Acute pancreatitis is an inflammation of the pancreas, which, unlike chronic pancreatitis, is mainly characterized by severe upper abdominal pain, nausea, nausea, constipation, as well as fever. Initial treatment measures for acute pancreatitis include nutrition via intravenous fluid administration and treatment with high-dose analgesics.
What is acute pancreatitis?
The occurrence of acute pancreatitis can have many causes. However, most often, pancreatitis is due to gallstones. In acute pancreatitis, self-digestion occurs during which digestive enzymes are released some time too early. The actual task of the released enzymes is to digest and utilize nutrients such as proteins, fat and carbohydrates. However, since this process can occur before food is ingested, the organ digests itself. Patients can suffer from this life-threatening disease several times, but in most cases they can also recover completely. Nevertheless, acute pancreatitis leads to numerous complications.
Causes
The occurrence of acute pancreatitis can have many causes. However, most often, pancreatitis is due to gallstones. These are located for some time in the duodenum (this is also the mouth of the pancreatic duct). Due to this process there is a reflux of the small intestine juice and at the same time the bile acid destroys the beginning of the pancreatic duct. These processes, in turn, lead to an increase in permeability to certain phosphates and enzymes. Another cause may be alcohol abuse, but this must be at least excessive or even chronic for it to lead to pancreatitis. Alcohol also triggers the processes described above. In a residual proportion of cases, no precise cause can be identified, which is why these patients are referred to as having idiopathic genesis.
Symptoms, complaints, and signs
Acute pancreatitis is characterized by sudden onset of severe pain in the upper abdomen. The pain is persistent and typically radiates to the back. In rarer cases, they also travel to the chest. In many cases, they encompass the body in a belt-like fashion. Furthermore, the abdominal wall is taut without becoming hard. This so-called rubber belly is characteristic of acute pancreatitis. These typical symptoms may be joined by nausea, vomiting, fever and flatulence. However, the bowel sounds are only faint, indicating paralysis of the intestine and the risk of intestinal obstruction. In severe cases, there may even be circulatory shock with a sharp drop in blood pressure, sweating, [[cyanosis9]], thirst, renal failure, and a sharp increase in respiratory rate. If pancreatitis is caused by gallstones or biliary tract disease, jaundice often develops, which is noticeable by the yellowing of the skin and greenish-colored sclera of the eyes. At the same time, the stools become discolored and the urine darkens. In most cases, however, acute pancreatitis is mild. It is characterized only by pain in the upper abdomen, which subsides after a few days. Complete healing occurs. However, if a large part of the pancreas is destroyed, the symptoms are very severe and the lethality is very high due to circulatory shock, intestinal obstruction, organ failure, or sepsis.
Diagnosis and course
In most cases, the first sign of acute pancreatitis is severe upper abdominal pain. This pain spreads radially down the back as it progresses, closing like a belt. When patients are examined, clear symptoms of pancreatitis include a tenderness abdomen and a rubber belly. The rubber belly (also called bloated abdomen) occurs due to a large accumulation of gas in the gastrointestinal tract. Also characteristic is first mild pain in the thoracic spine, which is quite similar to the pain sensation in lumbago. However, this pain increases to the point of intolerability. Other symptoms that accompany the above, but sometimes begin later in the course are constipation, nausea, vomiting and fever.Jaundice, abdominal dropsy and signs of shock, among others, can occur in very severe cases of acute pancreatitis. Most cases are mild if treatment is started in time. Nevertheless, 20% of cases are very serious and can lead to death in the most devastating cases. Acute pancreatitis can have a milder and a more severe course. The most serious complications are deaths, for which up to 5% are reported in the mild course and nearly 100% in the most severe degree of the severe course.
Complications
In addition, complications directly related to acute pancreatitis and late sequelae of this disease should be distinguished. The most serious complications directly related to pancreatitis are deaths due to failure of the heart, lungs, and kidneys. Observed are bleeding associated with hypotension to shock, systemic inflammatory reactions, serious blood count changes, and dehydration. Bleeding and fluid accumulation in the abdominal cavity may lead to multiple organ failure, pancreatic-derived trypsin may attack endogenous organs. Shallow breathing due to pain may collapse the lungs. Pressure increase in the abdomen and abdominal compartment syndrome may necessitate surgical opening of the abdomen. Pancreatitis can recur at any time after acute inflammation has been overcome. Formation of pseudocysts and scar tissue may cause pain and be associated with infection, rupture, and hemorrhage; there may be obstruction of the bile duct with resulting jaundice. Development of necrotizing pancreatitis with pus development, liquefaction and death of tissue is possible. Thus, complication of acute pancreatitis may be chronic disease
When should you see a doctor?
If acute pancreatitis is suspected, a physician should be consulted promptly. Medical advice is needed if there is a sudden onset of severe upper abdominal pain radiating in a belt-like pattern that cannot be attributed to any specific cause. If the symptoms persist for longer than usual, a visit to the doctor is necessary. If the symptoms are severe, an emergency doctor should be called. For example, fever and sweating indicate a severe inflammation of the pancreas, which can be fatal if left untreated. Sharp pains in the upper abdomen may also pose an acute danger to life. If the above-mentioned symptoms occur very suddenly and increase rapidly, it is highly likely that the patient has acute pancreatitis and must be treated medically. Further contacts are the gastroenterologist or internist. Anyone who regularly takes certain medications – such as diuretics, beta blockers or ACE inhibitors – should discuss the symptoms with the doctor in charge. If the symptoms occur after a viral infection such as mumps, a worm infestation or a salmonella infection, this must also be clarified. Tumor patients and people with changes in their genetic makeup (hereditary pancreatitis, cystic fibrosis, and others) should consult a physician at the first sign of pancreatitis.
Treatment and therapy
Once acute pancreatitis has been diagnosed, therapy should be started immediately. The first measure for pancreatitis is usually intravenous fluid administration. This is done to counteract an increasingly threatening volume deficiency shock, as this is caused by a considerable loss of fluid. The administration of fluids is usually accompanied by analgesic therapy to stop the severe cramps. For a long time, the medical community was convinced that pancreatitis could be controlled by a specific diet. However, in mild pancreatitis, the usual diet can continue to be consumed. In severe pancreatitis, where intestinal paralysis may occur, a naso-small bowel tube is usually inserted at an early stage so that nutrition is provided only through the intestines. If the acute pancreatitis is due to a stuck gallstone, it must be removed. Antibiotic therapy is also usually given to prevent infection.
Outlook and prognosis
Pancreatitis results in various unpleasant symptoms. First and foremost, the patient suffers from nausea with vomiting. There is also pain in the abdomen, as well as fever.These complaints can extremely restrict the patient’s everyday life and thus considerably reduce the quality of life. Often, pancreatitis also causes constipation and flatulence. In many cases, the abdominal pain also spreads to the back. Furthermore, jaundice and thus damage to the liver can occur if the disease is not treated promptly. Without treatment, the patient may die in the worst case. Even if pancreatitis is diagnosed and treated late, organ damage can occur that is usually not reversible. As a result, the affected person may also die from organ failure or be dependent on a transplant. In many cases, pancreatitis can be treated with pain medication and antibiotics. Whether the disease progresses favorably usually depends on the severity of the disease. In some circumstances, pancreatitis reduces life expectancy.
Prevention
Unfortunately, there are no preventive measures that can prevent acute pancreatitis. However, if the cause is excessive alcohol abuse, withdrawal can prevent further illness from pancreatitis. However, there are no effective preventive measures for stuck gallstones. In any case, however, treatment measures should begin as early as possible to prevent worse developments of acute pancreatitis.
Follow-up
It is essential that acute pancreatitis be treated by a physician, as it can bring life-threatening complications. The patient also has a role to play in follow-up care. This is because many triggers of pancreatitis are related to unhealthy habits of the affected person. First and foremost, alcohol and nicotine are the stimulants, and their elimination during aftercare is a decisive factor for recovery, but also for preventing a flare-up of the disease. The necessary information on this is provided by the family doctor, but also by the treating internist. Nutrition is another important factor in consistent aftercare. Here, the focus is on a balanced diet. It helps to lower elevated blood lipids, which frequently occur in connection with pancreatitis and which can also promote other serious diseases in the cardiovascular and vascular systems. Avoiding flatulent, fatty, fried, and cold foods is also important, as these can stress the pancreas in its function. Anyone who is unsure about which foods and drinks are suitable can find help from their family doctor, internist or dietician. Regular check-ups with the doctor are also important during the follow-up period and beyond. Follow-up appointments with the doctor should therefore be kept consistently in order to have blood values and functions of the internal organs checked professionally.
What you can do yourself
Immediate medical attention is needed for acute pancreatitis. There are clear limits to self-treatment at home. However, own measures are highly recommended during therapy or postoperatively. After a stay in the hospital, patients must continue to slowly build up their diet. The tolerance of vegetables, fish and meat should be tested slowly. In most cases there are disturbances of the digestive tract. In order to support the body, sufficient fluid intake should be ensured, and food should be carefully chewed and well cooked. Often, affected persons can only produce a few digestive enzymes. For this reason, fatty foods are poorly tolerated, resulting in flatulence and diarrhea. The missing enzymes can be replaced by a preparation. This should be taken with every meal. Furthermore, the consumption of nicotine and alcohol should be strictly avoided. There is also a risk of developing diabetes mellitus due to the damage to the pancreas. In this case, sugar should be strictly reduced and attention should be paid to a balanced diet with a high proportion of vegetables and fruit. Regular exercise also stabilizes the blood sugar level and can compensate a little for what the pancreas is no longer able to do. If it is necessary to take insulin, regular check-ups with a diabetologist are recommended to minimize the risk of further complications.
