What Is Acute Pancreatitis & What Happens In Acute Pancreatitis?LPC

Acute Pancreatitis:

This is an inflammation & swelling of the pancreas which develops very suddenly and, in the majority of patients (about 75%) improves steadily with good in hospital treatment over the course of a week or so.

Yes, It Requires a Certain Hospitalisation

A blood sample usually shows the presence of a large amount of amylase & lipase (pancreatic enzymes) in the blood.

What Happens In Acute Pancreatitis?

The pancreas produces chemicals called enzymes, as well as the hormones insulin and glucagon. Most of the time, the enzymes are only active after they reach the small intestine, where they are needed to digest food. Because premature activation of pancreatic enzymes within the pancreas leads to organ injury and pancreatitis, several mechanisms exist to limit this occurrence.

Under various conditions, these protective mechanisms are disrupted & enzymes somehow become active inside the pancreas, they eat (and digest) the tissue of the pancreas. This causes swelling of the pancreas, collection of fluid in surrounding areas & also in distant tissues, bleeding (hemorrhage); and damage to the pancreas and its blood vessels with eventually death or gangrene of pancreatic tissue (pancreatic necrosis).

As the toxins spread in the body, complications can arise in the rest of the body as well, such as microorganisms enter bloodstream through the porous intestinal walls, breathlessness (Acute Respiratory Distress Syndrome — ARDS) or respiratory failure due to accumulation of fluid in lungs (wet lungs) & around lungs (pleural effusion), gastrointestinal bleeding and renal failure. The inflammatory process initiated by pancreatitis can involve the entire body if very severe & is called Systemic Inflammatory Response Syndrome (SIRS) it can lead to the development of systemic shock. Eventually, the inflammation can become so overwhelming to the body that hemodynamic instability and death ensue.

What Is The Risk Of Complications And Death Following Pancreatitis?

The overall risk of death of patients with acute pancreatitis is 10-15%. About 20% of pancreatitis attacks are severe with associated pancreatic necrosis or some or other organ failure and chances of various complications are high in these patients. In patients with necrosis without organ failure, the mortality or death rate approaches zero. However in patients with severe disease (organ failure), the death rate is approximately 30%. This rate in mortality has not dropped in the last 10 years. In the first week of illness, most deaths result from multiple organ system failure. In subsequent weeks, infection plays a more significant role, but organ failure still constitutes a major cause of mortality.

Patients with biliary pancreatitis (caused by gall stones) tend to have a higher mortality rate than patients with alcoholic pancreatitis (caused by alcohol consumption). This rate has been falling over the last two decades as improvements in supportive care have been initiated.

What Are The Long Term Effects Of Acute Pancreatitis?

Usually after a regular mild attack of acute pancreatitis settles, the function remains unaffected. Once a patient has recovered from an attack of acute pancreatitis, they are perfectly well and there is usually no permanent damage to the pancreas.

However there are always exceptions to this rule. When the attack is very severe and causes death of pancreatic tissue, the function certainly gets affected. Similarly if there are repeated acute attacks then function can get affected over a period as chronic pancreatitis sets in. Therefore it is very important to find out the cause of acute pancreatitis, which must then be dealt with otherwise further attacks may follow. However cases of recurrent acute pancreatitis are few.

What Is Recurrent Acute Pancreatitis (Rap)?

If more than one attack of acute pancreatitis occurs, it is called recurrent acute pancreatitis.

What Causes Acute Pancreatitis?

There are many causes of acute pancreatitis, and it can affect people of any age. Men are affected more often than women. Alcoholism and gallstones most often cause the condition. Genetic changes may be a factor in some cases. Sometimes the cause is not known, however (termed idiopathic). In 10-30% of cases, the cause is unknown in the initial investigations, but persistent investigations are able to solve the dilemma in almost 70% of these.

The etiology in males is more often related to alcohol; in females, to biliary tract disease. Idiopathic pancreatitis has no clear predilection for either sex.

Other conditions that have been linked to pancreatitis are:

Autoimmune problems (when the immune system attacks the body)
Blockage of the pancreatic duct or common bile duct, the tubes that drain enzymes from the pancreas • Damage to the ducts or pancreas during surgery
High blood levels of fat called triglycerides (hypertriglyceridemia)
Injury (Trauma) to the pancreas from an accident
Pancreas divisum (congenital anatomical problem)
Annular pancreas (congenital anatomical problem)
Choledocal cyst (congenital anatomical problem)
Abnormal joining of pancreatic & bile duct (congenital anatomical problem)
Pregnancy
Heredity or genetic problems
High blood calcium levels (hypercalcemia)
High parathyroid hormone levels due to any cause (hyperparathyroidism)
Drugs (e.g. estrogens, corticosteroids, thiazide diuretics, and azathioprine)
Viral infections like mumps