Pancreatitis - Acute

Acute pancreatitis is an abrupt inflammation of the pancreas characterized by enzymatic autodigestion of pancreatic tissue, leading to local and systemic complications. It can range from mild, self-limited disease to severe, life-threatening illness.

Definition

Epidemiology

Incidence: 13–45 cases per 100,000 population per year globally
Slight male predominance in alcohol-induced cases; female predominance in gallstone-induced cases
Peak incidence: 50–70 years for gallstone pancreatitis, younger adults for alcohol-related
Mortality: ~2% in mild cases; up to 20–30% in severe cases with necrosis or organ failure

Etiology

Gallstones (most common in developed countries)
Alcohol consumption (second most common)
Hypertriglyceridemia (>1000 mg/dL)
Post-ERCP (endoscopic retrograde cholangiopancreatography)
Medications: azathioprine, corticosteroids, diuretics, valproate
Trauma, infections (mumps, coxsackie virus), autoimmune pancreatitis
Genetic mutations (PRSS1, SPINK1, CFTR) in hereditary pancreatitis

Pathophysiology

Premature activation of pancreatic enzymes (trypsin) within acinar cells
Autodigestion of pancreatic tissue causing inflammation, edema, and necrosis
Local complications: peripancreatic fluid collection, pseudocyst, necrosis
Systemic inflammatory response (SIRS) can lead to multi-organ failure
Release of cytokines (TNF-α, IL-1, IL-6) contributes to systemic manifestations
Microvascular injury and fat necrosis exacerbate inflammation