ACUTE PANCREATITIS Acute pancreatitis can be seen in the emergency department and involves an acute inflammation of the pancreas, usually from alcohol abuse or gallstones. It can be mild to severe, based on associated symptoms along with the inflammation. Gallstones cause about 40 percent of cases by increasing the pressure inside the pancreatic ductal system. Bile itself may be toxic to the pancreatic tissue. Alcohol abuse causes 30 percent of cases; it is not always made more prevalent by drinking more alcohol because the susceptibility to the disease varies with the person. The cells of the pancreas metabolize alcohol so that it becomes a toxic metabolite that aids in the autodigestion of pancreatic tissues. It can also cause plugs of protein in the pancreatic ducts, leading to obstructive damage to the pancreas. There can be genetic causes of acute pancreatitis, which can be autosomal dominant. Cystic fibrosis itself can cause both chronic and acute pancreatitis. Patients who’ve had an ERCP will have a risk of acute pancreatitis as well. Hypertriglyceridemia is a common cause of acute pancreatitis in some people. Pancreatitis can be interstitial in nature or necrotizing in nature. Interstitial pancreatitis is seen with an enlarged pancreas and self-limited disease. Necrotizing pancreatitis is seen in up to 10 percent of cases. Because there is necrosis, the disease is prolonged and tends to be more severe. The disease can also be mild, moderate, or severe. Mild disease is confined to the pancreas, while moderate disease involves the possibility of systemic disease but no organ failure. Severe disease will lead to multiple organ failure and a high rate of death. The complications can be localized or systemic. Localized disease processes include collection of enzyme-rich pancreatic fluid and necrotic material around the pancreas. These can wall off, leading to pancreatic pseudocyst formation. Systemic complications include cardiovascular failure, shock, respiratory failure, and acute kidney injury. Look for systemic inflammatory response syndrome if the temperature is very high, very low, or if there is tachycardia, tachypnea, and either a very low or very high white blood cell count. Most patients who die will die of multiple organ failure within a week of onset.
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