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==Overview==
==Overview==
There are different forms of pancreatitis, which are different in causes and symptoms, and require different treatment.
Based on the duration of symptoms, pancreatitis may be classified into either acute or chronic.
 
==Classification==
==Classification==
===Acute Pancreatitis===
===1. Acute Pancreatitis===
 
==== Subtypes: ====
* Interstitial edematous pancreatitis
 
* Necrotizing pancreatitis
* Hemorrhagic pancreatitis
Acute [[pancreatitis]] is a rapidly-onset [[inflammation]] of the [[pancreas]]. Depending on its severity, it can have severe complications and high mortality despite treatment. While mild cases are often successfully treated with conservative measures, such as[[NPO]] (abstaining from any oral intake) and IV fluid rehydration, severe cases may require admission to the ICU or even surgery (often more than one intervention) to deal with complications of the disease process.
Acute [[pancreatitis]] is a rapidly-onset [[inflammation]] of the [[pancreas]]. Depending on its severity, it can have severe complications and high mortality despite treatment. While mild cases are often successfully treated with conservative measures, such as[[NPO]] (abstaining from any oral intake) and IV fluid rehydration, severe cases may require admission to the ICU or even surgery (often more than one intervention) to deal with complications of the disease process.
===2. Chronic Pancreatitis===
* '''Chronic pancreatitis''' is a long-standing inflammatory disease of the [[pancreas]] characterized by irreversible change to pancreatic structure and function related to inflammation and fibrosis.
* Chronic pancreatitis presents as a complex of pain and poor quality of life<ref>Pezilli et al. Pancreatectomy for Pancreatic Disease and Quality of Life. JOP. J Pancreas (Online) 2007; 8(1 Suppl.):118-131.</ref> and, as it advances, develops symptoms related to exocrine and endocrine insufficiency, manifesting as [[malabsorption]] or [[diabetes]].<ref>Ammann RW. A clinically based classification system for alcoholic chronic pancreatitis: summary of an international workshop on chronic pancreatitis. Pancreas 1997; 14: 215–21.</ref>
===3. Hereditary Pancreatitis===
* '''Hereditary pancreatitis''' is a genetic disease affecting enzyme production in the pancreas.
*
=== 4. Gall stone pancreatitis ===
=== 5. Autoimmune pancreatitis ===


===Chronic Pancreatitis===
=== 6. Emphysematous pancreatitis ===
'''Chronic pancreatitis''' is a long-standing inflammatory disease of the [[pancreas]] characterized by irreversible change to pancreatic structure and function related to inflammation and fibrosis. Pancreatitis presents as a complex of pain and poor quality of life<ref>Pezilli et al. Pancreatectomy for Pancreatic Disease and Quality of Life. JOP. J Pancreas (Online) 2007; 8(1 Suppl.):118-131.</ref> and, as it advances, develops symptoms related to exocrine and endocrine insufficiency, manifesting as[[malabsorption]] or [[diabetes]].<ref>Ammann RW. A clinically based classification system for alcoholic chronic pancreatitis: summary of an international workshop on chronic pancreatitis. Pancreas 1997; 14: 215–21.</ref>


===Hereditary Pancreatitis===
=== 7. ''Ascaris''-induced pancreatitis ===
 
=== 8. Tropical pancreatitis ===
 
=== 9. Pancreatitis associated with cystic fibrosis ===
 
=== 10. Segmental pancreatitis ===
*  Paraduodenal pancreatitis
 
=== 11. Post-ERCP pancreatitis ===
 
==Subtypes of Pancreatitis==
* '''Interstitial Edematous Pancreatitis'''
:▸ Acute inflammation of the pancreatic parenchyma and peripancreatic tissues, but without recognizable tissue necrosis
:: ''CECT criteria''
::▸ Pancreatic parenchyma enhancement by intravenous contrast agent. <BR>
::▸ No findings of peripancreatic necrosis.
* '''Necrotizing Pancreatitis'''
:▸ Inflammation associated with pancreatic parenchymal necrosis and/or peripancreatic necrosis
:: ''CECT criteria''
::▸ Lack of pancreatic parenchymal enhancement by intravenous contrast agent <BR>
::▸ Presence of findings of peripancreatic necrosis.
* '''Infected Pancreatic Necrosis''':
:▸ It should be considered in patients with necrotizing pancreatitis who deteriorate or fail to improve after 7–10 days of hospitalization.<ref name="Banks-2013">{{Cite journal  | last1 = Banks | first1 = PA. | last2 = Bollen |first2 = TL. | last3 = Dervenis | first3 = C. | last4 = Gooszen | first4 = HG. | last5 = Johnson | first5 = CD. | last6 = Sarr | first6 = MG. | last7 = Tsiotos | first7 = GG. |last8 = Vege | first8 = SS. | last9 = Acosta | first9 = JM. | title = Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. | journal = Gut | volume = 62 | issue = 1 | pages = 102-11 | month = Jan | year = 2013 | doi = 10.1136/gutjnl-2012-302779 | PMID = 23100216 }}</ref>
:▸ It may be presumed by the presence of extraluminal gas on CECT or when fine-needle aspiration is positive for bacteria and/or fungi on Gram stain and culture.<ref name="Banks-1995">{{Cite journal  | last1 = Banks | first1 = PA. | last2 = Gerzof | first2 = SG. | last3 = Langevin | first3 = RE. | last4 = Silverman | first4 = SG. | last5 = Sica | first5 = GT. | last6 = Hughes | first6 = MD. | title = CT-guided aspiration of suspected pancreatic infection: bacteriology and clinical outcome. | journal = Int J Pancreatol | volume = 18 | issue = 3 | pages = 265-70 | month = Dec | year = 1995 | doi = 10.1007/BF02784951 | PMID = 8708399 }}</ref>
:▸ Antibiotics are able to penetrate pancreatic necrosis (such as [[carbapenem]]s, [[quinolone]]s, and [[metronidazole]]) and may be useful in delaying or sometimes totally avoiding intervention.<ref name="Petrov-2010">{{Cite journal  | last1 = Petrov | first1 = MS. | last2 = Shanbhag | first2 = S. | last3 = Chakraborty | first3 = M. | last4 = Phillips | first4 = AR. | last5 = Windsor | first5 = JA. | title = Organ failure and infection of pancreatic necrosis as determinants of mortality in patients with acute pancreatitis. | journal = Gastroenterology | volume = 139 | issue = 3 | pages = 813-20 | month = Sep | year = 2010 | doi = 10.1053/j.gastro.2010.06.010 | PMID = 20540942 }}</ref><ref name="van Santvoort-2011">{{Cite journal  | last1 = van Santvoort | first1 = HC. | last2 = Bakker | first2 = OJ. | last3 = Bollen | first3 = TL. | last4 = Besselink | first4 = MG. | last5 = Ahmed Ali | first5 = U. | last6 = Schrijver | first6 = AM. | last7 = Boermeester | first7 = MA. | last8 = van Goor | first8 = H. | last9 = Dejong | first9 = CH. | title = A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome. | journal = Gastroenterology | volume = 141 | issue = 4 | pages = 1254-63 | month = Oct | year = 2011 | doi = 10.1053/j.gastro.2011.06.073 | PMID = 21741922 }}</ref>


'''Hereditary pancreatitis''' is a genetic disease affecting enzyme production in the pancreas.


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:Inflammations]]
[[Category:Inflammations]]
[[Category:Abdominal pain]]
[[Category:Abdominal pain]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Primary care]]
[[Category:Needs overview]]
{{WH}}
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Latest revision as of 23:33, 29 July 2020

Pancreatitis Main Page

Patient Information

Overview

Causes

Classification

Acute Pancreatitis
Chronic Pancreatitis
Hereditary Pancreatitis
Autoimmune Pancreatitis

Differential Diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Based on the duration of symptoms, pancreatitis may be classified into either acute or chronic.

Classification

1. Acute Pancreatitis

Subtypes:

  • Interstitial edematous pancreatitis
  • Necrotizing pancreatitis
  • Hemorrhagic pancreatitis

Acute pancreatitis is a rapidly-onset inflammation of the pancreas. Depending on its severity, it can have severe complications and high mortality despite treatment. While mild cases are often successfully treated with conservative measures, such asNPO (abstaining from any oral intake) and IV fluid rehydration, severe cases may require admission to the ICU or even surgery (often more than one intervention) to deal with complications of the disease process.

2. Chronic Pancreatitis

  • Chronic pancreatitis is a long-standing inflammatory disease of the pancreas characterized by irreversible change to pancreatic structure and function related to inflammation and fibrosis.
  • Chronic pancreatitis presents as a complex of pain and poor quality of life[1] and, as it advances, develops symptoms related to exocrine and endocrine insufficiency, manifesting as malabsorption or diabetes.[2]

3. Hereditary Pancreatitis

  • Hereditary pancreatitis is a genetic disease affecting enzyme production in the pancreas.

4. Gall stone pancreatitis

5. Autoimmune pancreatitis

6. Emphysematous pancreatitis

7. Ascaris-induced pancreatitis 

8. Tropical pancreatitis

9. Pancreatitis associated with cystic fibrosis

10. Segmental pancreatitis

  •  Paraduodenal pancreatitis

11. Post-ERCP pancreatitis

Subtypes of Pancreatitis

  • Interstitial Edematous Pancreatitis
▸ Acute inflammation of the pancreatic parenchyma and peripancreatic tissues, but without recognizable tissue necrosis
CECT criteria
▸ Pancreatic parenchyma enhancement by intravenous contrast agent.
▸ No findings of peripancreatic necrosis.
  • Necrotizing Pancreatitis
▸ Inflammation associated with pancreatic parenchymal necrosis and/or peripancreatic necrosis
CECT criteria
▸ Lack of pancreatic parenchymal enhancement by intravenous contrast agent
▸ Presence of findings of peripancreatic necrosis.
  • Infected Pancreatic Necrosis:
▸ It should be considered in patients with necrotizing pancreatitis who deteriorate or fail to improve after 7–10 days of hospitalization.[3]
▸ It may be presumed by the presence of extraluminal gas on CECT or when fine-needle aspiration is positive for bacteria and/or fungi on Gram stain and culture.[4]
▸ Antibiotics are able to penetrate pancreatic necrosis (such as carbapenems, quinolones, and metronidazole) and may be useful in delaying or sometimes totally avoiding intervention.[5][6]


References

  1. ↑ Pezilli et al. Pancreatectomy for Pancreatic Disease and Quality of Life. JOP. J Pancreas (Online) 2007; 8(1 Suppl.):118-131.
  2. ↑ Ammann RW. A clinically based classification system for alcoholic chronic pancreatitis: summary of an international workshop on chronic pancreatitis. Pancreas 1997; 14: 215–21.
  3. ↑ Banks, PA.; Bollen, TL.; Dervenis, C.; Gooszen, HG.; Johnson, CD.; Sarr, MG.; Tsiotos, GG.; Vege, SS.; Acosta, JM. (2013). "Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus". Gut. 62 (1): 102–11. doi:10.1136/gutjnl-2012-302779. PMID 23100216. Unknown parameter |month= ignored (help)
  4. ↑ Banks, PA.; Gerzof, SG.; Langevin, RE.; Silverman, SG.; Sica, GT.; Hughes, MD. (1995). "CT-guided aspiration of suspected pancreatic infection: bacteriology and clinical outcome". Int J Pancreatol. 18 (3): 265–70. doi:10.1007/BF02784951. PMID 8708399. Unknown parameter |month= ignored (help)
  5. ↑ Petrov, MS.; Shanbhag, S.; Chakraborty, M.; Phillips, AR.; Windsor, JA. (2010). "Organ failure and infection of pancreatic necrosis as determinants of mortality in patients with acute pancreatitis". Gastroenterology. 139 (3): 813–20. doi:10.1053/j.gastro.2010.06.010. PMID 20540942. Unknown parameter |month= ignored (help)
  6. ↑ van Santvoort, HC.; Bakker, OJ.; Bollen, TL.; Besselink, MG.; Ahmed Ali, U.; Schrijver, AM.; Boermeester, MA.; van Goor, H.; Dejong, CH. (2011). "A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome". Gastroenterology. 141 (4): 1254–63. doi:10.1053/j.gastro.2011.06.073. PMID 21741922. Unknown parameter |month= ignored (help)

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