the patient should be hydrated and kept NPO with bowel rest when nausea, vomiting, and abdominal pain are an issue. The majority of patients will improve within 3 to 7 days. Patients with poor prognosis should be admitted to the ICU.

Complications
The most likely complication from pancreatitis is acute renal failure.

Prognosis
Early evaluation for patients with acute pancreatitis is important. Usually, patients with severe disease need intensive care treatment; this is why it is essential that we differentiate the patients with a mild level of pancreatitis from the ones with a more advanced disease. Several scoring systems can predict the severity of pancreatitis; exams such as the Computed Tomography (CT) Severity Index have been developed and validated to predict adverse outcomes, including mortality, in patients with pancreatitis.

Prevention
The most important aspect of prevention is patient education. Eating a balanced, low-fat diet, triglyceride control, and decreasing the amount of alcohol intake are a few dietary and behavioral measures that may decrease the incidence of acute pancreatitis.

Reference Huether, S. E. (2008). Understanding Pathophysilogy (4th ed.). , MO: Mosby.

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