Definition
Pancreatitis is inflammation of the pancreas due to inappropriate activation of digestive enzymes.
- Acute pancreatitis is a reversible inflammatory process affecting the pancreatic acini.
- Chronic pancreatitis involves persistent inflammation with irreversible structural damage, fibrosis, and progressive loss of exocrine and endocrine function.
Etiology
Acute Pancreatitis
- Most common:
- Alcohol abuse (stimulates pancreatic secretion + causes ductal obstruction)
- Gallstones (block common bile duct → enzyme activation)
- Others:
- Pancreatic tumors
- Drugs
- Trauma
Chronic Pancreatitis
- Same as acute but chronic exposure:
- Alcohol (main cause in adults)
- Tropical pancreatitis (common in children/young adults)
- Hereditary (mutation in PRSS1, SPINK1 genes)
- Autoimmune
- Cystic fibrosis (in children)
Pathogenesis
Acute Pancreatitis
- Autodigestion of pancreatic tissue by inappropriately activated enzymes (especially trypsin).
- Trypsin activates other enzymes: lipase, phospholipase, elastase → destruction of acinar cells, fat necrosis, hemorrhage.
- Results in intense inflammation which can progress to:
- Systemic Inflammatory Response Syndrome (SIRS)
- Multiorgan failure
Chronic Pancreatitis
Loss of exocrine and endocrine function.
Clinical Features
Acute Pancreatitis
- Sudden, severe epigastric pain radiating to the back
- Nausea, vomiting
- Fever
- Abdominal tenderness, guarding
- ↓ or absent bowel sounds
- Signs of internal bleeding:
- Cullen’s sign (periumbilical ecchymosis)
- Grey-Turner’s sign (flank ecchymosis)
- In gallstone pancreatitis: jaundice, possible cholangitis
- May progress to shock, tachycardia, hypotension
Chronic Pancreatitis
- Recurrent epigastric pain, often triggered by alcohol
- Anorexia, weight loss
- Vomiting, constipation, flatulence
- Steatorrhea (due to malabsorption of fat)
- Diabetes mellitus in advanced stages