CLYVELLE LANDA F. JAMORABON,M.

D, FPCP
 PANCREATITIS
• Endocrine (20%) • Exocrine (80%)
– Islets of langerhans – Digestive enzymes
– Insulin (beta) (pro enzymes)
– Glucagon( alpha) • Trypsinogen
– Somatostatin ( delta) • Chymotryspsinogen
- Controlled by
• Gastrin
• CCK
• Secretin
 Epidemiology
• Acute pancreatitis is the most common
inpatient principal gastrointestinal diagnosis in
US
• Annual incidence ranges from 13-45/100,000
persons
• Results in >250,000 hospitalizations per year
 Causes

1. Gallstones ( 30-60%)
– most common biliary tract disease leading to
Acute Pancreatitis (AP)
– The risk of AP in patients with at least gallstones
<5mm in diameter is 4x greater than that patients
with larger stone
– MOA: ductal obstruction causing ductal
hypertension and acinar cell inury
2. Alcohol (15-30%)
– 2nd most common cause of AP
3. Endoscopic Retrogade
Cholangeopancreatography ( ERCP) 5-10%
– Risk factors for post ERCP Pancreatitis
• Minor papilla sphincterotomy
• Sphincter of ODDI dysfunction
• Prior history of post ERCP Pancreatitis
• Age <60 years
• >2 contrast injection into the pancreatic duct
4. Hypertriglyceredemia (1.3-3.8%)
– TG level >11.3 mmol/L (>1000mg/dl)- diagnostic
criteria
5. Drugs (0.1-2%)
– Azathioprine, 6-mercaptopurine, sulfonamides,
estrogens, tetracycline, valproic acid, anti –HIV
medication ,5-ASA
– Due to hypersensitivity reaction or by generation
of active metabolites
6. Trauma ( blunt abdominal trauma)
7. Postoperative
 Uncommon Causes
1. Vascular causes and vasculitis
2.Connective tissue disorders and TTP
3. Cancer of the pancreas
4. Hypercalcemia
5. Periampullary diverticulum
6. Hereditary Pancreatitis
7. Cystic fibrosis
8. Renal failure
9.Infections ( mumps, coxsackie virus, CMV, echovirus,
parasites )
10. Autoimmune
 Causes to consider in patients with recurrent
bouts of AP without obvious etiology
1. Occult disease of the biliary tree
2. Drugs
3. Alcohol abuse
4. Metabolic : hypertriglyceredemia/ hypercalcemia
5. Anatomic pancreas divisum
6. Pancreatic CA
7. Intraductal papillary mucinous neoplasm
8. Hereditary pancreatitis
9.Cystic fibrosis
10. Autoimmune
11. Idiopathic
CLINICAL MANIFESTATIONS
• Abdominal Pain- cardinal symptom
Abdominal Examination
MANIFESTATIONS OF COMPLICATIONS
MANIFESTATIONS OF COMPLICATIONS
Early phase- 1-2 weeks Late phase - >2 weeks
Blunting of left costophrenic angle