Pancreatitis and Vomiting: Pathophysiology and Clinical Presentation

Vomiting is a **hallmark symptom of acute pancreatitis**, occurring in 75–90% of cases, often severe and persistent.

Mechanisms

• Inflammatory Mediators: Cytokines (TNF-α, IL-1, IL-6), bradykinin, substance P stimulate chemoreceptor trigger zone (CTZ) and vomiting center.
• Gastric/Ileal Dysmotility: Pancreatic inflammation → reflex gastric atony, ileus → distension → vomiting.
• Enzyme Activation: Premature trypsin activation digests pancreatic tissue; peritoneal irritation → nausea/vomiting.
• Metabolic: Hypertriglyceridemia (cause and effect), hyperglycemia, hypocalcemia contribute.

Associated Symptoms

• Epigastric pain radiating to back (95%).
• Fever, tachycardia, hypotension (severe).
• Abdominal distension, absent bowel sounds (ileus).
• Jaundice (biliary etiology).

Diagnosis

2 of 3: (1) characteristic pain, (2) lipase/amylase >3× ULN, (3) imaging (CT/MRI) findings.

Management

• Aggressive IV fluid resuscitation (RL/LR).
• Analgesia (opioids).
• NPO initially; early enteral feeding (nasogastric/nasojejunal) if tolerated.
• Antiemetics (ondansetron, metoclopramide, haloperidol).
• Treat etiology (cholecystectomy for gallstone, alcohol cessation, fibrate/insulin for HTG).

Severe cases (necrotizing, organ failure) → ICU, possible necrosectomy.