Pancreatitis is an inflammatory process in which pancreatic enzymes auto digest the gland.

Acute pancreatitis: The pancreas can sometimes heal without any impairment of function or any morphologic changes.

Chronic pancreatitis: It can recur intermittently, contributing to the functional and morphologic loss of the gland.

Pathophysiology

Since the pancreas is retroperitoneal organ with no capsule, inflammation can spread easily.

• In acute pancreatitis, parenchymal edema and peripancreatic fat necrosis occur first. This process is known as acute edematous pancreatitis.
• Parenchymal necrosis is accompanied by hemorrhage and dysfunction of the gland, the inflammation evolves into hemorrhagic or necrotizing pancreatitis.
• Pseudocysts and pancreatic abscesses can result from necrotizing pancreatitis

Diagnosis: Ultrasonography or, preferably, CT.

The inflammatory process can cause systemic effects because of the presence of cytokines, such as bradykinins and phospholipase A.

These cytokines may cause vasodilatation (dilatation of blood vessels), increase in vascular permeability, pain, and leukocyte accumulation in the vessel walls. Fat necrosis may cause hypocalcaemia. Pancreatic B-cell injury may lead to hyperglycemia.(increase in blood sugar)

Frequency

Incidence of acute pancreatitis is approximately 40 cases per year per 100,000 adults.

Mortality/Morbidity

• Acute respiratory distress syndrome (ARDS), acute renal failure, cardiac depression, hemorrhage, and hypotensive shock all may be systemic manifestations of acute pancreatitis in its most severe form.
• Mild edematous pancreatitis occurs in about 80% of presentations, and the mortality rate is below 1%.
• Severe acute pancreatitis occurs in about 20% of presentations, with a mortality rate reaching 30%.3

The following are some of the symptoms of Pancreatitis:

• The main presentation of acute pancreatitis is epigastric pain or right upper quadrant pain radiating through, rather than around, to the back.
• Nausea and/or vomiting
• Fever
• Underlying recent surgery or invasive procedure (ie, endoscopic retrograde cholangiopancreatography) or family history of hypertriglyceridemia.
• Patients frequently have a history of previous biliary colic and binge alcohol consumption, the major causes of acute pancreatitis.
• Physical
• Tachycardia
• Tachypnea
• Hypotension
• Fever
• Abdominal tenderness, distension, guarding, and rigidity
• Mild jaundice
• Diminished or absent bowel sounds
• Because of contiguous spread of inflammation (effusion) from the pancreas, lung auscultation may reveal basilar rales, especially in the left lung.
• Occasionally, in the extremities, muscular spasm may be noted secondary to hypocalcemia.
• Severe cases may have a Grey Turner sign (ie, bluish discoloration of the flanks) and Cullen sign (ie, bluish discoloration of the periumbilical area) caused by the retroperitoneal leak of blood from the pancreas in hemorrhagic pancreatitis.
• Causes
• The major causes are long-standing alcohol consumption and biliary stone disease.
• Ethanol leads to intracellular accumulation of digestive enzymes and their premature activation and release.
• Ethanol increases the permeability of ductules, which allow enzymes to reach the parenchyma, resulting in pancreatic damage.
• Ethanol increases the protein content of the pancreatic juice and decreases bicarbonate levels and trypsin inhibitor concentrations. This forms protein plugs that block the pancreatic outflow and obstruction.
• biliary stone disease (eg, cholelithiasis, choledocholithiasis).
• Minor causes of acute pancreatitis
• Medications :azathioprine, corticosteroids, sulfonamides, thiazides, furosemides, nonsteroidal anti-inflammatory drugs (NSAIDs), mercaptopurine, methyldopa, and tetracyclines
• Endoscopic retrograde cholangiopancreatography (ERCP)
• Hypertriglyceridemia (When levels more than 1000 mg/U )
• Peptic ulcer disease
• Abdominal or cardiopulmonary bypass surgery, (ischemia to gland)
• Trauma to the abdomen or back, resulting in sudden compression of the gland against the spine posteriorly
• Carcinoma of the pancreas
• Viral infections, including mumps, coxsackievirus, cytomegalovirus (CMV), hepatitis virus, Epstein-Barr virus (EBV), and rubellav • Bacterial infections, such as mycoplasma
• Intestinal parasites, such as Ascaris, which can block the pancreatic outflow
• Pancreas divisum
• Scorpion and snake bites
• Vascular factors, such as ischemia or vasculitis
• Autoimmune pancreatitis (pathogenesis unclear and is rare)

As per the underlying diagnosis the treatment varies from medication to surgeries.