gastrointestinal disorders
Acute Pancreatitis
Complications of Acute Pancreatitis
Complications of acute pancreatitis can be categorized as ( Complications reference ) Local: Pancreatic and peripancreatic fluid collections, splenic vein thrombosis, pseudoaneurysm formation, and gastric outlet dysfunction Systemic: Shock, organ failure Pancreatic and peripancreatic collectionsof enzyme-rich pancreatic fluid can occur early in the disease course. The collections contain only fluid or only fluid and necrotic material. Most of these collections resolve spontaneously, but if they do not resolve after about 4 weeks, they develop a fibrous capsule that can be seen on cross-sectional imaging. Such encapsulated collections are termed pancreatic pseudocysts or walled-off necrosis according to their contents; a pseudocyst contains only fluid, and walled-off necrosis contains both fluid and solid necrotic material. About one third of pseudocysts resolve spontaneously. In about one third of patients with pancreatic necrosis the fluid becomes infected by gut bacteria, which leads to very high morbidity and mortality. include acute single or multiple organ failure (eg, cardiovascular and/or respiratory failure, acute kidney injury) and Shock . Risk is increased in patients with underlying comorbidities and/or a persistent systemic inflammatory response syndrome (SIRS). SIRS, in the appropriate clinical setting, is defined as the presence of two or more of the following: Temperature > 38.3° C or < 36.0° C Heart rate > 90/minute Respiratory rate > 20/minute or PACO2 < 32 mmHg White blood cell count > 12,000/mcL (12 × 109/L), < 4,000/mcL (4 × 109/L) or with > 10% bands Organ failure is defined using the modified Marshall scoring system (see table Modified Marshall Organ Failure Score ; Mortalityin the early phase (within 1 week) of acute pancreatitis usually results from multiorgan failure, whereas mortality in the late phase (> 1 week) usually results from a combination of factors, including multiorgan failure, infection of pancreatic necrosis, and complications of surgical and endoscopic interventions. 1.Banks PA, Bollen TL, Dervenis C, et al: Classification of acute pancreatitis 2012: Revision of the Atlanta classification and definitions by international consensus.Gut62:102–111, 2013. doi: 10.1136/gutjnl-2012-302779 