Acute Pancreatitis - Pancreatic Pathologies by the Pancreas Care Center at CCHMC

Acute pancreatitis is an insult to the pancreas that leads to the presence of acute inflammatory cells, edema, and necrosis that in some cases may result in organ damage or fibrosis.

The majority of acute pancreatitis cases are self-limited, but about 30% have recurrence.

Acute pancreatitis pathophysiology involves an insult leading to zymogen activation, generation of inflammatory mediators, then further inflammation and ischemia, necrosis and apoptosis in the gland that in a subset could lead to SIRS and multi-organ failure.

Acute pancreatitis by definition requires two out of three criteria: pain that is classic epigastric origin, lipase or amylase 3 times the upper limit of normal, and imaging findings.

Ultrasound remains the first-line test of choice in acute pancreatitis due to its availability and lack of ionizing radiation.

Ultrasound is only moderately sensitive for acute pancreatitis.

CT or MRI should be used when unable to make a diagnosis with ultrasound, when looking for complications, or when needing to confirm a diagnosis.

MRCP is not the first imaging modality to consider in acute pancreatitis.

Pancreatitis is a state of hypoxia requiring reestablishment of intravascular flow to the pancreas to prevent hypoxia, necrosis, and atrophic pancreas insufficiency.

Early fluid resuscitation was associated with reduced incidence of SIRS and organ failure at 72 hours.

Excessive fluid administration worsens outcomes in acute pancreatitis.

Lactated Ringer's solution decreases the incidence of inflammatory response and C-reactive protein at 24 hours compared to normal saline.

There is no reason to give antibiotics for pancreatitis, even in the face of necrosis or necrotizing pancreatitis.

Enteral nutrition should be started as soon as the patient is able to tolerate oral intake.

Enteral nutrition is significantly better compared to TPN or NPO in acute pancreatitis.

It is acceptable to tolerate some vomiting when initiating enteral nutrition in acute pancreatitis.