Anatomy Thorax Abdomen · Year 1 · from Anatomy Thorax Abdomen
Case 2: Acute Pancreatitis
Clinical Presentation
A 52-year-old male with a history of heavy alcohol use presents with severe epigastric pain that began 8 hours ago after a drinking binge. The pain radiates straight through to his back and is partially relieved by leaning forward. He has had multiple episodes of vomiting. On examination, he is tachycardic at 115 beats per minute with blood pressure of 100/60 mmHg. He appears uncomfortable and diaphoretic.
Abdominal examination reveals epigastric tenderness with voluntary guarding but no rigidity. Bowel sounds are hypoactive. There is faint periumbilical ecchymosis (Cullen sign). Laboratory studies show lipase elevated at 1,850 U/L (normal <160), amylase 980 U/L, and mildly elevated liver enzymes. CT scan reveals an edematous pancreas with surrounding fat stranding and a small peripancreatic fluid collection. He is admitted for aggressive IV fluid resuscitation, pain control, and bowel rest with gradual improvement over 5 days.
Key Anatomical Points
- The pancreas is a retroperitoneal organ extending from the duodenal C-loop to the splenic hilum
- The pancreatic head lies within the duodenal curve; the neck overlies the portal vein formation site
- The splenic vein runs along the posterior surface of the pancreatic body and tail
- The pancreas lacks a complete capsule, allowing inflammatory exudate to spread into the retroperitoneum
Key Learning Points
- Pain radiating to the back reflects the retroperitoneal position of the pancreas against the vertebral column
- Cullen sign (periumbilical ecchymosis) and Grey-Turner sign (flank ecchymosis) indicate hemorrhagic pancreatitis
- The two most common causes are gallstones and alcohol, accounting for 80% of cases
- The main pancreatic duct joins the common bile duct at the ampulla of Vater - a stone impacted here can cause biliary and pancreatic obstruction