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  1. Idiopathic: 3rd most common - thought to be hypertensive sphincter or microlithiasis
  2. Gallstones (45%)
  3. Ethanol (35%)
  4. Tumors: pancreas, ampulla, choledochocele
  5. Microbiological
    • Bacterial: mycoplasma, Campylobacter, TB, MAI, legionella,eptospirosis
    • viral: mumps, rubella, varicella, viral hepatitis, CMV, EBV,HIV, Coxsackievirus, echo virus, adenovirus
    • parasites: Ascariasis, Clonorchiasis, Echinococcosis
  6. Autoimmune: lupus, PAN, Crohnís
  7. Surgery/trauma
    • manipulation of sphincter of Oddi (e.g. ERCP), post-cardiac surgery, blunt trauma to abdomen, penetrating peptic ulcer
  8. Hyperlipidemia (TG >11.3 mmol/L), hypercalcemia, hypothermia
  9. Emboli or ischemia
  10. Drugs/toxins: azathioprine, mercaptopurine, DDI, furosemide, estrogens, H2 blockers, valproic acid, antibiotics, acetaminophen,
    methyldopa, salicylates, ethanol, methanol, organophosphates





  1. peripancreatic fat necrosis
  2. interstitial edema 



  1. extensive peripancreatic and intrapancreatic fat necrosis
  2. parenchymal necrosis and hemorrhage --->  infection in 60%
  3. release of toxic factors into systemic circulation and peritoneal space 
  4. severity of clinical features may not always correlate with pathology





  1. patient can look well or pre-morbid!
  2. pain: epigastric, noncolicky, constant, can radiate to back, may  improve when leaning forward (Inglefinger's sign); tender rigid abdomen; guarding
  3. nausea and vomiting
  4. abdominal distension from paralytic ileus
  5. fever: chemical, not due to infection
  6. jaundice: compression or obstruction of bile duct
  7. Tetany: transient hypocalcemia
  8. hypovolemic shock: can lead to renal failure
  9. adult respiratory distress syndrome
    • breakdown of phospholipase A2
  10. coma 
  11. body wall ecchymoses occur, around the umbilicus (Cullen's sign) or in the flanks (Grey Turner's sign)





  1. increased pancreatic enzymes in blood
    • increased amylase: sensitive but not specific
    • increased lipase: > sensitivity and specificity - and stays elevated longer
  2. increased WBC
  3. imaging
  4. x-ray: “sentinel loop” (dilated proximal jejunem), calcification and “colon cut-off sign” (colonic spasm)
  5. U/S: best for evaluating biliary tree (67% SENS, 100% SPEC)
  6. C/T scan with IV contrast: useful prognostic indicator because contrast seen only in viable  pancreatic tissue.  Non-viable areas can be biopsied percutaneously to diagnose infected pancreatic necrosis
  7. ERCP + manometry: if no cause found



  1. usually a benign, self-limiting course, single or recurrent
  2. occasionally severe leading to
    • shock
    • renal and pulmonary insufficiency
    • pancreatic abscess
    • coagulopathy
    • hyperglycemia and hypoglycemia
    • GI ulceration due to stress
    • death
  3. functional restitution to normal occurs if primary cause and complications are eliminated (exception: alcohol)
  4. occasional persistence of scarring and pseudocysts
  5. rarely does chronic pancreatitis ever develop
ACUTE PANCREATITIS Part 01 ACUTE PANCREATITIS Part 01 Reviewed by Radiology Madeeasy on August 29, 2010 Rating: 5
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