What is Acute pancreatitis?
Acute pancreatitis is an inflammation of the pancreas. It is painful, sudden development of pancreatitis and in some cases, it can be life threatening.
Some mild cases sort out without any treatment, but severe, acute pancreatitis can trigger all possible fatal complications. The mortality rate lies between less than 5 percent to over 30 percent, depending upon the severity of the condition and if it has affected other organs beyond the pancreas.
Acute pancreatitis is approximately affect between 4.5 and 35 in every 100,000 individuals every year. However, this data may not include the many mild cases that relieve without medical assessment or treatment. There are 275,000 hospitalizations for acute pancreatitis in the United States per year.
The pancreas is a elongated flat gland situated behind the stomach in the upper abdomen. It produces digestive enzymes and hormones, which regulate the glucose precessing in the body. for instance, insulin.
Acute pancreatitis starts quickly, but chronic pancreatitis is repeating or continuous. This article will focus on acute pancreatitis.
The patient will experience a quick appearance of pain in the center of the upper abdomen, below the sternum or breastbone.
Rarely, the pain is first felt in the lower abdomen. It will slowly become more intense ultimately converted into a constant ache.
The pain may intensify further and become severe. It also spreads into the back in about half of cases. Eating may eggravate the pain.
Pancreatitis that is caused by gallstones will grow very fast. When it is caused by alcohol, symptoms appear more slowly, and can take number of days.
Leaning forward or having a fetal position (curling up) may help in reducing the pain slightly. Anybody who feels constant pain should go for medical attention.
The following symptoms may also be present:
- loss of appetite
- Increased pulse
- coughing with pain, strong movements, and deep breathing
- tenderness when the abdomen is touched
- fever and a minimum of temperature of 100.4 °F (38 °C) atleast
- jaundice, when the skin and sclera of the eyes turns yellowish
- pain cannot be relieved even with strong painkillers
- blood pressure fluctuations (may fall or rise)but it will fall when the patient stands sometimes leading to faintness
Treatment for acute pancreatitis will depend on whether it is mild or severe. In mild cases, the risk of complications is lower while in serious cases, the risk is significant.
Treatment for mild acute pancreatitis
Treatment aims to maintain bodily function and relieve symptoms while the pancreas is repairing by its own.
- Painkillers: Mild acute pancreatitis can be little or highly painful.
- Nasogastric tubes: A tube may remove extra liquids and air as a treatment for nausea and vomiting.
- Bowel rest: The gastrointestinal tract will need not to work for a few days, so the person will not take any food or drink by mouth until their condition gots better
- Preventing dehydration: Dehydration often follows pancreatitis, and it can worsen the symptoms and complications. Fluid is often given intravenously for the first 24-48 hours.
The person can usually leave the hospital after about 5 to 7 days.
Treatment for severe acute pancreatitis
In severe acute pancreatitis, there is usually some death of tissues or necrosis. This increases the risk of sepsis,( a severe bacterial infection that can affect the entire) body. Sepsis can be fatal and can result in multi-organ damage or failure.
Severe acute pancreatitis can also lead to hypovolemic shock. Severe blood and fluid loss can make the heart unable to pump the required blood to the body. Organs and tissues of the body can soon become oxygen-deprived . This is a life-threatening condition.
Treatment for this kind of pancreatitis has:
- Treatment in the intensive care unit (ICU): Injections with antibiotics focus to prevent any infection from developing in the dead tissue.
- Intravenous fluids: These help maintain hydration thus prevent hypovolemic shock.
- Breathing assistance: Ventilation equipment will help the patient breathe.
- Feeding tubes: These provide adequate nutrition . In this case, early feeding improves results.
- Surgery: In some cases, surgery can be required to remove the dead tissue.
The patient will kept in ICU until they are no longer at risk of organ failure, hypovolemic shock, and sepsis.
If acute pancreatitis is caused by gallstones, the patient might undergo for surgical procedure or an endoscopic retrograde cholangiopancreatography (ERCP) after their condition improves.
After the removal of gallstones up, the patient may be suggested to follow a special diet to reduce blood cholesterol, because excessive cholesterol supports the growth of gallstones.
The American Gastroenterological Association suggests surgery to remove the gallbladder of any patient who develops pancreatitis due to gallstones.
Gallstones, infections, and alcohol abuse are common causes of acute pancreatitis.
People who consume alcohol for many years may develop pancreatitis. A higher consumption of alcohol is associated with increased chance of chronic pancreatitis.
Trypsin is a digestive enzyme released from the pancreas in it’s inactive form.
Alcohol overuse can lead to activation of trypsin when it is still inside the pancreas, but scientists are not sure about it’s actual cause.
Researchers believe that ethanol molecules triggers the pancreatic cells, to premature activation of trypsin.
Gallstones are small, stone like formations that form in the gallbladder, generally,if there is excessive cholesterol in the bile.
Sometimes, the gallstones can block the hepatopancreatic duct or pancreatic duct as they make their way out of the bile ducts and into the intestine.
This obstruction will also affect the pancreas and prevent it from releasing its enzymes into the intestine.
If the acute pancreatitis is associated with gallstones, cholecystectomy (removal of the gallbladder) is generally suggested before the patient leaves the hospital.
Bacterial infections that can cause acute pancreatitis are: Salmonellosis, a form of food poisoning caused by the bacterium Salmonella, or Legionnaires’ disease, an infection caused by the bacterium Legionella pneumophila which are found in plumbing, shower heads, and water-storage tanks.
Other probable causes are:
- some autoimmune diseases, such as lupus, or Sjogren’s syndrome
- genetic mutations that make some people more susceptible
- pancreatic injuries
- increased triglyceride levels in the blood
- increased calcium levels in the blood
Over 10 percent of all cases of acute pancreatitis are called as idiopathic, means there is no clear cause.
For most of the people with acute pancreatitis, there are no dietary restrictions, but the person may be unable to eat for a few days, or they don’t have to take solid foods.
In the hospital, some people may require a feeding tube.
When the person restarts eating, they will probably be advised to follow a healthy, low-fat diet, and to eat in small amounts at regular intervals.
It is important to drink lots of fluids but to avoid caffeine and alcohol based drinks.
The American Dietary Guidelines offer advice to have a healthy, low-fat, diet.
Pancreatitis can lead to possibly life threatening complications.
- Blockage of a bile or pancreatic duct
- leakage from the pancreatic duct
- pseudocysts, having a risk of rupture, hemorrhage, or infection
- damage to the pancreatic cells
- pleural effusion
- splenic vein thrombosis
Failure of organs such as heart, lung, and kidney may occur. In severe cases, organ failure can occur around 48 hours after appearance of symptoms. These can cause death if left untreated. It is important to seek treatment immediately if someone shows signs of acute pancreatitis.
The doctor will ask the patient about symptoms and examine their abdomen. If certain areas of the abdomen are sensitive to touch, this could indicate acute pancreatitis.
In acute pancreatitis, the abdominal wall muscles will be hard. When listening the abdominal sound with a stethoscope, there may be very low or no intestinal sounds.
If blood levels of amylase and lipase are elevated than normal, the patient will probably be sent to the hospital. The pancreas produces increased levels of both the enzymes during acute pancreatitis.
However, blood tests may not be accurate if they are not sampled on the first or second day of illness. This is because lipase and amylase levels are highest within the first few hours and return back to normal level after a few days.
Amylase backs to normal within 3-7 days, and lipase returns to normal in about 8-14 days.
Further testing in hospital
To find out the risk of complications, a doctor will want to asure about the severity of inflammation of the pancreas ; the following tests may be performed for it:
- ERCP (endoscopic retrograde cholangiopancreatography) scan: An endoscope (a thin, flexible tube with a camera fixed at the end) is inserted into the GIT. An ERCP can help to find out the exact location of a gallstone.
- An ultrasound scan: High-frequency sound waves create a picture of pancreas , gallbladder, and their surroundings on the monitor.
- CECT (contrast-enhanced computed tomography) scan: These are used to take images of the same area from different angles; these are then combined to produce a 3-D image. CECT scans can help identify inflammation of the pancreas, fluid collection, and any changes in it’s density.
- Chest X-ray: The doctor may suggest a chest X-ray to determine the areas of collapsed lung tissue, or fluid accumulation in the chest cavity.
Acute pancreatitis generally ends in a few days with proper treatment, however, some people may need to stay in the hospital for some time,