Acute Pancreatitis.- 1 General Considerations.- 1.1 Anatomy.- 1.2 Physiology.- 1.2.1 Stimulation of Pancreatic Secretion.- 1.2.2 Response of the Pancreas to a Meal.- 1.2.3 Composition of Pancreatic Juice.- 1.2.4 Cellular Processes in Pancreatic Secretion.- 2 Etiology of Acute Pancreatitis.- 2.1 Biliary Tract Disease.- 2.2 Alcohol.- 2.3 Hyperlipidemia.- 2.4 Hereditary Pancreatitis.- 2.5 Hyperparathyroidism and Hypercalcemia.- 2.6 Structural Abnormalities.- 2.6.1 Common Bile Duct and Ampullary Region.- 2.6.2 Duodenum.- 2.6.3 Pancreatic Duct.- 2.7 Iatrogenic Causes.- 2.7.1 Medications.- 2.7.2 Endoscopic Retrograde Cholangiopancreatography.- 2.7.3 Postoperative Pancreatitis.- 2.7.4 Renal transplantation.- 2.8 Pancreatic Trauma.- 2.8.1 Penetrating Injuries.- 2.8.2 Blunt Trauma.- 2.9 Vascular Diseases.- 2.9.1 Thrombi and Emboli.- 2.9.2 Vasculitis.- 2.9.3 Severe Hypotension.- 2.9.4 Miscellaneous.- 2.10 Infectious Agents and Toxins.- 2.11 Other Causes.- 2.11.1 Congenital Abnormalities.- 2.11.2 Pancreatitis in Childhood.- 2.11.3 Pancreatitis in Association with Pregnancy.- 2.11.4 Miscellaneous.- 3 Pathophysiology of Acute Pancreatitis.- 4 Pathology of Acute Pancreatitis.- 4.1 Edematous Pancreatitis.- 4.2 Hemorrhagic Pancreatitis.- 5 Clinical Manifestations of Acute Pancreatitis.- 6 Diagnosis of Acute Pancreatitis.- 6.1 Amylase.- 6.1.1 Metabolism of Amylase.- 6.1.2 Laboratory Measurement of Amylase.- 6.1.3 Causes of Increased Serum Amylase.- 6.1.4 Causes of Persistently Elevated Serum Amylase.- 6.1.5 Usefulness of the Amylase-Creatinine Clearance Ratio.- 6.1.6 Usefulness of Isoamylase Determination.- 6.1.7 Diagnostic Usefulness of Amylase Measurements in Other Fluids.- 6.1.8 Serum Amylase in Acute Pancreatitis.- 6.2 Lipase.- 6.3 Other Laboratory Tests.- 6.3.1 Miscellaneous.- 6.3.2 Calcium.- 6.3.3 Magnesium.- 6.4 Radiologic Diagnosis.- 6.4.1 Survey Film of the Abdomen.- 6.4.2 Chest Radiograph.- 6.4.3 Cholecystographic Techniques.- 6.4.4 Barium Studies.- 6.4.5 Angiography.- 6.5 Ultrasonography.- 6.6 Computed Tomography (C-T Scan).- 6.7 Summary of Diagnostic Tests.- 7 Differential Diagnosis of Acute Pancreatitis.- 7.1 Acute Pancreatitis vs. Other Intraabdominal Disorders.- 7.1.1 Perforation of Duodenal Ulcer.- 7.1.2 Biliary Tract Disease.- 7.1.3 Mesenteric Vascular Disease.- 7.1.4 Miscellaneous Conditions.- 7.2 Edematous vs. Hemorrhagic Pancreatitis.- 7.3 Pancreatitis Secondary to Biliary Tract Disease vs. Alcoholic Pancreatitis.- 8 Treatment of Acute Pancreatitis.- 8.1 Medical Treatment.- 8.1.1 General Treatment of Acute Pancreatitis.- 8.1.2 Treatment of Severe Protracted Pancreatitis.- 8.1.3 Treatment of Subsiding Acute Pancreatitis.- 8.2 Surgical Treatment.- 8.2.1 Urgent Indications.- 8.2.2 Semiurgent or Elective Surgery.- 8.2.3 Surgical Treatment of Recurrent Pancreatitis.- 8.2.4 Surgical Treatment of Severe Protracted Pancreatitis.- 9 Complications of Acute Pancreatitis.- 9.1 Early Complications.- 9.1.1 Shock.- 9.1.2 Renal Abnormalities.- 9.1.3 Splenic Abnormalities.- 9.1.4 Gastrointestinal Bleeding.- 9.1.5 Liver.- 9.1.6 Common Bile Duct Obstruction.- 9.1.7 Fat Necrosis.- 9.1.8 Respiratory Complications.- 9.1.9 Cardiac Complications.- 9.1.10 Coagulation Abnormalities.- 9.2 Late Complications.- 9.2.1 Colon.- 9.2.2 Small Intestine.- 9.2.3 Pancreatic Pseudocyst.- 9.2.4 Pancreatic Abscess.- 9.2.5 Pancreatic Ascites.- 10 Prognosis of Acute Pancreatitis.- Chronic Pancreatitis.- 11 Etiology of Chronic Pancreatitis.- 11.1 Acute vs. Chronic Pancreatitis.- 11.2 Chronic and Chronic Relapsing Pancreatitis.- 12 Pathology of Chronic Pancreatitis.- 13 Clinical Features of Chronic Pancreatitis.- 13.1 Abdominal Pain.- 13.2 Steatorrhea.- 13.3 Creatorrhea.- 13.4 Diabetes Mellitus.- 14 Diagnosis of Chronic Pancreatitis.- 14.1 Basic Laboratory Tests.- 14.2 Radiologic Studies.- 14.2.1 Conventional Studies.- 14.2.2 Endoscopic Retrograde Cholangiopancreatography..- 14.2.3 Diagnostic Ultrasound and C-T Scan.- 14.2.4 Angiography.- 14.2.5 Radioisotopic Scan.- 14.3 Tests of Exocrine Deficiency.- 14.3.1 Stool Examination.- 14.3.2 Urinary Tests.- 14.3.3 Aspiration of Duodenal Contents.- 14.3.4 Miscellaneous Laboratory Tests.- 14.4 Tests of Endocrine Deficiency.- 14.5 Summary of Tests.- 15 Treatment of Chronic Pancreatitis.- 15.1 Medical Treatment.- 15.1.1 Abdominal Pain.- 15.1.2 Steatorrhea.- 15.1.3 Creatorrhea.- 15.1.4 Diabetes Mellitus.- 15.2 Surgical Treatment.- 16 Complications of Chronic Pancreatitis.- 16.1 Metabolic Consequences.- 16.2 Gastrointestinal Complications.- 16.3 Pancreatic Calcification.- 16.4 Carcinoma of the Pancreas.- 16.5 Miscellaneous.- 17 Prognosis of Chronic Pancreatitis.

It is with much pleasure that I introduce this first volume in a series of Topics in Gastroenterology aimed at the intelligent clinician. Dr. Peter Banks is first and foremost a clinician and teacher and therefore an ideal lead-off author. His very helpful review of pancreatitis is based not only on a thorough assimilation of clinical and experimental evidence but also on his long clinical practice in university hospitals and in private practice. Dr. Banks understands what we clinicians need to know about the patho­ physiology of this challenging disorder. I found much practical informa­ tion in this volume to help me in thinking about my own patients, and I recommend it with enthusiasm. Howard M. Spiro, M.D. vii Preface In the preparation of this book, I have made a special effort to provide detailed clinical information on the care of the patient with pancreatitis. The usefulness of newer diagnostic tests such as amylase/creatinine clearance ratio, ERCP, diagnostic ultrasound, and C-T scan has been carefully evaluated. Particular attention has been devoted to the manage­ ment of the more difficult therapeutic problems such as severe protracted pancreatitis, pancreatitis of unknown etiology, pancreatic pseudocyst, and pancreatic insufficiency. Points of controversy regarding medical and surgical alternatives in the treatment of acute and chronic pancreatitis have been reviewed with specific recommendations for therapy. In all discussions, emphasis has been placed on basic physiological principles that govern treatment. A comprehensive and current bibliography accom­ panies each chapter.