Pancreatitis: Clinical

Pancreatitis is inflammation of the pancreas.

In acute pancreatitis, the pancreas’ own digestive enzymes get suddenly get activated within the pancreas and cause autodigestion which results in inflammation and hemorrhaging.

In chronic pancreatitis, there are indolent causes of inflammation that damage the pancreas, leading to impairment of both endocrine and exocrine functions of the pancreas.

Now, first thing’s first. Acute pancreatitis is usually caused by gallstones and ethanol abuse, but there are other causes as well, and the full list can be remembered using the mnemonic “I GET SMASHED”: where ‘I’ refers to unknown, or Idiopathic, causes; ‘G’ is obstruction by Gallstones, ‘E’ is Ethanol abuse; ‘T’ is a pancreatic Trauma, which is more likely if the trauma is the result of a puncture injury, like a knife wound rather than a punch; ‘S’ is the use of Steroids; ‘M’ is infection with Mumps virus, ‘A’ is the result of Autoimmune diseases; the second ‘S’ is the result of a Scorpion sting—which is probably the most exciting item on this list and one of the more rare causes - so check your shoes!; ‘H’ is a cheat and stands for both Hypertriglyceridemia and for Hypercalcemia; ‘E’ is trauma from an Endoscopic retrograde cholangiopancreatography or ERCP which is a technique used to diagnose and treat various biliary and pancreatic diseases; and finally ‘D’ stands for Drugs, like sulfa drugs, reverse-transcriptase inhibitors, and protease inhibitors.

Individuals with acute pancreatitis usually have severe epigastric abdominal pain that radiates to the back, along with nausea and vomiting over several hours.

In mild cases, there may be tenderness in the epigastrium, and in severe cases, there might be hypovolemic shock which can cause tachypnea, hypoxemia, and hypotension or systemic inflammatory response syndrome or SIRS, which can cause those same symptoms as well as fever.

So for SIRS - three of the hallmarks - tachypnea, hypotension, and fever - are identified in the vital signs.