Acute pancreatitis by Dr Arun Aggarwal

Acute pancreatitis refers to inflammation of the pancreas, causing sudden and severe abdominal pain. The pancreas is an organ that lies in the back of the mid-abdomen. It produces digestive juices and certain hormones, including insulin.

In all cases, it is essential to determine the underlying cause of acute pancreatitis and, if possible, to treat this condition to prevent a recurrence.

PANCREATITIS CAUSES — There are many possible underlying causes of acute pancreatitis, but 60 to 75 percent of all cases are caused by gallstones or alcohol abuse.

Gallstone pancreatitis — Because the gallbladder and pancreas share a drainage duct, gallstones that lodge in this duct can prevent the normal flow of pancreatic enzymes and trigger acute pancreatitis.

Alcoholic pancreatitis — more common in individuals who have a long history of alcohol abuse.

Drug-induced pancreatitis — A number of drugs used to treat medical conditions can trigger acute pancreatitis.

Post-ERCP — Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure that is done to evaluate the gallbladder or pancreas. Acute pancreatitis develops in about 3 to 5 percent of people who undergo ERCP.

Hereditary conditions — Acute pancreatitis can be caused by hereditary conditions, such as familial hypertriglyceridemia (high blood triglyceride levels) and hereditary pancreatitis.

Unexplained — No underlying cause can be identified in about 20 percent of people with acute pancreatitis. This condition is called idiopathic pancreatitis.

PANCREATITIS SYMPTOMS — Acute pancreatitis frequently presents with sudden, constant pain in the upper part of the abdomen. The pain may wrap around your upper body and involve the back in a band-like pattern. The pain typically lasts days and is often relieved by leaning forward.

PANCREATITIS DIAGNOSIS — The diagnosis is usually based upon a medical history, physical examination, and the results of diagnostic tests. Two of the following three are required to make a diagnosis: (1) typical abdominal pain; (2) threefold or more elevation of pancreatic enzyme values in the blood; and (3) inflammation of the gland on computed tomography (CT) scan or magnetic resonance imaging (MRI) scan. Once a diagnosis of acute pancreatitis is made, additional tests are needed to determine the underlying cause.

Endoscopic retrograde cholangiopancreatography (ERCP) — ERCP is a procedure that can be used to remove stones from the bile duct if your pancreatitis is due to gallstones or other problems with the bile or pancreatic ducts. In addition, ERCP can be used to treat some causes of pancreatitis.

PANCREATITIS TREATMENT — The goals of treatment of acute pancreatitis are to alleviate pancreatic inflammation and to correct the underlying cause. Treatment usually requires hospitalization.

Mild pancreatitis — Mild pancreatitis usually resolves with simple supportive care, which entails monitoring, drugs to control pain, and intravenous fluids.

Moderate to severe pancreatitis — Moderate to severe pancreatitis requires more extensive monitoring and supportive care. This is because severe pancreatitis can lead to potentially life-threatening complications. During this time you may be given one or more of the following treatments:

• Intravenous fluids are given to help prevent dehydration.
• Many patients with moderate to severe pancreatitis may not be able to eat in the early course of their illness. Instead, you may be fed through a tube placed through the nose or mouth into the small intestine. You can resume eating gradually once your pain resolves and bowel function returns to normal.
• About 30 percent of people with severe acute pancreatitis develop an infection in the damaged pancreatic tissue. Antibiotics can prevent infections and control infections that are already present.
• Acute pancreatitis is sometimes complicated by extensive damage and/or infection to the pancreatic tissue. In these cases, the damaged and/or infected tissue may be removed in a procedure referred to as a necrosectomy.

Gallstone pancreatitis treatment — In people who have gallstone pancreatitis, the treatment of pancreatitis is usually coupled with the treatment of gallstones. This may include a procedure to relieve the blockage caused by the gallstone(s).