Pancreatic Necrosis and Pancreatic Abscess Clinical Presentation

  • Author: Alan BR Thomson, MD; Chief Editor: Julian Katz, MD   more...
 
Updated: Jul 15, 2010
 

History

  • Diagnosed pancreatitis with an unexpectedly prolonged course, hemodynamic instability, fever, failure of medical therapy, or the presence of fluid collections on CT scan all point to the possibility of necrosis and, potentially, abscess formation later in the course.
  • Abscess formation takes weeks, and infected pancreatic necrosis may be diagnosed earlier in the course.
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Physical

  • Abdominal pain with or without a mass on palpation of the epigastrium is suggestive of parietal peritoneal irritation.
  • Classic physical examination findings, such as Grey-Turner sign or Cullen sign, are supposedly characteristic of pancreatitis but rarely are noted in clinical practice.
  • Other physical findings are nonspecific and include abnormal vital signs consistent with sepsis, abdominal guarding, and rebound tenderness.
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Causes

  • The inciting events for pancreatitis are legion; however, cholelithiasis and alcohol account for more than 80% of cases in the developed world.
  • Peripancreatic fluid encased in a fibrinous capsule defines pseudocysts.
  • Superinfection of pseudocysts is one way that pancreatic abscesses may form, though pseudocysts are not a prerequisite for abscess formation.
  • Evidence suggests that colonic translocation of bacterial flora accounts for many cases of pancreatic infection.
  • The most typical organisms isolated from infected necrosis and abscesses are enteric bacteria and Candida species.
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Contributor Information and Disclosures
Author

Alan BR Thomson, MD  Professor of Medicine, Division of Gastroenterology, University of Alberta, Canada

Alan BR Thomson, MD is a member of the following medical societies: Alberta Medical Association, American College of Gastroenterology, American Gastroenterological Association, Canadian Association of Gastroenterology, Canadian Medical Association, College of Physicians and Surgeons of Alberta, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Coauthor(s)

Eric R Frizzell, MD  Instructor of Medicine, Uniformed Services University of the Health Sciences; Consulting Staff, Department of Medicine, Division of Gastroenterology, Walter Reed Army Medical Center

Eric R Frizzell, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Specialty Editor Board

Jose A Perez Jr, MD, MSEd, MBA  Residency Director, Vice Chair of Education, Department of Medicine, Methodist Hospital, Houston; Associate Professor of Clinical Medicine, Weill Cornell Medical College

Jose A Perez Jr, MD, MSEd, MBA, is a member of the following medical societies: American College of Physician Executives, American College of Physicians, Society of General Internal Medicine, and Society of Hospital Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Douglas M Heuman, MD, FACP, FACG, AGAF  Chief of Hepatology, Hunter Holmes McGuire Department of Veterans Affairs Medical Center; Professor, Department of Internal Medicine, Division of Gastroenterology, Virginia Commonwealth University School of Medicine

Douglas M Heuman, MD, FACP, FACG, AGAF is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Physicians, and American Gastroenterological Association

Disclosure: Nothing to disclose.

Alex J Mechaber, MD, FACP  Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine

Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD  Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

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Contrast-enhanced CT scan of infected pancreatic pseudocyst.
 
 
 
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