Acute pancreatitis is sudden inflammation of the pancreas that may be mild or life threatening but usually subsides. In severe acute pancreatitis, there is usually some tissue death, or necrosis. This increases the risk of sepsis, a severe bacterial infection that can affect the whole body. Sepsis can lead to multi-organ damage or failure.
Severe acute pancreatitis can also cause hypovolemic shock. Severe blood and fluid loss can leave the heart unable to pump enough blood to the body. Parts of the body can become rapidly oxygen deprived. This is a life-threatening situation.
Symptoms:
Typically, the patient will experience a sudden onset of pain in the center of the upper abdomen, below the breastbone (sternum).
Rarely, the pain is first felt in the lower abdomen. It will gradually become more intense until it is a constant ache. The ache may intensify further and become severe. It also spreads into the back in around half of cases. Eating may exacerbate the pain.
Pancreatitis that is caused by gallstones will develop very fast. When it is caused by alcohol, symptoms develop more slowly, over several days.
Leaning forward or assuming a fetal position (curling up) may help lessen the pain slightly. Anybody who experiences constant pain should seek medical attention.
The following symptoms may also be present:
• Vomiting
• Nausea
• Diarrhea
• Loss of appetite
• Rapid pulse
• Pain with coughing, vigorous movements, and deep breathing
• Tenderness when the abdomen is touched
• Fever and a temperature of at least 100.4 °F (38 °C)
• Jaundice, when the skin and whites of the eyes take on a yellowish tinge
• Pain cannot be relieved even with strong painkillers
• Blood pressure may fall or rise, but it will fall when the patient stands, sometimes causing faintness.
Causes:
The most common causes (more than 70% of cases) of acute pancreatitis are Gallstones and alcohol use
Gallstones:
Gallstones cause about 40% of cases of acute pancreatitis. Gallstones are collections of solid material in the gallbladder. These stones sometimes pass into and block the duct that the gallbladder shares with the pancreas (called the common bile duct).
Normally, the pancreas secretes pancreatic fluid through the pancreatic duct into the first part of the small intestine (duodenum). This pancreatic fluid contains digestive enzymes that help digest food. If a gallstone becomes stuck in the sphincter of Oddi (the opening where the pancreatic duct empties into the duodenum), pancreatic fluid stops flowing. Usually, the blockage is temporary and causes limited damage, which is soon repaired. But if the blockage remains, the enzymes collect in the pancreas and begin to digest the cells of the pancreas, causing severe inflammation.
Alcohol:
Alcohol use causes about 30% of cases of acute pancreatitis. The risk of developing pancreatitis increases with increasing amounts of alcohol (4 to 7 drinks per day in men and 3 or more drinks per day in women). However, less than 10% of people who frequently consume alcohol develop acute pancreatitis, which suggests additional triggers or other factors are needed for pancreatitis to develop.
How alcohol causes pancreatitis is not fully understood. One theory is that alcohol is converted into toxic chemicals in the pancreas that cause damage. Another theory is that alcohol may cause the small ductulus in the pancreas that drain into the pancreatic duct to clog, eventually causing acute pancreatitis.
Other Causes:
• Drugs such as angiotensin-converting enzyme (ACE) inhibitors, azathioprine, furosemide, 6-mercaptopurine, pentamidine, sulfa drugs, and valproate
• Estrogen use in women with high levels of lipids in the blood
• High levels of calcium in the blood (which may be caused by hyperparathyroidism)
• Viruses such as mumps, coxsackie B virus, and cytomegalovirus
• High levels of triglycerides in the blood (hypertriglyceridemia)
• Damage to the pancreas caused by surgery or endoscopy (such as endoscopic retrograde cholangiopancreatography [ERCP]).
• Damage to the pancreas caused by blunt or penetrating injuries.
• Cancer of the pancreas, or other blockages of the pancreatic duct.
• Hereditary pancreatitis, including a small percentage of people with cystic fibrosis or cystic fibrosis genes.
• Cigarette smoking
• Kidney transplantation
• Pregnancy (rare)
• Tropical pancreatitis
• For some people, acute pancreatitis is hereditary. Gene mutations that predispose people to developing acute pancreatitis have been identified. People who have cystic fibrosis or carry the cystic fibrosis genes have an increased risk of developing acute as well as chronic pancreatitis.
• Many drugs can irritate the pancreas. Usually, the inflammation resolves when the drugs are stopped.
• Viruses can cause pancreatitis, which is usually short-lived.
Treatment:
Treatment for acute pancreatitis will depend on whether it is mild or serious. In mild cases, the risk of complications is small. In serious cases, the risk is significant.
Treatment for mild acute pancreatitis aims to maintain bodily function and ease symptoms while the pancreas is repairing itself. This will include:
• Painkillers: Mild acute pancreatitis can be moderately or severely painful.
• Nasogastric tubes: A tube may remove excess liquids and air as a treatment for nausea and vomiting.
• Bowel rest: The gastrointestinal tract will need to rest for a few days, so the person will not take any food or drink by mouth until their condition improves.
• Preventing dehydration: Dehydration often accompanies pancreatitis, and it can worsen the symptoms and complications. Fluid is often provided intravenously for the first 24-48 hours.
• The person can usually go home after about 5 to 7 days.
Treatment for Severe Acute Pancreatitis includes:
• Treatment in the intensive care unit (ICU): Injections with antibiotics aim to stop any infection from developing in the dead tissue.
• Intravenous fluids: These helps maintain hydration and prevent hypovolemic shock.
• Breathing assistance: Ventilation equipment will help the patient breathe.
• Feeding tubes: These provide nutrition as appropriate. In this case, early feeding improves outcomes.
• Surgery: In some cases, the dead tissue may need to be surgically removed.
• The patient will stay in ICU until they are no longer at risk of organ failure, hypovolemic shock, and sepsis.
Treating gallstones:
If gallstones caused the acute pancreatitis, the patient might undergo surgery or an endoscopic retrograde cholangio-pancreatography (ERCP) after their condition improves. After the gallstones are removed, the patient may be advised to follow a special diet to lower blood cholesterol, because excess cholesterol encourages the growth of gallstones.
The American Gastroenterological Association recommends surgery to remove the gallbladder of any patient who develops pancreatitis from gallstones.
Treating alcohol misuse:
If doctors determine that alcohol misuse was the underlying cause of the acute pancreatitis, the patient may be offered a treatment program for alcohol misuse.
