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Pancreatitis- sign and symptoms, diagnosis, investigations

Pancreatitis- Sign and Symptoms

Acute Pancreatitis

  1. Severe abdominal pain: Typically, the pain occurs in the mid-epigastrium. Pain is frequently acute in onset, occurring 24 to 48 hours after a very heavy meal or alcohol ingestion, and it may be diffuse and difficult to localize. It is generally more severe after meals and is unrelieved by antacids.
  2. Abdominal tenderness and back pain result from irritation and edema of the inflamed pancreas that stimulate the nerve endings.
  3. Abdominal distention: A poorly defined, palpable abdominal mass; and decreased peristalsis.
  4. Nausea and Vomiting: Frequent vomiting that does not relieve the pain or nausea. The emesis is usually astric in origin but may be bile-stained.
  5. Abdominal guarding: The patient appears acutely ill and abdominal guarding is present. A rigid or board-like abdomen may develop and is generally an ominous sign; the abdomen may remain soft in the absence of peritonitis.
  6. Ecchymosis (bruising) in the flank or around the umbilicus may indicate severe pancreatitis.
  7. Fever, jaundice, mental confusion, and agitation also may occur.
  8. Hypotension: It is typical and reflects hypovolemia and shock caused by the loss of large amounts of protein-rich fluid into the tissues and peritoneal cavity. The patient may develop tachycardia, cyanosis, and cold, clammy skin in addition to hypotension.
  9. Acute renal failure is common.
  10. Respiratory distress and hypoxia are common, and the patient may develop diffuse pulmonary infiltrates, dyspnea, tachypnea, and abnormal blood gas values.
  11. Myocardial depression, hypocalcemia, hyperglycemia, and disseminated intravascular coagulopathy (DIC) may also occur with acute pancreatitis.

 

Chronic Pancreatitis

  1. Severe upper abdominal and back pain: It is recurrent and does not get relief with opoids (even in large dose). As the disease progresses, recurring attacks of pain are more severe, more frequent, and of longer duration. Some patients experience continuous severe pain; others have a dull, nagging constant pain.
  2. Nausea and Vomiting: It is very severe and patient be unable to take food.
  3. Weight loss: It is usually caused by decreased dietary intake secondary to anorexia or fear that eating will precipitate another attack.
  4. Malabsorption: It occurs late in the disease, when as little as 10% of pancreatic function remains. As a result, digestion, especially of proteins and fats, is impaired.
  5. Steatorrhea: The stools become frequent, frothy, and foul-smelling because of impaired fat digestion, which results in stools with a high fat content.
  6. Dependence on opioids: It is increased in pancreatitis because of the chronic nature and severity of the pain.
  7. Calcification of the gland may occur, and calcium stones may form within the ducts.

 

INVESTIGATIONS

  1. History of abdominal pain and the presence of known risk factors
  2. Physical examination findings
  3. Diagnostic findings
  • Serum amylase and lipase levels are used in making the diagnosis of acute pancreatitis. In 90% of the cases, serum amylase and lipase levels usually rise in excess of three times their normal upper limit within 24 hours. Serum amylase usually returns to normal within 48 to 72 hours. Serum lipase levels may remain elevated for 7 to 14 days.
  • Urinary amylase levels also become elevated and remain elevated longer than serum amylase levels.
  • The white blood cell count is usually elevated.
  • Hematocrit and hemoglobin levels are used to monitor the patient for bleeding.
  • Hypocalcemia is present in many patients and correlates well with the severity of pancreatitis. Transient hyperglycemia and glucosuria and elevated serum bilirubin levels occur in some patients with acute pancreatitis.
  • The stools of patients with pancreatic disease are often bulky, pale, and foul-smelling. Fat content of stools varies between 50% and 90% in pancreatic disease; normally, the fat content is 20%.
  • Glucose tolerance test is mainly used in Chronic pancreatitis
  • X-ray studies of the abdomen and chest may be obtained to differentiate pancreatitis from other disorders that may cause similar symptoms and to detect pleural effusions.
  • Ultrasonography
  • Contrast-enhanced CT scans and MRI are used to identify an increase in the diameter of the pancreas and to detect pancreatic cysts, abscesses, or pseudocysts.
  • Peritoneal fluid, obtained through paracentesis or peritoneal lavage, may contain increased levels of pancreatic enzymes.
  • ERCP is commonly used in the diagnostic evaluation of chronic pancreatitis because the patient is acutely ill; however, it may be valuable in the treatment of gallstone pancreatitis.

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