Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e
|Section 9. Gastrointestinal Emergencies >|
Chapter 82. Pancreatitis and Cholecystitis
Sections: Pancreatitis, Cholecystitis, References.
Excerpt:"Acute pancreatitis is an acute inflammatory process of the pancreas
that may involve surrounding tissue and remote organ systems. The
disease can range from mild inflammation to severe extensive pancreatic
necrosis and multi-organ failure with mortality rates of 20% to
30% or higher.13 Most cases
are mild with a mortality rate <1% and resolve spontaneously
with supportive care.46 Diagnosis can
be difficult, because there is no pathognomonic clinical presentation
and no diagnostic gold standard.7Acute pancreatitis is caused by the unregulated activation of trypsin
within pancreatic acinar cells and the lack of prompt elimination
of active trypsin inside the pancreas. Trypsin activates digestive
enzymes, complement, and kinins, causing autodigestion, pancreatic
injury, and inflammation.17,18 Inflammation is
also initiated with local production of mediators such as interleukin-1,
interleukin-6, and interleukin-8 from neutrophils, macrophages,
and lymphocytes. Tumor necrosis factor- is released
by macrophages within the pancreatic tissue. Then local complications
such as acinar cell necrosis, pseudocyst formation,..."
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