Acute pancreatitis - the sudden inflammation and haemorrhaging of the pancreas due to destruction by its own digestive enzymes (AUTODIGESTION)

Prognosis is usually mild but can become severe

presents with a rapid onset of inflammation and symptoms. After an episode of acute pancreatitis, normal function usually returns.

Pathophysiology

Pancreatic enzymes are inactive in the pancreas (zymogens) and are in storage vesicles - to protect the pancreas. Once they enter the duodenum they are acted on by enteropeptidase turning the zymogen into its active form.

If these zygomens (e.g. trypsinogen) are activated too early = acute pancreatitis. As a result of:

• damage to acinar cells

• Impaired secretion of pro-enzymes into the duodenum

• Third space fluid sequestration in pancreatitis is the result of a combination of inflammatory mediators, vasoactive mediators and tissues which lead to vascular injury, vasoconstriction and increased capillary permeability leading to extravasation of fluid into the third space.

  • This can lead to ARDS (Acute Respiratory Distress Syndrome), pleural effusions and hypovolaemia leading to AKI (Acute Kidney Injury).

Causes

• I GET SMASHED

Leading causes:

• Alcohol abuse - more common in men and younger patients
• Gall stones - more common in women and older patients.

PC

• Severe pain in the epigastrium - can radiate to the back