Pancreatitis Lecture Notes

Vocabulary terms and definitions related to the etiology, mechanism, diagnosis, assessment, and treatment of pancreatitis as covered in the lecture notes.

Pancreatitis (Severity Classification)

Usually classified by sudden disease; $80\%$ of cases are self-limited, while $20\%$ present as severe disease associated with mortality.

Biliary Risk Factors

Presence of small gallstones ($<5\,mm$) or wide cystic ducts which allow small stones or biliary sludge to pass into the common bile duct.

Ampulla of Vater

The anatomical location where the common bile duct (CBD) and the pancreatic duct open into the duodenum; a common site for stone impaction.

Biliopancreatic reflux

Occurs when pressure in the pancreatic duct becomes greater than pressure in the bile duct due to obstruction.

Clinical Presentation of Pain

Sudden onset of severe, persistent epigastric or right upper quadrant abdominal pain that radiates to the back (belt shape), worsens after meals, and improves when leaning forward.

Paralytic ileus

Inhibited intestinal motility caused by peripancreatic inflammation; presents with abdominal distension, absent bowel sounds, and no passage of gas or stool.

SIRS Criteria in Pancreatitis

Systemic Inflammatory Response Syndrome defined by fever $>38^{\circ}C$ or hypothermia $<36^{\circ}C$, heart rate $>90\,bpm$, respiratory rate $>20/min$ (or $PaCO_2 <32\,mmHg$), and WBC count $>12,000$ or $<4,000$.

Cullen sign

Periumbilical ecchymosis indicating intra-abdominal or retroperitoneal bleeding.

Grey-Turner sign

Flank ecchymosis indicating intra-abdominal or retroperitoneal bleeding.

Laboratory Diagnostic Threshold

A $3\times$ increase in amylase or lipase is considered $90\%$ sensitive for diagnosis, though levels do not correlate with disease severity.

Hemoconcentration

An increase in hematocrit that indicates severe pancreatitis.

Hypocalcemia in Pancreatitis

A lab finding due to fat necrosis in the pancreas which suggests a severe case.

CT (Computed Tomography)

The best modality to detect pancreatitis and anatomic changes; shows pancreatic necrosis best at $2-3$ days after onset.

Pancreatic divisum

A variation in pancreatic duct anatomy characterized by the failure of the ducts to fuse.

IOC (Intraoperative cholangiography)

An X-ray of the biliary tree performed during surgery to detect bile duct stones that may have migrated.

Vigorous fluid resuscitation

The primary initial treatment to maintain microcirculation and perfusion of the pancreas to prevent hypovolemia and toxic shock.

ERCP (Endoscopic Retrograde Cholangiopancreatography)

The gold standard therapeutic tool for biliary obstruction; indicates early use ($<72\,h$) in severe biliary pancreatitis or cholangitis.

Sphincterotomy

A therapeutic procedure during ERCP where the sphincter of Oddi is cut to widen the bile duct opening.

Ranson criteria

A clinical index based on $11$ parameters measured at admission and $48$ hours later to estimate pancreatitis severity.

APACHE-II score

Acute Physiological And Chronic Health Evaluation; estimates mortality in ICU patients and can be scored at any time.

Balthazar CT severity index

A prognostic tool that assesses gland width, inflammation, liquid collection, retroperitoneal gas, and pancreatic necrosis grade.

Pancreatic pseudocyst

A localized collection of enzyme-rich fluid surrounded by a non-epithelial wall of fibrous tissue, developing $\ge 4$ weeks after acute pancreatitis.

Cystogastrostomy

The preferred surgical treatment for complex pancreatic pseudocysts.