Master Acute Pancreatitis with a Mnemonic

Patients present with severe epigastric abdominal pain that radiates to the back. This pain usually worsens after meals.

Patients with acute pancreatitis develop a severe loss of appetite, or anorexia.

With acute pancreatitis, patients feel nauseous and sometimes have severe vomiting.

Elevated serum amylase and lipase levels, in combination with severe abdominal pain, often trigger the initial diagnosis of acute pancreatitis. However, enzymes have no role in assessing disease severity. Lipase is more sensitive for alcohol-induced pancreatitis, and if the lipase level is about 2.5 to 3 times that of amylase, it is suggestive of pancreatitis due to alcohol. Lipase is also more specific than amylase.

Pancreatitis may progress to DIC (disseminated intravascular coagulation), which is a consumptive thrombotic-hemorrhagic disease. It may present with abnormal bleeding, kidney or liver failure, and shock.

Pancreatic necrosis can subsequently lead to infection. Pathogens are typically gut microflora such as E. coli or Klebsiella. Treatment includes antibiotics and/or surgical debridement.

This is caused primarily by precipitation of calcium soaps in the abdominal cavity. When the pancreas is damaged, free fatty acids are generated by the action of pancreatic lipase. Insoluble calcium salts are present in the pancreas, and the free fatty acids avidly chelate the salts, resulting in calcium deposition in the retroperitoneum (saponification). Hypocalcemia can present with tetany.

SIRS (systemic inflammatory response syndrome) is a serious complication of acute pancreatic disease and occurs due to cytokine activation and widespread systemic inflammation. SIRS is associated with multi-organ failure, notably ARDS (acute respiratory distress syndrome) and renal failure, as well as shock.

ARDS (acute respiratory distress syndrome) is a serious complication of acute pancreatic disease and occurs due to widespread systemic inflammation. It often manifests as dyspnea in patients with acute pancreatic disease.

Pancreatic pseudocyst is a circumscribed collection of fluid rich in pancreatic enzymes, blood, and necrotic tissue. It is lined with granulation tissue. Disruption of pancreatic parenchyma and the ductal system results in extravasation of pancreatic enzymes, which in turn digest the adjoining tissues. This results in a collection of fluid containing pancreatic enzymes, hemolyzed blood and necrotic debris around the pancreas usually around four weeks after the onset of pancreatitis. Treatment can include endoscopic drainage or surgery.

Acute necrotic destruction of pancreatic parenchyma, fat, or local vessels can lead to life-threatening hemorrhage. Rupture of a pancreatic pseudocyst can also lead to hemorrhage a few weeks after the initial presentation of pancreatitis.