Recent Modalities In Diagnosis and Treatment of Acute Pancreatitis

Abstract

Acute pancreatitis is an inflammatory disorder of the pancreas, causing sudden and severe abdominal pain. The pancreas is an organ that lies in the back of the mid-abdomen. It is responsible for insulin production and the manufacture and secretion of digestive enzymes. Most attacks of acute pancreatitis do not lead to complications, and most people recover uneventfully with medical care. However, a small proportion of people have a more serious illness that requires intensive medical care. In all cases, it is essential to determine the underlying cause of acute pancreatitis and, if possible, to treat this conditions to prevent a recurrence. Gallstone pancreatitis is the most common cause of AP. Because the gallbladder and pancreas share a drainage duct, gallstones that lodge in this duct can prevent the normal flow of pancreatic enzymes and trigger acute pancreatitis. Alcoholic pancreatitis is seen more frequently in men. Ethanol causes spasm of the sphincter of Oddi, and more importantly, it is a metabolic toxin to pancreatic acinar cells. It also transiently decreases pancreatic blood flow, possibly causing focal ischemic injury to the gland. As regards pathogenesis of acute pancreatitis, the principle mechanism for it is premature activation of the pancreatic enzymes within the pancreas that leads to organ injury and pancreatitis, also inflammatory mediators (IL-1, IL-6, TNF and others) should be taken in consideration as it causes increases in the pancreatic vascular permeability leading to hemorrhage, edema and eventually pancreatic necrosis. Clinical diagnosis: Symptoms of pancreatitis usually include severe constant epigastric pain radiating to the back and flanks and vomiting. Signs may include pyrexia, abdominal distension and peritonism. The classical signs of discoloration of the flanks (Grey-Turner's sign), peri-umbilicus (Cullen's sign) and inguinal ligament (Fox's sign) are not always seen and are a result of retroperitoneal hemorrhage tracking along tissue planes. In addition, symptoms and signs of end-organ involvement may be evident, including respiratory distress, shock, oliguria, jaundice and delirium. It is also possible for SAP to be painless. Laboratory diagnosis: Amylase, lipase and trypsinogen are all enzymes derived from pancreatic acinar cells; they can be measured with relative ease. Serum amylase is most commonly used in clinical practice. Serum lipase has been recommended as the assay of choice when available. Lipase concentrations are increased for up to 14 days after onset of pancreatitis and appear to be more sensitive and specific than amylase. Imaging diagnosis: Imaging tests provide information about the structure of the pancreas, the ducts that drain the pancreas and gallbladder, and the tissues surrounding the pancreas. Imaging tests may include transabdominal ultrasound, Computed tomography scanning of abdomen, MRI and Magnetic resonance cholangiopancreatography. Assessment of disease severity: Accurate prediction of severity early in the course of disease offers potential benefits in that complications can be anticipated and detected early through the use of intensive monitoring and frequent clinical assessment, and early and aggressive therapies can be instituted to attempt to prevent these complications. Routine clinical assessment at the time of admission is associated with low sensitivities (<50%) in identifying patients with SAP. Therefore, alternative methods for assessing disease severity based on scoring systems, CT scanning, and serum markers have been widely studied. In addition to these methods, hemoconcentration and obesity have been reported to be predictive of severe disease. Treatment: