文章基本信息

标题：Acute Pancreatitis
本地全文：下载
作者：Wray, Alisa ; Pena, Jonathan ; Goubert, Ronald 等
期刊名称：Journal of Education and Teaching in Emergency Medicine
印刷版ISSN：2474-1949
出版年度：2019
卷号：4
期号：2
页码：1-3
DOI：10.21980/J88W5X
出版社：University of California Press
摘要：History of present illness: A 28-year-old female presented to the emergency department with slow onset epigastric abdominal pain that radiated to her back for one day. The patient described the pain as sharp, constant, and 9/10 in severity. Her pain was associated with non-bilious, non-bloody vomiting. On physical exam, the patient had tenderness in the epigastric region. Pregnancy test was negative. There was no evidence of periumbilical or flank ecchymosis. Due to the severity of her pain, a computed tomography (CT) scan of her abdomen and pelvis was ordered. Significant findings: Computed tomography of the abdomen and pelvis with contrast show edema of the pancreas (red outline) and duodenum (yellow arrow) with peripancreatic inflammation, fluid and fat stranding (blue highlight). The distal pancreatic tail was noted to appear normal (green arrow). There was no organized drainable fluid collection, and no parenchymal hypo-enhancement. These findings are consistent with moderate severity acute interstitial pancreatitis. Discussion: Pancreatitis is one of the most common diagnoses in hospitalizations among gastrointestinal disorders, accounting for more than 200,000 admissions each year.1-3 Premature activation of trypsin in the acinar cells of the pancreas leads to activation of proteolytic enzymes. Subsequent leakage of fluid into the pancreas and surrounding tissues causing an inflammatory response.3-5 Although most cases of pancreatitis are mild in nature, 10%-20% of cases lead to systemic inflammatory response syndrome (SIRS), which can predispose patients to multiple organ system failure and pancreatic necrosis.4, 6 Common complications of acute pancreatitis include pancreatic fluid collections and the development of pseudocysts, which may require surgical intervention.6 The most common risk factors for pancreatitis are cholelithiasis and alcoholism.7 Clinical features include epigastric abdominal pain radiating to the back, nausea, and vomiting. Although serum lipase is often found to be elevated in acute pancreatitis, a normal serum lipase does not exclude the diagnosis of acute pancreatitis. 2, 6 The diagnosis of acute pancreatitis typically requires two of the three following findings: abdominal pain characteristic of acute pancreatitis, serum amylase or lipase greater than three times the upper limit of normal and/or findings of acute pancreatitis on CT. 4 Although imaging is not required forthe diagnosis, and the majority of patients will likely not receive imaging, information obtained from radiologic studies may elucidate possible etiologies, severity, and sequelae of acute pancreatic necrosis (APN).5 Computed tomography is the most common imaging modality for suspected acute pancreatitis with a sensitivity and specificity of 78% and 86% respectively.7 Common findings include focal or diffuse enlargement and heterogenous enhancement of the pancreas.8 However, magnetic resonance imaging (MRI) is better able to characterize fluid collections and to detect early pancreatitis.5,6 The patient in this case had a normal lipase and pain consistent with acute pancreatitis; because it was a first episode and she had significant abdominal pain, she received a CT of her abdomen and pelvis to evaluate for possible etiologies or complications.