Abstract
In 1925, Moynihan described the dramatic nature of acute pancreatitis as the “most terrible of all calamities that occurs in connection with the abdominal viscera. The suddenness of its onset, the illimitable agony which accompanies it, and the mortality attendant upon it renders it the most formidable of catastrophes” [1]. From mild and self-limiting disease to multiorgan failure and sepsis, acute pancreatitis is a disorder that has numerous causes, an obscure pathogenesis, few effective remedies, and an often unpredictable outcome. The anatomopathological alterations of the pancreatic parenchyma vary from interstitial edema and very limited necrosis of the parenchymal fat to extensive areas of pancreatic necrosis and bleeding.
Keywords
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsPreview
Unable to display preview. Download preview PDF.
References
Moynihan B (1925) Acute pancreatitis. Ann Surg 81:132–142
Cavallini G, Riela A, Brocco G et al (1987) Epidemiology of acute pancreatitis. In: Beger HG, Büchler M (eds) Acute pancreatitis: research and clinical management. Springer, Berlin Heidelberg New York, pp 25–31
Thomson SR, Hendry WS, McFarlane GA, Davidson AI (1987) Epidemiology and outcome of acute pancreatitis. Br J Surg 74:398–401
Bourke JB (1975) Variation in annual incidence of primary acute pancreatitis in Nottingham, 1969-74. Lancet 2:967–969
Wilson C, Imrie CW (1980) Changing patterns of incidence and mortality from acute pancreatitis in Scotland, 1961–1985. Br J Surg 77:731–734
Russo MW, Wei JT, Thiny MT et al (2004) Digestive and liver diseases statistics, 2004. Gastroenterology 126:1448–1453
DeFrances CJ, Hall MJ, Podgornik MN (2005) 2003 National Hospital Discharge Survey. Advance data from vital and health statistics. No. 359. Hyattsville, Md: National Center for Health Statistics
Werner J, Uhl W, Büchler MW (2004) Acute pancreatitis. In: Cameron JL (ed) Current surgical therapy, 8th edn. Mosby, Philadelphia
Triester SL, Kowdley KV (2002) Prognostic factors in acute pancreatitis. J Clin Gastroenterol 34:167–176
McKay CJ, Imrie CW (2004) The continuing challenge of early mortality in acute pancreatitis. Br J Surg 91:1243–1244
Bradley EL (1993) A clinically based classification system for acute pancreatitis: summary of the Atlanta symposium. Arch Surg 128:586–590
Rigamonti M, Ferraro A, Madau A, Simonini L (2001) Stadiazione e monitoraggio della pancreatite acuta. In: D’Amico DF, Favia G, Eccher C (eds) Pancreatite acuta. Aspetti diagnostico-terapeutici. Atti del convegno Pancreatite acuta, Trento. La Garangola, Padua
Opie EL (1901) The relation of cholelithiasis to disease of the pancreas and to fat necrosis. Am J Med Sci 121:27–43
Yeo CJ, Cameron JL (2001) Exocrine pancreas. In: Townsend CM, Beauchamp RD, Evers BM, Maddox KL (eds) Sabiston textbook of surgery, 16th edn. Saunders, Philadelphia, pp 1112–1143
Favia G, Polistina F (2000) Pancreas. In: D’amico DF (ed) Manuale di Chirurgia. McGraw Hill, Milan, pp 674–675
Amman RW, Muelhaut B (1994) Progression of alcoholic acute to chronic pancreatitis. Gut 35:552–556
Symmers WSC (1917) Acute alcoholic pancreatitis. Dublin J Med Sci 143:244–247
Hanck C, Whitcomb DC (2004) Alcoholic pancreatitis. Gastroenterol Clin North Am 33:751
Yadav D, Pitchumoni CS (2005) Issues in hyperlipidemic pancreatitis. J Clin Gastroenterol 36:54
Fortson MR, Freedman SN, Webster PD III (1995) Clinical assessment of hyperlipidemic pancreatitis. Am J Gastroenterol 90:2134–2139
Whitcomb DC, Gorry MC, Preston RA et al (1996) Hereditary pancreatitis is caused by a mutation in the cationic trypsinogen gene. Nat Genet 14:141–45
Varallyay E, Pal G, Patthy A et al (1998) Two mutations in rat trypsin confer resistance against autolysis. Biochem Biophys Res Commun 243:56–60
Whang EE (2006) Acute pancreatitis. In: Greenfield LJ, Mulholland MW, Oldham KT et al. (ed) Greenfield’s surgery: scientific principles and practice, 4th edn. Lippincott Williams and Wilkins, Philadelphia
Lora LP, Chari ST (2005) Autoimmune pancreatitis. Curr Gastroenterol Rep 7:101
Klein SD, Affronti JP (2004) Pancreas divisum, an evidence-based review: part I, pathophysiology. Gastrointest Endosc 60:419
Klein SD, Affronti JP (2004) Pancreas divisum, an evidence-based review: part II, patient selection and treatment. Gastrointest Endosc 60:585
Trivedi CD, Pitchumoni CS (2005) Drug-induced pancreatitis: an update. J Clin Gastroenterol 239:709
Wilson RH, Moorhead RJ (1991) Current management of trauma to the pancreas. Br J Surg 78:1196–1202
Pezzulli R, Romboli E, Campana D, Corinaldesi R (2002) Mechanisms involved in the onset of post-ERCP pancreatitis. JOP. J Pancreas (Online) 3(6):162–168
Draganov P, Forsmark CE (2006) Gastroenterology V: Diseases of the pancreas. ACP Medicine online. WebMD Inc. http://www.apicella.com/pancreas.pdf [accessed 17 June 2008]
Reisler RB, Murphy RL, Redfield RR et al (2005) Incidence of pancreatitis in HIV-1 infected individuals enrolled in 20 adult AIDS clinical trials group studies: lessons learned. J Acquir Immune Defic Syndr 37:565
Khuroo MS, Zargar SA, Yattoo GN et al (1992) Ascaris-induced acute pancreatitis. Br J Surg 79:1335–1338
Ros E, Navarro S, Bru C et al (1991) Occult microlithiasis in “idiopathic” acute pancreatitis: prevention of relapses by cholecystectomy or ursodeoxycholic acid therapy. Gastroenterology 101:1701
Lee Sp, Nichols JP, Park Hz (1992) Biliary sludges as a cause of acute pancreatitis. N Engl J Med 326:589
Halangk W, Lerch MM (2004) Early events in acute pancreatitis. Gastroenterol Clin North Am 33:717
Bathia M, Wong Fl, Cao Y et al (2005) Pathophysiology of acute pancreatitis. Pancreatology 5:132
van Acker G JD, Perides G, Steer ML (2006) Co-localization hypothesis: a mechanism for the intrapancreatic activation of digestive enzymes during the early phases of acute pancreatitis. World J Gastroenterol 12:1985–1990
Palade G (1975) Intracellular aspects of the process of protein synthesis. Science 189:347–358
Kelly RB (1985) Pathways of protein secretion in eukaryotes. Science 230:25–32
Karanjia ND, Widdison AL, Jehanli A et al (1993) Assay of trypsinogen activation in the cat experimental model of acute pancreatitis. Pancreas 8:189–195
Kornfeld S (1986) Trafficking of lysosomal enzymes in normal and disease states. J Clin Invest 77:1–6
Andrews NW (2000) Regulated secretion of conventional lysosomes. Trends Cell Biol 10:316–321
Ishidoh K, Kominami E (2002) Processing and activation of lysosomal proteinases. Biol Chem 383:1827–1831
Saluja A, Hashimoto S, Saluja M et al (1987) Subcellular redistribution of lysosomal enzymes during caerulein-induced pancreatitis. Am J Physiol 253:G508–G516
Hofbauer B, Saluja AK, Lerch MM et al (1998) Intra-acinar cell activation of trypsinogen during caerulein-induced pancreatitis in rats. Am J Physiol 275:G352–G362
Otani T, Chepilko SM, Grendell JH, Gorelick FS (1998) Codistribution of TAP and the granule membrane protein GRAMP-92 in rat caerulein-induced pancreatitis. Am J Physiol 275:G999–G1009
Greenbaum LM, Hirshkowitz A, Shoichet I (1959) The activation of trypsinogen by cathepsin B. J Biol Chem 234:2885–2890
Figarella C, Miszczuk-Jamska B, Barrett AJ (1988) Possible lysosomal activation of pancreatic zymogens. Activation of both human trypsinogens by cathepsin B and spontaneous acid. Activation of human trypsinogen 1. Biol Chem Hoppe Seyler 369(Suppl): 293–298
Watanabe O, Baccino FM, Steer ML, Meldolesi J (1984) Supramaximal caerulein stimulation and ultrastructure of rat pancreatic acinar cell: early morphological changes during development of experimental pancreatitis. Am J Physiol 246:G457–G467
Gennaro A, Stefanelli N, Vassiliadis A (2001) Quadro clinico e fisiopatologia della pancreatite acuta. In: D’Amico DF, Favia G, Eccher C (eds) Pancreatite acuta. Aspetti diagnosticoterapeutici. Atti del convegno Pancreatite acuta, Trento. La Garangola, Milan
Pederzoli P, Giardino A, Bandoni L et al (2005) Pancreatite acuta. In: Staudacher C (ed) Chirurgia d’urgenza. Masson, Milan, pp 115–131
Chvanov M, Petersen OH, Tepikin A (2005) Free radicals and the pancreatic acinar cells: role in physiology and pathology. Philos Trans R Soc Lond B Biol Sci 360:2273–2284
Lipsett PA (2001) Serum cytokines, proteins, and receptors in acute pancreatitis: mediators, marker, or more of the same? Crit Care Med 29:1642–1644
Hirota M, Nozawa F, Okabe A et al (2000) Relationship between plasma cytokine concentration and multiple organ failure in patients with acute pancreatitis. Pancreas 21:141–146
Ogawa M (1998) Acute pancreatitis and cytokines: “second attack” by septic complication leads to organ failure. Pancreas 16:312–315
Liu LR, Xia SH (2006) Role of platelet-activating factor in the pathogenesis of acute pancreatitis. World J Gastroenterol 12:539–545
Gukovskaya AS, Gukovsky I, Zaninovic V et al (1997) Pancreatic acinar cells produce, release, and respond to tumor necrosis factor-α. Role in regulating cell death and pancreatitis. J Clin Invest 100:1853–1862
Denham W, Norman J (1999) The potential role of therapeutic cytokine manipulation in acute pancreatitis. Surg Clin North Am 79:767–781
Pezzilli R, Billi P, Miniero R et al (1995) Serum interleukin-6, interleukin-8, and beta 2-microglobulin in early assessment of severity of acute pancreatitis. Comparison with serum C-reactive protein. Dig Dis Sci 40:2341–2348
Gross V, Andreesen R, Leser HG et al (1992) Interleukin-8 and neutrophil activation in acute pancreatitis. Eur J Clin Invest 22:200–203
Browne GW, Pitchumoni CS (2006) Pathophysiology of pulmonary complications of acute pancreatitis. World J Gastroenterol 12:7087–7096
Zhang XP, Tian H (2007) Pathogenesis of pancreatic encephalopathy in severe acute pancreatitis. Hepatobiliary Pancreat Dis Int 6:134–140
Zhang XP, Wang L, Zhang J (2007) Study progress on mechanism of severe acute pancreatitis complicated with hepatic injury. J Zhejiang Univ Sci B 8(4):228–236
Schmid SW, Uhl W, Friess H et al (1999) The role of infection in acute pancreatitis. Gut 45:311–316
Clavien PA, Burgan S, Moossa AR (1989) Serum enzymes and other laboratory tests in acute pancreatitis. Br J Surg 76:1234–1243
Al-Bahrani AZ, Ammori BJ (2005) Clinical laboratory assessment of acute pancreatitis. Clin Chim Acta 362:26
Smotkin J, Tenner S (2002) Clinical reviews: pancreatic and biliary disease: laboratory diagnostic tests in acute pancreatitis. J Clin Gastroenterol 34:459–462
Yadav D, Agarwal N, Pitchumoni CS (2002) A critical evaluation of laboratory tests in acute pancreatitis. Am J Gastroenterol 97:1309–1318
Clavien PA, Robert J, Meyer P et al (1989) Acute pancreatitis and normoamylasemia. Not an uncommon combination. Ann Surg 210:614–620
Winslet M, Hall C, London NJ, Neoptolemos JP (1992) Relation of diagnostic serum amylase levels to aetiology and severity of acute pancreatitis. Gut 33:982–986
Matull WR, Pereira SP, O’Donohue JW (2006) Biochemical markers of acute pancreatitis. J Clin Pathol 59:340–344
American Gastroenterological Association (AGA) Institute on “Management of Acute Pancreatitis” Clinical Practice and Economics Committee; AGA Institute Governing Board. (2007) AGA Institute medical position statement on acute pancreatitis. Gastroenterology 132:2019–2021
Banks PA, Freeman ML (2006) Practice Parameters Committee of the American College of Gastroenterology. Practice guidelines in acute pancreatitis. Am J Gastroenterol 101:2379–2400
Schein M (2005) Acute pancreatitis. In: Shein M, Rogers PM (eds) Schein’s common sense emergency abdominal surgery. Springer, pp 151–161
Baron TH, Morgan D (1999) Acute necrotizing pancreatitis. N Engl J Med 340:1412–1416
Ranson JH, Rifkind KM, Roses DF et al (1974) Prognostic signs and the role of operative management in acute pancreatitis. Surg Gynecol Obstet 139:69–81
Ranson JH (1982) Etiological and prognostic factors in human acute pancreatitis: a review. Am J Gastroenterol 77:633–638
Imrie CW, Benjamin IS, Ferguson JC et al (1978) A single-center double-blind trial of Trasylol therapy in primary acute pancreatitis. Br J Surg 65:337–341
Larvin M, McMahon MJ (1989) APACHE-II score for assessment and monitoring of acute pancreatitis. Lancet 2:201–205
Osvaldt AB, Viero P, Borges da Costa MS et al (2002) l. Evaluation of Ranson, Glasgow, APACHE II and APACHE 0 criteria to predict severity in acute pancreatitis. Int Surg 86(3):158–161
Gürleyik G, Emir S, Kiliçoglu G et al(2005) Computed Tomography Severity Index, APACHE II score and serum CRP concentration for predicting the severity of acute pancreatitis. JOP J Pancreas 6:562–567
Sandberg AA, Borgström A (2002) Early prediction of severity in acute pancreatitis. Is this possible? JOP J Pancreas (Online) 3(5):116–125
Wilson C, Heads A, Shenkin A, Imrie CW (1989) C-reactive protein, antiproteases and complement factors as objective markers of severity in acute pancreatitis. Br J Surg 76:177–181
Neoptolemos JP, Kemppainen EA, Mayer JM et al (2000) Early prediction of severity in acute pancreatitis by urinary trypsinogen activation peptide: a multicentre study. Lancet 355:1955–1960
Puolakkainen P, Valtonen V, Paananen A, Schröder T (1987) C-reactive protein (CRP) and serum phospholipase A2 in the assessment of acute pancreatitis. Gut 28:764–771
Assicot M, Gendrel D, Carsin H et al (1993) Serum pro-calcitonin and C-reactive protein levels as markers of bacterial infection. Lancet 341:515–518
Rau B, Steinbach G, Gansauge F et al (1997) The potential role of procalcitonin and interleukin 8 in the prediction of infected necrosis in acute pancreatitis. Gut 41:832–840
Rau BM, Kemppainen EA, Gumbs AA et al (2007) Early assessment of pancreatic infections and overall prognosis in severe acute pancreatitis by procalcitonin (PCT). A prospective international multicenter study. Ann Surg 245:745–754
Frossard JL, Hadengue A, Pastor CM (2001) New serum markers for the detection of severe acute pancreatitis in humans. Am J Respir Crit Care Med 164:162–170
Author information
Authors and Affiliations
Rights and permissions
Copyright information
© 2009 Springer-Verlag Italia
About this chapter
Cite this chapter
Guercioni, G., Siquini, W., Senati, E. (2009). Epidemiology, Classification, Etiopathogenesis, and Diagnosis of Acute Pancreatitis. In: Surgical Treatment of Pancreatic Diseases. Updates in Surgery. Springer, Milano. https://doi.org/10.1007/978-88-470-0856-4_4
Download citation
DOI: https://doi.org/10.1007/978-88-470-0856-4_4
Publisher Name: Springer, Milano
Print ISBN: 978-88-470-0855-7
Online ISBN: 978-88-470-0856-4
eBook Packages: MedicineMedicine (R0)