Acute Pancreatitis

Definition

Definition of Acute Pancreatitis
Acute pancreatitis or acute pancreatic necrosis is a sudden inflammation of the pancreas. It can have severe complications and high mortality despite treatment. While mild cases are often successfully treated with conservative measures, such as NPO (nil per os, English nothing by mouth (NBM)) and aggressive intravenous fluid rehydration, severe cases may require admission to the intensive care unit or even surgery to deal with complications of the disease process.

Symptoms

Symptoms of Acute Pancreatitis
The main symptom of pancreatitis is abdominal pain felt in the upper left side or middle of the abdomen.

The pain:

1. May be worse within minutes after eating or drinking at first, especially if foods have a high fat content
2. Becomes constant and more severe, lasting for several days
3. May be worse when lying flat on the back
4. May spread (radiate) to the back or below the left shoulder blade

Causes

Causes of Acute Pancreatitis
When these enzymes somehow become active inside the pancreas, they eat (and digest) the tissue of the pancreas. This causes swelling, bleeding (hemorrhage), and damage to the pancreas and its blood vessels.

Acute pancreatitis affects men more often than women. Certain diseases, surgeries, and habits make you more likely to develop this condition.

The condition is most often caused by alcoholism and alcohol abuse (70% of cases in the United States). Genetics may be a factor in some cases. Sometimes the cause is not known, however.

Other conditions that have been linked to pancreatitis are:

1. Autoimmune problems (when the immune system attacks the body)
2. Blockage of the pancreatic duct or common bile duct, the tubes that drain enzymes from the pancreas
3. Damage to the ducts or pancreas during surgery
4. High blood levels of a fat called triglycerides (hypertriglyceridemia)
5. Injury to the pancreas from an accident

Diagnosis

Diagnosis of Acute Pancreatitis
Acute pancreatitis is diagnosed clinically but requires CT evaluation to differentiate mild acute pancreatitis from severe necrotic pancreatitis. Experienced clinicians were able to detect severe pancreatitis in approximately 34-39% of patients who later had imaging confirmed severe necrotic pancreatitis. Blood studies are used to identify organ failure, offer prognostic information, determine if fluid resuscitation is adequate, and if antibiotics are indicated.

Treatment

Treatment of Acute Pancreatitis
Treatment often requires a stay in the hospital and may involve:

1. Pain medicines
2. Fluids given through a vein (IV)
3. Stopping food or fluid by mouth to limit the activity of the pancreas

Occasionally a tube will be inserted through the nose or mouth to remove the contents of the stomach (nasogastric suctioning). This may be done if vomiting or severe pain do not improve, or if a paralyzed bowel (paralytic ileus) develops. The tube will stay in for 1 - 2 days to 1 - 2 weeks.

Prognosis

Prognosis of Acute Pancreatitis
Most cases go away in a week. However, some cases develop into a life-threatening illness.

Prevention

Prevention of Acute Pancreatitis
You may lower your risk of new or repeat episodes of pancreatitis by taking steps to prevent the medical conditions that can lead to the disease:

1. Avoid aspirin when treating a fever in children, especially if they may have a viral illness, to reduce the risk of Reye syndrome.
2. Do NOT drink too much alcohol.
3. Make sure children receive vaccines to protect them against mumps and other childhood illnesses (see: Immunizations - general overview).