Acute pancreatitis

Acute Pancreatitis: the pancreas is a gland located behind the stomach which secretes potent digestive juices or enzymes into the small intestine to aid the digestion of carbohydrates, proteins, and fat. It also releases the hormones insulin and glucagon into the bloodstream; which are involved in blood glucose metabolism, regulating how the body stores and uses food for energy.
Normally, digestive enzymes secreted by the pancreas do not become active until they reach the small intestine. But when the pancreas is inflamed (pancreatitis), the enzymes inside it attack and damage the tissues that produce them. Pancreatitis can be acute or chronic. Either form is serious and can lead to complications. In severe cases, bleeding, infection, and permanent tissue damage may occur. Both forms of pancreatitis occur more often in men than women.

WHAT ARE THE CAUSES OF ACUTE PANCREATITIS?

Acute pancreatitis is inflammation of the pancreas that occurs suddenly and usually resolves in a few days with treatment. Acute pancreatitis can be a life-threatening illness with severe complications. The most common cause of acute pancreatitis is the presence of gallstones – small, pebble-like substances made of hardened bile – that cause inflammation in the pancreas as they pass through the common bile duct obstructing the pancreatic duct. Chronic, heavy alcohol use is also a common cause. Acute pancreatitis can occur within hours or as long as 2 days after consuming alcohol. Other causes of acute pancreatitis include abdominal trauma, medications, infections, tumors, and genetic abnormalities of the pancreas.

>>>> CAUSES of Acute Pancreatitis MNEMONIC <<<<

SIGNS AND SYMPTOMS OF PANCREATITIS:

Signs and symptoms of pancreatitis may vary, depending on which type you experience.
Acute pancreatitis signs and symptoms include:

  • Upper abdominal pain (epigastric)
  • Abdominal pain that radiates to your back
  • Abdominal pain that feels worse after eating
  • Nausea
  • Vomiting
  • Tenderness when touching the abdomen

Chronic pancreatitis signs and symptoms include:

  • Upper abdominal pain (epigastric)
  • Losing weight without trying
  • Oily, smelly stools (steatorrhea)

DIAGNOSIS OF ACUTE PANCREATITIS:

While asking about a person’s medical history and conducting a thorough physical examination, the doctor will order a blood test to assist in the diagnosis. During acute pancreatitis, the blood contains at least three times the normal amount of amylase and lipase, digestive enzymes formed in the pancreas. Changes may also occur in other body chemicals such as glucose, calcium, magnesium, sodium, potassium, and bicarbonate. After the person’s condition improves, the levels usually return to normal.

Diagnosing acute pancreatitis is often difficult because of the deep location of the pancreas. The doctor will likely order one or more of the following tests:

  • Abdominal ultrasound: Sound waves are sent toward the pancreas through a handheld device that a technician glides over the abdomen. The sound waves bounce off the pancreas, gallbladder, liver, and other organs, and their echoes make electrical impulses that create a picture – called a sonogram – on a video monitor. If gallstones are causing inflammation, the sound waves will also bounce off them, showing their location.
  • Computerized tomography (CT) scan: The CT scan is a noninvasive X-ray that produces three-dimensional pictures of parts of the body. The person lies on a table that slides into a donut-shaped machine. The test may show gallstones and the extent of damage to the pancreas.
  • Endoscopic ultrasound (EUS): After spraying a solution to numb the patient’s throat, the doctor inserts an endoscope – a thin, flexible, lighted tube – down the throat, through the stomach, and into the small intestine. The doctor turns on an ultrasound attachment to the scope that produces sound waves to create visual images of the pancreas and bile ducts.
  • Magnetic resonance cholangiopancreatography (MRCP): MRCP uses magnetic resonance imaging, a noninvasive test that produces cross-section images of parts of the body. After being lightly sedated, the patient lies in a cylinder-like tube for the test. The technician injects dye into the patient’s veins that helps show the pancreas, gallbladder, and pancreatic and bile ducts.

TREATMENTS FOR ACUTE PANCREATITIS:

HOSPITALIZATION TO STABILIZE PANCREATITIS:

Treatment for pancreatitis usually requires hospitalization. Once your condition is stabilized in the hospital and inflammation in the pancreas is controlled, doctors can treat the underlying cause of your pancreatitis so if you’re experiencing pancreatitis, your doctor may admit you to the hospital for care.

Initial treatments to help control the inflammation in your pancreas and make you more comfortable may include:

  • Fasting: You’ll stop eating for a couple of days in the hospital in order to give your pancreas a chance to recover. Once the inflammation in your pancreas is controlled, you may begin drinking clear liquids and eating bland foods. With time, you can go back to your normal diet. If your pancreatitis persists and you still experience pain when eating, your doctor may recommend a feeding tube to help you get nutrition.
  • Pain medications: Pancreatitis can cause severe pain. Your health care team will give you medications to help control the pain.
  • Intravenous (IV) fluids: As your body devotes energy and fluids to repairing your pancreas, you may become dehydrated. For this reason, you’ll receive extra fluids through a vein in your arm during your hospital stay.

How long you stay in the hospital will depend on your situation. Some people recover quickly and others develop complications that require a longer hospitalization.

TREATING THE UNDERLYING CAUSE OF PANCREATITIS:

Once your pancreatitis is brought under control, your health care team can treat the underlying cause of your pancreatitis. Treatment will depend on the cause of your pancreatitis, but examples of treatment may include:

  • Procedures to remove bile duct obstructions. Pancreatitis caused by a narrowed or blocked bile duct may require procedures to open or widen the bile duct. A procedure called endoscopic retrograde cholangiopancreatography (ERCP) uses a long tube with a camera on the end to examine your pancreas and bile ducts. The tube is passed down your throat, and the camera sends pictures of your digestive system to a monitor. ERCP can aid in diagnosing problems in the bile duct and in making repairs.
  • Gallbladder surgery. If gallstones caused your pancreatitis, your doctor may recommend surgery to remove your gallbladder (cholecystectomy).
  • Pancreas surgery. Surgery may be necessary to drain fluid from your pancreas or to remove diseased tissue.
  • Treatment for alcohol dependence. Drinking several drinks a day over many years can cause pancreatitis. If this is the cause of your pancreatitis, your doctor may recommend you enter a treatment program for alcohol addiction. Continuing to drink may worsen your pancreatitis and lead to serious complications.

 


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What is acute pancreatitis? Acute pancreatitis describes a sudden inflammation of the pancreas, which can lead to a variety of severe complications. This video discusses the pathophysiology, signs and symptoms, diagnosis, and treatment of acute pancreatitis.

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Sources:
Pathoma
First Aid 2016
http://emedicine.medscape.com/article/181364-overview
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http://www.medscape.com/viewarticle/706319
http://emedicine.medscape.com/article/181554-overview#showall
https://en.wikipedia.org/wiki/Pancreatic_abscess
http://emedicine.medscape.com/article/184237-overview

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