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Encyclopedia > Pancreatitis
Pancreatitis
Classification & external resources
ICD-10 K85., K86.0-K86.1
ICD-9 577.0-577.1
eMedicine emerg/354 

Pancreatitis is inflammation of the pancreas. See also acute pancreatitis and chronic pancreatitis for more details. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // K00-K93 - Diseases of the digestive system (K00-K14) Diseases of oral cavity, salivary glands and jaws (K00) Disorders of tooth development and eruption (K01) Embedded and impacted teeth (K02) Dental caries (K03) Other diseases of hard tissues of teeth (K04) Diseases of pulp and periapical tissues (K040) Pulpitis (K05... // K00-K93 - Diseases of the digestive system (K00-K14) Diseases of oral cavity, salivary glands and jaws (K00) Disorders of tooth development and eruption (K01) Embedded and impacted teeth (K02) Dental caries (K03) Other diseases of hard tissues of teeth (K04) Diseases of pulp and periapical tissues (K040) Pulpitis (K05... // K00-K93 - Diseases of the digestive system (K00-K14) Diseases of oral cavity, salivary glands and jaws (K00) Disorders of tooth development and eruption (K01) Embedded and impacted teeth (K02) Dental caries (K03) Other diseases of hard tissues of teeth (K04) Diseases of pulp and periapical tissues (K040) Pulpitis (K05... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... An abscess on the skin, showing the redness and swelling characteristic of inflammation. ... The pancreas is an organ in the digestive and endocrine system (of vertebrates[2]). It is both exocrine (secreting pancreatic juice containing digestive enzymes) and endocrine (producing several important hormones, including insulin, glucagon, and somatostatin). ... Chronic pancreatitis can present as episodes of acute inflammation in a previously injured pancreas, or as chronic damage with persistent pain or malabsorption. ...

Contents

Causes

The most common cause of acute pancreatitis is gallstones. Excessive alcohol use is often cited as the second most common cause of acute pancreatitis, but this is technically incorrect, as these patients invariably have enough destruction to their pancreatic parenchyma to be considered to have chronic pancreatitis, so it is more correct to say that these patients present with acute flare-ups of their chronic pancreatitis rather than acute pancreatitis. Less common causes include hypertriglyceridemia (but not hypercholesterolemia) and only when triglyceride values exceed 1500 mg/dl (16 mmol/L), hypercalcemia, viral infection (e.g. mumps), trauma (to the abdomen or elsewhere in the body) including post-ERCP (i.e. Endoscopic Retrograde Cholangio-Pancreatography), vasculitis (i.e. inflammation of the small blood vessels within the pancreas), and autoimmune pancreatitis. Pregnancy can also cause pancreatitis, but in some cases the development of pancreatitis is probably just a reflection of the hypertriglyceridemia which often occurs in pregnant women. Pancreas divisum, a common congenital malformation of the pancreas may underlie some cases of recurrent pancreatitis. This article or section does not adequately cite its references or sources. ... In medicine, hypertriglyceridemia (or Hypertriglyceridaemia) denotes high (hyper-) blood levels (-emia) of triglycerides, the most abundant fatty molecule in most organisms. ... Hypercholesterolemia (literally: high blood cholesterol) is the presence of high levels of cholesterol in the blood [1]. It is not a disease but a metabolic derangement that can be secondary to many diseases and can contribute to many forms of disease, most notably cardiovascular disease. ... Hypercalcaemia is an elevated calcium level in the blood. ... Endoscopic retrograde cholangiopancreatography (ERCP) is endoscopy of the biliary tree and the pancreatic duct. ... In medicine, vasculitis (plural: vasculitides) is a group of diseases featuring inflammation of the wall of blood vessels due to leukocyte migration and resultant damage. ... This article or section does not cite its references or sources. ... In medicine, hypertriglyceridemia (or Hypertriglyceridaemia) denotes high (hyper-) blood levels (-emia) of triglycerides, the most abundant fatty molecule in most organisms. ... Pancreas divisum is a congenital defect in which parts of the pancreas to fail to fuse together. ...


Many medications have been reported to cause pancreatitis. Some of the more common ones include the AIDS drugs DDI and pentamidine, diuretics such as furosemide and hydrochlorothiazide, the chemotherapeutic agents L-asparaginase and azathioprine, and estrogen. Just as is the case with pregnancy associated pancreatitis, estrogen may lead to the disorder because of its effect to raise blood triglyceride levels. Didanosine (2-3-dideoxyinosine, ddI) is sold under the trade names Videx® and Videx EC®. It is a reverse transcriptase inhibitor, effective against HIV and usually used in combination with other antiviral drug therapy as part of highly active antiretroviral therapy (HAART). ... Pentamidine isethionate is a drug primarily given for prevention and treatment of Pneumocystis carinii pneumonia (PCP), a type of pneumonia often seen in people with HIV infection. ... A diuretic is any drug that tends to increase the flow of urine from the body (diuresis). ... Furosemide (INN) or frusemide (former BAN) is a loop diuretic used in the treatment of congestive heart failure and oedema. ... Hydrochlorothiazide (Apo-Hydro®, Aquazide H®, Microzide®, Oretic®), sometimes abbreviated HCT, HCTZ, or HZT is a popular diuretic drug that acts by inhibiting the kidneys ability to retain water. ... Chemotherapy is the use of chemical substances to treat disease. ... Asparaginase (EC 3. ... Azathioprine is a chemotherapy drug, now rarely used for chemotherapy but more for immunosuppression in organ transplantation, autoimmune disease such as rheumatoid arthritis or inflammatory bowel disease such as Crohns disease. ... Estriol. ...


Conditions that can lead to gut dysmotility predispose patients to pancreatitis. This includes the inherited neurovisceral porphyrias and related metabolic disorders. Alcohol, hormones and many drugs including statins are known porphyrinogenic agents. Physicians should be on alert concerning underlying porphyrias in patients presenting with pancreatitis and should investigate and eliminate any drugs that may be activating the disorders.


It is worth noting that pancreatic cancer is seldom the cause of pancreatitis. Pancreatic cancer is a malignant tumour within the pancreatic gland. ...


Symptoms and Signs

Severe upper abdominal pain, with radiation through to the back, is the hallmark of pancreatitis. Nausea and vomiting are prominent symptoms. Findings on the physical exam will vary according to the severity of the pancreatitis, and whether or not it is associated with significant internal bleeding. The blood pressure may be high (when pain is prominent) or low (if internal bleeding or dehydration has occurred). Typically, both the heart and respiratory rates are elevated. Abdominal tenderness is usually found but may be less severe than expected given the patient's degree of abdominal pain. Bowel sounds may be reduced as a reflection of the reflex bowel paralysis (i.e. ileus) that may accompany any abdominal catastrophe. The intestine is the portion of the alimentary canal extending from the stomach to the anus and, in humans and other mammals, consists of two segments, the small intestine and the large intestine. ... Ileus refers to limited or absent intestinal passage. ...


Diagnosis

The diagnostic criteria for pancreatitis are "two of the following three features: 1) abdominal pain characteristic of acute pancreatitis, 2) serum amylase and/or lipase ≥3 times the upper limit of normal, and 3) characteristic findings of acute pancreatitis on CT scan."[1]


Laboratory tests

Most frequently, measurement is made of amylase and/or lipase, and often one, or both, are elevated in cases of pancreatitis. Two practice guidelines state: Amylase is the name given to glycoside hydrolase enzymes that break down starch into glucose molecules. ... A computer-generated image of a type of pancreatic lipase (PLRP2) from the guinea pig. ...

"It is usually not necessary to measure both serum amylase and lipase. Serum lipase may be preferable because it remains normal in some nonpancreatic conditions that increase serum amylase including macroamylasemia, parotitis, and some carcinomas. In general, serum lipase is thought to be more sensitive and specific than serum amylase in the diagnosis of acute pancreatitis"[1]
"Although amylase is widely available and provides acceptable accuracy of diagnosis, where lipase is available it is preferred for the diagnosis of acute pancreatitis (recommendation grade A)"[2]

Two notable scoring systems are used to help predict the severity of an attack of Pancreatitis, this is the Glasgow criteria and Ranson's scoring. They are similar and overlap in their criteria but help differentiate patients who may require high dependancy care.


Glasgow's criteria: The original system used 9 data elements. This was subsequently modified to 8 data elements, with removal of assessment for transaminase levels (either AST (SGOT) or ALT (SGPT) greater than 100 U/L).


Parameters used:


At admisson:


(1) age in years >55years = 1


(2) TLC > 16000/mcL= 1


(3) blood glucose > 200 mg/dL = 1


(4) AST > 250 IU/L = 1


(5) serum LDH > 350 IU/L = 1



After 48 hours:


(1)Haematocrit fall > 10%


(2)BUN > 8mg%


(3)S. calcium < 8mg%


(4)sPo2 <60mm(Hg)


(5)Base deficit > 4Meq/L


(6)Estimated fluid sequestration > 6L


The criteria for point assignment is that a certain breakpoint be met at anytime during that 48 hour period, so that in some situations it can be calculated shortly after admission. It is applicable to both biliary and alcoholic pancreatitis.


Interpretation:


• minimum score 0


• maximum score 8


• If the score >=3, severe pancreatitis likely.


• If the score < 3, severe pancreatitis is unlikely


Most (PMID 15943725, PMID 11552931, PMID 2580467, PMID 2466075, PMID 9436862), but not all (PMID 11156345, PMID 8945483) individual studies support the superiority of the lipase. In one large study, there were no patients with pancreatitis who had an elevated amylase with a normal lipase.[3] Another study found that the amylase could add diagnostic value to the lipase, but only if the results of the two tests were combined with a discriminant function equation.[4]


Conditions other than pancreatitis may lead to rises in these enzymes and, further, that those conditions may also cause pain that resembles that of pancreatitis (e.g. cholecystitis, perforated ulcer, bowel infarction (i.e. dead bowel as a result of poor blood supply), and even diabetic ketoacidosis. Cholecystitis is inflammation of the gallbladder. ... Endoscopic images of a duodenal ulcer. ... The intestine is the portion of the alimentary canal extending from the stomach to the anus and, in humans and other mammals, consists of two segments, the small intestine and the large intestine. ... This article does not adequately cite its references or sources. ... Diabetic ketoacidosis (DKA) is a life-threatening complication in patients with untreated diabetes mellitus (chronic high blood sugar or hyperglycemia). ...


Imaging

Although ultrasound imaging and CT scanning of the abdomen can be used to confirm the diagnosis of pancreatitis, neither is usually necessary as a primary diagnostic modality[5] . In addition, CT contrast may exacerbate pancreatitis,[6] although this is disputed.[7] See acute pancreatitis. Medical ultrasonography is an ultrasound-based imaging diagnostic technique used to visualize internal organs, their size, structure and their pathological lesions. ... CAT apparatus in a hospital Computed axial tomography (CAT), computer-assisted tomography, computed tomography, CT, or body section roentgenography is the process of using digital processing to generate a three-dimensional image of the internals of an object from a large series of two-dimensional X-ray images taken around... The abdomen is a part of the body. ...


Genetic Testing

Pancreatic diseases are notoriously complex disorders resulting from the interaction of multiple genetic, environmental and metabolic factors. Three candidates for genetic testing are currently investigation: Trypsinogen mutations, Cystic Fibrosis Transmembrane Conductance Regulator Gene (CFTR) mutations and SPINK1 which codes for PSTI - a specific trypsin inhibitor.[8]


Complications

Acute (early) complications of pancreatitis include shock, hypocalcemia (low blood calcium), high blood glucose, dehydration, and kidney failure (resulting from inadequate blood volume which, in turn, may result from a combination of fluid loss from vomiting, internal bleeding, or oozing of fluid from the circulation into the abdominal cavity in response to the pancreas inflammation). Respiratory complications are frequent and are major contributors to the mortality of pancreatitis. Some degree of pleural effusion is almost ubiquitous in pancreatitis. Some or all of the lungs may collapse (atelectasis) as a result of the shallow breathing which occurs because of the abdominal pain. Pneumonitis may occur as a result of pancreatic enzymes directly damaging the lung, or simply as a final common pathway response to any major insult to the body (i.e. ARDS or Acute Respiratory Distress Syndrome). Likewise, SIRS (Systemic inflammatory response syndrome) may ensue. This article is about the medical condition. ... In medicine, hypocalcaemia is the presence of less than a total calcium of 2. ... Pleural effusion Chest x-ray of a pleural effusion. ... Atelectasis is defined as collapse of a part of the lung or the whole lung, where the alveoli are deflated, as distinct from pulmonary consolidation. ... Pneumonia is an inflammation of the lung. ... ARDS has multiple meanings: Ards is a district in Northern Ireland ARDS is the abbreviation of Acute respiratory distress syndrome, formerly known as adult respiratory distress syndrome This is a disambiguation page &#8212; a navigational aid which lists other pages that might otherwise share the same title. ... Acute respiratory distress syndrome (ARDS), also known as respiratory distress syndrome (RDS) or adult respiratory distress syndrome (in contrast with IRDS) is a serious reaction to various forms of injuries to the lung. ... In medicine, systemic inflammatory response syndrome (SIRS) is an inflammatory state of the whole body (the system). It is characterized by fast heart rate (tachycardia, heart rate >90/min), low blood pressure (systolic <90 or MAP <65), low or high body temperature (<36 or >38 C), high respiratory rate (>20... It has been suggested that this article or section be merged with Sepsis. ...


Infection of the inflamed pancreatic bed can occur at any time during the course of the disease. In fact, in cases of severe hemorrhagic pancreatitis, antibiotics should be given prophylactically.


Late complications of pancreatitis include recurrent pancreatitis and the development of pancreatic pseudocysts. A pancreatic pseudocyst is essentially a collection of pancreatic secretions which has been walled off by scar and inflammatory tissue. Pseudocysts may cause pain, may become infected, may rupture and hemorrhage, may press on and block structures such as the bile duct, thereby leading to jaundice, and may even migrate around the abdomen. A pancreatic pseudocyst is a circumscribed collection of pancreatic fluid typically located in the lesser omentum. ... Jaundice, also known as icterus (attributive adjective: icteric), is a yellowing of the skin, conjunctiva (a clear covering over the sclera, or whites of the eyes) and mucous membranes caused by increased levels of bilirubin in red blooded animals. ...


Treatment

The treatment of pancreatitis will, of course, depend on the severity of the pancreatitis itself. Still, general principles apply and include 1. provision of pain relief (with morphine, contrary to earlier pronouncements, being the agent of choice), 2. provision of adequate replacement fluids and salts (intravenously), 3. limitation of oral intake (with dietary fat restriction the most important point), and 4. monitoring and assessment for, and treatment of, the various complications listed above. When necrotizing pancreatitis ensues and the patient shows signs of infection it is imperative to start antibiotics such as Imipenem due to its high penetration of the drug in the pancreas. Morphine (INN) (IPA: ) is a highly potent opiate analgesic drug and is the principal active agent in opium and the prototypical opiate. ... An intravenous drip in a hospital Intravenous therapy or IV therapy is the administration of liquid substances directly into a vein. ...


Types

There are three forms of pancreatitis, which are different in causes and symptoms, and require different treatment:

Acute hepatic porphyrias, including acute intermittent porphyria, hereditary coproporphyria and variegate porphyria, are genetic disorders that can be linked to both acute and chronic pancreatitis. Acute pancreatitis has also occurred with erythropoietic protoporphyria. Chronic pancreatitis can present as episodes of acute inflammation in a previously injured pancreas, or as chronic damage with persistent pain or malabsorption. ... Hereditary Pancreatitis is a genetic disease affecting enzyme production in the pancreas. ... Trypsinogen (EC 3. ... The pancreas is an organ in the digestive and endocrine system (of vertebrates[2]). It is both exocrine (secreting pancreatic juice containing digestive enzymes) and endocrine (producing several important hormones, including insulin, glucagon, and somatostatin). ... The pancreas is an organ in the digestive and endocrine system (of vertebrates[2]). It is both exocrine (secreting pancreatic juice containing digestive enzymes) and endocrine (producing several important hormones, including insulin, glucagon, and somatostatin). ... Hepatic porphyrias can refer to: hereditary coproporphyria acute intermittent porphyria porphyria cutanea tarda hepatoerythropoietic porphyria variegate porphyria erythropoietic protoporphyria Porphyrias Erythropoietic porphyria MeSH Porphyrias,+Hepatic Categories: | ... Acute intermittent porphyria (AIP) is a rare metabolic disorder that is characterized by a deficiency of the enzyme, porphobilinogen deaminase (PBG-D), also known as uroporphyrinogen I-synthase. ... The porphyrias are inherited or acquired disorders of certain enzymes in the heme biosynthetic pathway (also called porphyrin pathway). ... The porphyrias are inherited or acquired disorders of certain enzymes in the heme biosynthetic pathway (also called porphyrin pathway). ... Acute pancreatitis is rapidly-onset inflammation of the pancreas. ... Chronic pancreatitis can present as episodes of acute inflammation in a previously injured pancreas, or as chronic damage with persistent pain or malabsorption. ... The porphyrias are inherited or acquired disorders of certain enzymes in the heme biosynthetic pathway (also called porphyrin pathway). ...


References

  1. ^ a b Banks P, Freeman M (2006). "Practice guidelines in acute pancreatitis". Am J Gastroenterol 101 (10): 2379-400. DOI:10.1111/j.1572-0241.2006.00856.x. PMID 17032204. 
  2. ^ UK Working Party on Acute Pancreatitis (2005). "UK guidelines for the management of acute pancreatitis". Gut 54 Suppl 3: iii1-9. DOI:10.1136/gut.2004.057026. PMID 15831893. 
  3. ^ Smith R, Southwell-Keely J, Chesher D (2005). "Should serum pancreatic lipase replace serum amylase as a biomarker of acute pancreatitis?". ANZ J Surg 75 (6): 399-404. DOI:10.1111/j.1445-2197.2005.03391.x. PMID 15943725. 
  4. ^ Corsetti J, Cox C, Schulz T, Arvan D (1993). "Combined serum amylase and lipase determinations for diagnosis of suspected acute pancreatitis". Clin Chem 39 (12): 2495-9. PMID 7504593. 
  5. ^ Fleszler F, Friedenberg F, Krevsky B, Friedel D, Braitman L (2003). "Abdominal computed tomography prolongs length of stay and is frequently unnecessary in the evaluation of acute pancreatitis". Am J Med Sci 325 (5): 251-5. PMID 12792243. 
  6. ^ McMenamin D, Gates L (1996). "A retrospective analysis of the effect of contrast-enhanced CT on the outcome of acute pancreatitis". Am J Gastroenterol 91 (7): 1384-7. PMID 8678000. 
  7. ^ Hwang T, Chang K, Ho Y (2000). "Contrast-enhanced dynamic computed tomography does not aggravate the clinical severity of patients with severe acute pancreatitis: reevaluation of the effect of intravenous contrast medium on the severity of acute pancreatitis". Arch Surg 135 (3): 287-90. PMID 10722029. 
  8. ^ D. Whitcomb (2006). Genetic Testing for Pancreatitis.

A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ...

External links

  • Medical information and Treatment options for pancreatitis
  • Pancreatitis Supporters' Network
  • NHS Direct - Health encyclopaedia -Pancreatitis
  • Surgeons Net Education - Pancreatitis tutorial and discussion
  • National Digestive Diseases Information Clearing House

  Results from FactBites:
 
P - Pancreatitis (1309 words)
Miniature schnauzers are predisposed to pancreatitis due to a tendency to have high levels of lipoproteins in their blood streams.
When your vet examines your dog and suspects pancreatitis, she will look for abdominal pain that seems to be centered in the portion of the abdomen that is partially covered by the ribs.
Pancreatitis is harder to diagnose in cats because they are less likely to have high enzyme levels and either hide pain better or experience less pain, making the need for testing less obvious.
  More results at FactBites »

 
 

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