Internal Medicine

0521779407-01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:45

Acute Pancreatitis 45

Acute Pancreatitis.....................................

ANSON W. LOWE, MD

history & physical

Risk Factors

■Obstruction:

➣Gallstone disease (∼45%)

➣Pancreatic cancer

■Toxins & drugs:

➣Alcohol abuse (35%)

■Drugs:

➣Immunosuppressives (eg, azathioprine, 6-mercaptopurine);

most common drug-induced cause (3–5% incidence)

➣Anti-retrovirals

➣Many others implicated w/ lower frequencies (eg, furosemide,

estrogens, etc)

■Genetic causes:

➣Familial history of hereditary pancreatitis or cystic fibrosis

➣Metabolic causes:

➣Hypertriglyceridemia (>1000mg/dL or 11.3 mmol/L)

➣Hypercalcemia

■Vascular:

➣Ischemia

➣Vasculitis (eg, SLE)

Signs & Symptoms

■Abdominal or back pain

■Epigastric tenderness

■Nausea & vomiting

■Jaundice

tests

Basic Blood Tests

■Serum amylase and lipase are the most sensitive & widely used; amy-

lase cleared rapidly & may be normal if pt presents >24–48 h after

onset of symptoms

■LFTs may suggest presence of biliary tract or gallbladder disease

■Serum triglyceride level

■Other tests useful in managing & clinically staging pt: CBC, elec-

trolytes, BUN/creatinine, glucose, calcium, LDH