Pancreatitis

Acute Pancreatitis.- 1 General Considerations.- 1.1 Anatomy.- 1.2 Physiology.- 1.2.1 Stimulation of Pancreatic Secretion.- 1.2.2 Response of the Pancreas to a Meal.- 1.2.3 Composition of Pancreatic Juice.- 1.2.4 Cellular Processes in Pancreatic Secretion.- 2 Etiology of Acute Pancreatitis.- 2.1 Biliary Tract Disease.- 2.2 Alcohol.- 2.3 Hyperlipidemia.- 2.4 Hereditary Pancreatitis.- 2.5 Hyperparathyroidism and Hypercalcemia.- 2.6 Structural Abnormalities.- 2.6.1 Common Bile Duct and Ampullary Region.- 2.6.2 Duodenum.- 2.6.3 Pancreatic Duct.- 2.7 Iatrogenic Causes.- 2.7.1 Medications.- 2.7.2 Endoscopic Retrograde Cholangiopancreatography.- 2.7.3 Postoperative Pancreatitis.- 2.7.4 Renal transplantation.- 2.8 Pancreatic Trauma.- 2.8.1 Penetrating Injuries.- 2.8.2 Blunt Trauma.- 2.9 Vascular Diseases.- 2.9.1 Thrombi and Emboli.- 2.9.2 Vasculitis.- 2.9.3 Severe Hypotension.- 2.9.4 Miscellaneous.- 2.10 Infectious Agents and Toxins.- 2.11 Other Causes.- 2.11.1 Congenital Abnormalities.- 2.11.2 Pancreatitis in Childhood.- 2.11.3 Pancreatitis in Association with Pregnancy.- 2.11.4 Miscellaneous.- 3 Pathophysiology of Acute Pancreatitis.- 4 Pathology of Acute Pancreatitis.- 4.1 Edematous Pancreatitis.- 4.2 Hemorrhagic Pancreatitis.- 5 Clinical Manifestations of Acute Pancreatitis.- 6 Diagnosis of Acute Pancreatitis.- 6.1 Amylase.- 6.1.1 Metabolism of Amylase.- 6.1.2 Laboratory Measurement of Amylase.- 6.1.3 Causes of Increased Serum Amylase.- 6.1.4 Causes of Persistently Elevated Serum Amylase.- 6.1.5 Usefulness of the Amylase-Creatinine Clearance Ratio.- 6.1.6 Usefulness of Isoamylase Determination.- 6.1.7 Diagnostic Usefulness of Amylase Measurements in Other Fluids.- 6.1.8 Serum Amylase in Acute Pancreatitis.- 6.2 Lipase.- 6.3 Other Laboratory Tests.- 6.3.1 Miscellaneous.- 6.3.2 Calcium.- 6.3.3 Magnesium.- 6.4 Radiologic Diagnosis.- 6.4.1 Survey Film of the Abdomen.- 6.4.2 Chest Radiograph.- 6.4.3 Cholecystographic Techniques.- 6.4.4 Barium Studies.- 6.4.5 Angiography.- 6.5 Ultrasonography.- 6.6 Computed Tomography (C-T Scan).- 6.7 Summary of Diagnostic Tests.- 7 Differential Diagnosis of Acute Pancreatitis.- 7.1 Acute Pancreatitis vs. Other Intraabdominal Disorders.- 7.1.1 Perforation of Duodenal Ulcer.- 7.1.2 Biliary Tract Disease.- 7.1.3 Mesenteric Vascular Disease.- 7.1.4 Miscellaneous Conditions.- 7.2 Edematous vs. Hemorrhagic Pancreatitis.- 7.3 Pancreatitis Secondary to Biliary Tract Disease vs. Alcoholic Pancreatitis.- 8 Treatment of Acute Pancreatitis.- 8.1 Medical Treatment.- 8.1.1 General Treatment of Acute Pancreatitis.- 8.1.2 Treatment of Severe Protracted Pancreatitis.- 8.1.3 Treatment of Subsiding Acute Pancreatitis.- 8.2 Surgical Treatment.- 8.2.1 Urgent Indications.- 8.2.2 Semiurgent or Elective Surgery.- 8.2.3 Surgical Treatment of Recurrent Pancreatitis.- 8.2.4 Surgical Treatment of Severe Protracted Pancreatitis.- 9 Complications of Acute Pancreatitis.- 9.1 Early Complications.- 9.1.1 Shock.- 9.1.2 Renal Abnormalities.- 9.1.3 Splenic Abnormalities.- 9.1.4 Gastrointestinal Bleeding.- 9.1.5 Liver.- 9.1.6 Common Bile Duct Obstruction.- 9.1.7 Fat Necrosis.- 9.1.8 Respiratory Complications.- 9.1.9 Cardiac Complications.- 9.1.10 Coagulation Abnormalities.- 9.2 Late Complications.- 9.2.1 Colon.- 9.2.2 Small Intestine.- 9.2.3 Pancreatic Pseudocyst.- 9.2.4 Pancreatic Abscess.- 9.2.5 Pancreatic Ascites.- 10 Prognosis of Acute Pancreatitis.- Chronic Pancreatitis.- 11 Etiology of Chronic Pancreatitis.- 11.1 Acute vs. Chronic Pancreatitis.- 11.2 Chronic and Chronic Relapsing Pancreatitis.- 12 Pathology of Chronic Pancreatitis.- 13 Clinical Features of Chronic Pancreatitis.- 13.1 Abdominal Pain.- 13.2 Steatorrhea.- 13.3 Creatorrhea.- 13.4 Diabetes Mellitus.- 14 Diagnosis of Chronic Pancreatitis.- 14.1 Basic Laboratory Tests.- 14.2 Radiologic Studies.- 14.2.1 Conventional Studies.- 14.2.2 Endoscopic Retrograde Cholangiopancreatography..- 14.2.3 Diagnostic Ultrasound and C-T Scan.- 14.2.4 Angiography.- 14.2.5 Radioisotopic Scan.- 14.3 Tests of Exocrine Deficiency.- 14.3.1 Stool Examination.- 14.3.2 Urinary Tests.- 14.3.3 Aspiration of Duodenal Contents.- 14.3.4 Miscellaneous Laboratory Tests.- 14.4 Tests of Endocrine Deficiency.- 14.5 Summary of Tests.- 15 Treatment of Chronic Pancreatitis.- 15.1 Medical Treatment.- 15.1.1 Abdominal Pain.- 15.1.2 Steatorrhea.- 15.1.3 Creatorrhea.- 15.1.4 Diabetes Mellitus.- 15.2 Surgical Treatment.- 16 Complications of Chronic Pancreatitis.- 16.1 Metabolic Consequences.- 16.2 Gastrointestinal Complications.- 16.3 Pancreatic Calcification.- 16.4 Carcinoma of the Pancreas.- 16.5 Miscellaneous.- 17 Prognosis of Chronic Pancreatitis.