Inflammatory process ranges from mild oedema to necrosis of pancreas & peripancreatic tissues. Clinically it presents as abrupt onset of epigastric pain, frequently with back pain, nausea and vomiting. Diagnosis is confirmed by elevated Serum or Urinary Amylase.
- Gallstones in 40% of cases.
- Alcohol in 40 % of cases.
- Drugs e.g. INH, isoniazid, estrogens, & thiazides in 10% cases.
- Infectious diseases e.g. mumps, orchitis, hepatitis A & B.
- Usually presentation is of shock with cold, clammy skin; low B.P.; rapid low volume pulse
- Severe central abdominal pain radiating directly to the back
- Abdomen diffusely tender, rigidity not as marked as in other causes of peritonitis.
- Discoloration around umbilicus & in flanks may be present.
- Bowel sounds absent.
- Hypoxemia & renal failure may be the only presenting features.
- CBC, leukocytosis.
- Serum amylase > 300 IU.
- Serum lipase is elevated. It is more specific and returns to normal after 3-5 days
- Serum Ca++ is low in very severe cases.
- Plain X-Ray Abdomen & chest to;
- Rule out duodenal perforation as a differential diagnosis.
- Pancreatic calcification.
- Ultrasonography may reveal cholelithiasis, acute cholecystitis, or a swollen pancreas.
- C.T. Scan with I/V contrast
- Treatment of shock including O2 therapy
- Inj. Nalbufin 10 mg to relieve pain, then repeats according to response and Maxolon for vomiting.
- Give I/V fluids. During treatment, over-infusion is avoided by monitoring the JVP & auscultation of the chest (basal crepts).
- Nasogastric tube for gastric decompression if patient vomiting.
- (Prophylactic antibiotics) Inj. Meropenam I/V 50mg BD for five days.
- Calcium gluconate (10%) 10 ml is given 1/V.
- Insulin if marked hyperglycemia.
- Injection cimetidine 200 mg I/V 6 hourly
- Blood transfusion in case of severe haemorrhagic shock.
- Patients with hypoxia require oxygen therapy or assisted ventilation
- Look out for complications i.e. ARDS, pseudopancreatic cyst or pancreatic abscess etc.
- Consider standostatin