Acute or chronic inflammation of the pancreas

Cause

• Related to prolonged excessive alcohol intake
• Gall stones
• Biliary tract disease
• Infections, eg. mumps
• Drugs, eg. sulphonamides, furosemide
• Peptic/duodenal ulcers

Clinical features

• Acute abdominal pain usually in the epigastrium radiating to the back
• Nausea, vomiting, abdominal distension
• Fever
• Tachycardia

Differential diagnosis

• Perforated peptic ulcer
• Acute cholecystitis
• Inflammation of biliary tract
• Sickle-cell anaemia crisis

Investigations

Blood: serum analysis, cell count

Management HC4

a) Acute:

Nil by mouth until signs and symptoms of acute inflammation subside (ie. cessation of abdominal tenderness and pain, return of hunger and well-being)

Pass a nasogastric tube for suction when persistent vomiting or ileus occurs

Monitor electrolytes

Give IV fluids to correct metabolic and electrolyte disturbances and to prevent hypovolaemia and hypotension, see p354

For severe pain: pethidine 25-100mg SC or IM or 25-50mg slow IV

- repeat prn every 4-6 hours

Do not give morphine

- it causes the sphincter of Oddi to contract

In case of specific infection, eg. biliary sepsis, pulmonary infection or UTI:

Treat vigorously with appropriate antibiotic therapy

b) Chronic:

Relapsing pancreatitis is characterised by:

• intermittent abdominal pain

• diarrhoea

• loss of weight

pethidine 50-100mg orally as required

Avoid alcohol and fatty foods

In case of malabsorption:

Refer for specialist management

Note

♦ Look out for diabetes mellitus as a consequence of damage to the pancreas

Prevention

• Reduce alcohol intake

- moderate consumption

• Limit use of toxic drugs

• Treat infections comprehensively