Pancreatitis is the acute inflammation of the pancreas. A distinction is made between acute and chronic forms of progression. The following is information about acute pancreatitis. This is defined as sudden inflammation of the pancreas, which may occur once or several times.
Gallstones as causes of acute pancreatitis.
The cause of acute pancreatitis is that the digestive enzymes produced by the pancreas already take effect in the pancreas itself (instead of in the intestine) and attack the tissue. In effect, self-digestion of the organ occurs. Most often, acute pancreatitis is caused by gallstones. The excretory duct of the gallbladder (choledochal duct) opens into the duodenum together with the excretory duct of the pancreas (pancreatic duct). When gallstones pass, they can obstruct the duct, causing the pancreatic secretion to back up as well. Because bile can also back up, jaundice (icterus) is also possible.
Other possible triggers
Alcohol abuse is another common cause. Less common causes of acute inflammation of the pancreas are:
- Injury to the pancreas
- Infections (mumps and other viral diseases).
- Disturbances in lipid metabolism or mineral balance
- Medication
- Vascular diseases
- Malformations or mechanical obstructions (tumor or stenosis at the orifice, scars, ascarids).
Acute pancreatitis: course.
Due to the backlog of secretions, the enzymes that would normally be released into the intestines are activated in the wrong place. These enzymes are supposed to break down food components. The premature activation causes pancreatic cells to become digested. Blood vessels can also be attacked and bleeding can occur. The body loses a lot of protein-rich fluid and blood as a result of these processes, and shock may result. In addition, the activated enzymes can enter the bloodstream. Thus, they are distributed throughout the body and can cause damage to other organs. In the abdominal cavity, irritation of the intestine to the point of paralytic ileus and peritonitis develop. In the pancreas itself, edema of the tissue or even necrosis occurs. At 60 percent, the edematous form is the most common. Partial necrosis occurs in 30 percent of cases, and complete necrosis in 10 percent of cases. The more pronounced the necrosis, the more complications occur and the higher the risk of dying from pancreatitis. After the acute phase, the cause of pancreatitis must be removed to prevent recurrence (for example, removal of the gallbladder if gallstones were the cause).
Symptoms of acute pancreatitis
Acute pancreatitis presents as an “acute abdomen.” Typical symptoms of acute pancreatitis are:
- Sudden onset of severe pain in the upper abdomen (often girdling with radiation to the back).
- Vomiting
- Nausea
- Flatulence
- Flushed face
Palpitations, accelerated pulse, drop in blood pressure and weakness are signs of incipient shock. Patients look seriously ill, the abdomen is bulging elastic and pressure painful. Bowel sounds are diminished in concurrent ileus. The conjunctiva of the eye may be yellowish in color as an expression of concomitant jaundice. In the blood serum, pancreatic enzymes a-amylase and lipase are elevated.
Diagnosis of acute inflammation of the pancreas.
Diagnosis is usually made by ultrasound: the pancreas is swollen; any gallstones present can be seen. If ultrasound is not informative enough, a CT scan with contrast may be performed. To rule out other possible causes of acute abdomen, an x-ray of the chest and abdomen is taken in each case. If gallstones are detected, an ERC is performed early.
Chances of cure and prognosis
The course is more severe the more necrosis and complications occur. In the edematous form without complications, mortality is five percent. With partial necrosis and one or two complications, mortality is already between 25 and 50 percent. With total necrosis and three to four complications, mortality rises to 80 to 100 percent.If acute pancreatitis is overcome and the triggering cause is removed, the disease usually heals. However, scars and cysts may remain and limit the function of the organ.
Complications of acute pancreatitis
The potential complications of acute pancreatitis are many and feared:
- Shock due to fluid loss
- Acute renal failure
- Acute respiratory failure
- Sepsis
- Formation of an abscess
- Necrosis of adjacent organs
- Bleeding in the gastrointestinal tract (blood flowing from the pancreas into the intestine; stress bleeding in the stomach).
Treatment of acute pancreatitis
Treatment of acute pancreatitis must be carried out in the hospital, and even in the intensive care unit in severe cases, as patients must be carefully monitored. Therapy consists of bed rest and prohibition of food and fluid intake. In case of vomiting, ileus and complications, a stomach tube is placed. Patients receive pain medication, antibiotics if needed. In severe courses, surgery to remove dead tissue may be necessary. When a patient with acute pancreatitis is allowed to eat again varies. Tea and rusks are started slowly, followed by light food (no fat, coffee, alcohol).
