Friday, March 12, 2010
Acute Pancreatitis
8:02 PM | 
Diposkan oleh
Hermanto
Acute pancreatitis is an inflammatory process arising in the exocrine pancreas, with variable involvement of peripancreatic tissues or remote organ systems. Incidence of acute pancreatitis from about 10 to 50 case per 100,000 per year.
Gallstone disease and alcoholism are the most common etiology of this disease in industrialized country. Other etiologies are infection (ascariasis, mumps, cytomegalo virus infection), hyperlipidemia, chronic hypercalcemia, abdominal trauma (blunt or penetrating), surgery.
Acute pancreatitis primary complain is abdominal pain (about 95%). The characteristic of this pain are epigastric location and radiates to the back in one-half to two-thirds of patients and usually worsened by ingesting food or alcohol or by vomiting. Patient usually assume a knee-to-chest position to relief their pain. Other symptoms are nausea, vomiting and distention of abdominal.
On examination, abdominal tenderness is usually present. It may be mild and limited to the epigastrium or marked, diffuse, and accompanied by abdominal rigidity and rebound tenderness.
Fever, tachycardia, tachypnea and hypotension manifest depend of the severity of this disease. Patient with biliary obstruction usually present icterus.
Serum amylase consentration has been used to diagnose acute pancreatitis for more than 70 years. But serum amylase levels may also be elevated in several conditions that can closely mimic acute pancreatitis (e.g., cholangitis, gastrointestinal perforation or ischemia, ruptured ectopic pregnancy).
Abdominal CT scan also has a great contribution to help us diagnose acute pancreatitis. Abdominal ultrasonography may be useful in determining whether gallstones are the cause of an episode of acute pancreatitis.
Providing supportive care, Decreasing pancreatic inflammation and preventing the complications are the goal of treatment. For mild acute pancreatitis, patient need full bed rest, intravenous hydration and electrolytes, analgesia to relief pain. For severy acute pancreatitis, patient usually need an intensive care unit with careful attention to monitoring of hemodynamics , urine output, and respiratory and renal function. Patients should initially be kept at bed rest with no oral intake, and large amounts of intravenous narcotic analgesics are typically needed for pain relief as well as nasogastric suction for treatment of severe ileus, nausea, and vomiting. Several pharmacologic agents have been tried to inactivate trypsin and other serine proteases, decrease pancreatic secretion and reduce inflammation.
The most lethal complication is hypovolemia shock due to transudation and exudation of fluid into the retroperitoneum and peritoneum.
