Pancréatite aiguë II: manifestations cliniques et prise en charge

Acute pancreatitis presents with intense upper abdominal pain that often radiates to the back and worsens after consuming fatty foods. Additional symptoms include nausea, vomiting, abdominal distention, fever, dyspnea, and jaundice. The severity and combination of symptoms vary among patients but significantly impact overall well-being.

Acute pancreatitis diagnosis requires three main criteria: severe abdominal pain, elevated serum amylase or lipase levels indicating pancreatic inflammation, and imaging studies such as CT scans, ultrasounds, or MRIs showing pancreatic abnormalities like cysts, hemorrhage, or necrosis. Additional findings include hypertriglyceridemia, hyperglycemia, and elevated liver enzymes.

Elevated serum amylase or lipase levels are hallmark biochemical markers of acute pancreatitis. When found in high concentrations, these enzymes indicate pancreatic stress or injury from inflammation. These enzyme levels are critical diagnostic indicators used alongside clinical symptoms and imaging findings to confirm the condition.

Initial management focuses on keeping patients NPO (nil per oral) to reduce pancreatic stimulation and enzyme production. Early enteral feeding is recommended to support nutritional needs without exacerbating the condition. Pain management with parenteral opioids and NSAIDs is administered concurrently to address discomfort and inflammation.

Intensive care involves meticulous monitoring and correction of fluid and blood loss to manage hemodynamics and prevent hypovolemic shock. Antibiotics are administered prophylactically to prevent infections, particularly when necrotic tissue is present. Managing associated metabolic disturbances such as hyperglycemia is vital for overall patient stability and recovery.

CT scans and ultrasounds visualize anatomical changes within the pancreas, including enlargement, cysts, hemorrhage, and tissue necrosis. MRI may detect finer details such as parenchymal atrophy and duct dilation, offering further insights into disease progression. These imaging modalities are essential for confirming diagnosis and assessing severity.

Surgical interventions such as biliary drainage or surgical procedures may be necessary when gallstones trigger acute pancreatitis and conservative therapies do not yield sufficient results. These procedures aim to remove obstructions and restore normal biliary function, addressing the underlying cause of pancreatic inflammation and preventing recurrence.