1. UNIVERSITY OF THE GAMBIA
SCHOOL OF MEDICINE & ALLIED HEALTH
SCIENCES
ACADEMIC YEAR 2007-2008
MEDICAL PROGRAMME
4th YEAR SECOND SEMESTER
MEDICINE I
COURSE 2007 - 2008

2. Dr Ygber Luis Gonzalez de la Cruz
Consultant phycisian
R.V.T.H
Visiting Lecturer

3. Pancreatitis

4. Acute Pancreatitis
 Is a clinical syndrome defined by a discrete episode of
abdominal pain and elevations in serum enzyme levels
 Inflammation of the pancreas with varying amounts of
injury to adjacent and distant organs
 more than 80% of the cases are related to biliary stones
or alcohol use
 The criteria for diagnosing Pancreatitis areabdominal
pain, fever, and jaundice, along with physical findings

5. Etiologic factors

6. Acute Pancreatitis
Interstitial Necrotizing
Pancreatitis Pancreatitis

7. PATHOLOGY
 Interstitial
1. The gland is edematous, but its gross
architecture is preserved
2. Parenchymal inflammatory cells are present
3. Reduced enzyme secretion
4. Partial cell necrosis may allow the acinus to
regenerate rapidly after injury.

8. Necrotizing Pancreatitis
 Marked tissue necrosis and hemorrhage
 Surrounding areas of fat necrosis
 Large hematomas often are located in the
retroperitoneal space
 Vascular inflammation and thrombosis are
common.

9. PATHOPHYSIOLOGY
 Three major pathological processes within the
acinar cell
1. Inactive digestive zymogens are converted into
active enzymes
2. Pancreatic exocrine secretion is inhibited
3. The pancreas generates pro-inflammatory
mediators

10. Activation of Pancreatic Zymogens
 May be the first step in a process that leads to
pancreatic auto-digestion
 Potential consequences are
1. damaging local effects
2. Attack on other tissues
3. Promotion or activation of additional
pathways leading to tissue injury

11. Inhibition of Secretion
 Retention of active enzymes within the acinar
cell instead of their secretion into the pancreatic
duct

12. DIAGNOSIS
 Presence of severe abdominal pain
 Biochemical evidence of pancreatic injury

13. Symptoms
 Pain
1. Occurs in 95% of patients
2. Often located in the epigastric and umbilical
region
3. Deep, visceral pain is among the most severe
described
4. Nausea and vomiting are present in 85%

14. Signs
 Low-grade fevers are reported in 60% of patients
 Tachycardia and hypotension are found in up to 40%
of patients
 Abdominal tenderness and guarding
 Bowel sounds are decreased or absent
 Pleural effusions
 Mild jaundice
 Dark discoloration in the back, flank, or the para-
umbilical region

15. Grey Turner’s sign in acute pancreatitis

16. Markers of Pancreatic Injury
 A number of factors influence the level of
serum markers of Pancreatitis
1. Serum levels of pancreatic enzymes are the
sum of tissue production, release into the
blood, and clearance
2. In patients with renal failure, the serum
amylase may increase

17.  Measured enzyme activities may be influenced
by a number of “serum factors” as
hyperlipidemia
 Enzymes may be produced from non-pancreatic
tissues
 Standard enzyme assays, such as amylase and
lipase, provide no information on the severity of
the pancreatitis

19. Markers of Pancreatic Injury
 Amylase
 Lipase
 Urinary enzymes (urinary trypsinogen 2)
 Trypsinogen activation peptide

20. Inflammatory Markers
 Inflammatory cells release neutrophil-specific
elastase
 Interleukin-6 (IL-6)
 C-reactive protein

21. Markers of Biliary Tract Involvement
 alanine aminotransferase (ALT)
 Ratio of lipase to amylaseratio of lipase to
amylase in alcoholic
 Serum bilirubin level over 3

22. Imaging
 Abdominal Radiographs to exclude non-
pancreatic diseases
 Radiographic findings
1. Pleural effusions
2. Intestinal gas patterns may demonstrate an
ileus pattern
3. Isolated dilated loop of small bowel overlying
the pancreas

23. 4. Colon cutoff sign
5. Loss of the psoas margins
6. Pancreatic calcification or calcified gallstones

24.  Sonography
1. appears hyp-oechoic
 Computed Tomography
1. Pancreatic enlargement
2. Inhomogeneity of the pancreatic parenchyma
3. Fluid infiltrating the peri-pancreatic fat
 Endoscopic Cholangiopancreatography

26. LOCAL COMPLICATIONS
 Acute Fluid Collections
 Necrosis and Infected Necrosis
 Pseudocysts
 Pancreatic Abscesses
 Ascites and Fistulae
 Vascular and Splenic Complications
 Gastrointestinal Obstruction
 Gastrointestinal Obstruction