Pancreatitis is accompanied by severe abdominal pain. Depending on the cause and severity of the pancreatitis, pancreatic enzymes can affect their own environment, especially the proteases secreted by the pancreas which are released and activated upon arrival of food in the duodenum. When these enzymes cannot be released into the duodenum, they can cause damage and destruction of the pancreatic tissue itself (autolysis). The decreased function of the pancreas can cause fatty diarrhoea and increased glucose levels (as in diabetes).
An inflammation of the pancreas can have various causes. In acute pancreatitis, gallstones and alcohol account for 70% of cases. Many drugs may give rise to pancreatitis. The following drugs are well-known to cause acute pancreatitis:
- Diuretics like furosemide and hydrochlorothiazide
- Antimicrobial drugs: tetracyclines, sulphonamides, rifampicin, and metronidazole
- Immunosuppressants: corticosteroids, azathioprine, and mercaptopurine
- Selective serotonin reuptake inhibitors (SSRIs)
- 5-acetylsalicylic acid agents (mesalazine and olsalazine)
- miscellaneous: indometacin, enalapril, methyldopa, simvastatin, sodium valproate
Male (50) with history of chronic alcohol abuse. Abdominal pain in the past year, which worsened last month. PE: right upper and left upper quadrant pain with guarding. X-ray: no free air, but extensive peritoneal fluid collection along with dilated loops of small bowel. CT scan: a 7 cm cystic mass in the tail of the pancreas. Which of the following is the most likely diagnosis?
Extra info: A pseudocyst is a complication of chronic pancreatitis seen most frequently in persons with a history of chronic alcoholism. The pseudocyst is an area of necrosis with a wall composed of granulation tissue
All of the following are effective antimicrobial therapies in severe necrotizing pancreatitis except: