الفهرس 
Anatomy of the PancreasOnly 14 pages are availabe for public view
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Abstract
Acute pancreatitis (AP) is a nonbacterial inflammation of the pancreatic gland caused by the activation and digestion of the gland by its own enzymes. (Reber, 1999).
The two major causes of AP are biliary calculi, which occur in 50%-70% of patients, and alcohol abuse which account for 25% .The remaining cases due to rare causes as (idiopathic, drug induced, hyperparathyroidism, autoimmune, post-ERCP). (Chang et al., 2003).
In about 80% of cases, AP is a mild self –limiting disease characterized by minimal local and systemic effects and an uneventful recovery. In 15% to 20% of cases, sever AP develops that is accompanied by an exaggerated systemic response characterized by release of inflammatory cytokines and other mediators, also known as the Systemic Inflammatory Response Syndrome(SIRS). (Bhatia et al., 2005).
Serum lipase is thought to be more sensitive and specific than serum amylase in the diagnosis of acute pancreatitis. (Banks and Freeman., 2006)..
Computed tomography (CT) is the imaging modality of choice for the diagnosis, evaluation of severity, and assessment of complications. The sensitivity of CT scan approaches 90%
for the diagnosis of AP. Diagnosis of SAP is linked to diagnosis of necrosis and acute fluid collections.(Balthazar., 2002).
Ranson used 11 criteria; five of them are measured at the time of admission and the other 6 in the first 48 hours after admission. The number of Ranson signs is correlated with the incidence of systemic complications. Ranson criteria proved to be as powerful a prognostic model as the more complicated APACHE II scoring system, but with the disadvantage of a 48 hours delay(Todd and Desire; 1999).
The major advantage of APACHE II is the ability to calculate a score on admission, and thus the potential of earlier stratification to intensive care admission. Additionally, APACHE II can be updated daily allowing for monitoring of disease progression and response to therapy. (Papachristou and Whitcomb, 2005).
The initial therapy is aimed at adequate resuscitation, provision of oxygen to maintain arterial oxygen saturation, intravenous fluid therapy and adequate analgesia constitute the mainstays of therapy. (Uhl et al., 2002).
Combination of enteral nutrition and antibiotic prophylaxis significantly reduced the rate of septic complications and the requirement for surgical intervention when compared with parenteral nutrition (Mayumi et al., 2002).
Several guidelines recommended ERCP and papillotomy only with severe cases and signs of biliary obstruction or cholangitis. (Uhl et al., 2002).
Proven infected necrosis & septic complications resulting from pancreatic infection are well-accepted indications for surgical treatment. With surgical treatment, the mortality rate for patients with infected pancreatic necrosis was decreased to about 20% to 30% .(Buchler et al., 2002).
The high mortality in infected pancreatic necrosis despite surgery has led to the development of several minimally invasive techniques, as radiologic, endoscopic, and alternative procedures (Werner et al., 2007).
These techniques also may be used to control sepsis initially and to delay surgery for better demarcation of necrotic tissue (Werner et al., 2007).