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.

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.

Acute Pancreatitis Causes

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

Acute Pancreatitis Symptoms & Signs

The cardinal symptom of acute pancreatitis is abdominal pain, which is characteristically dull, boring, and steady. Usually, the pain is sudden in onset and gradually intensifies in severity until reaching a constant ache. Most often, it is located in the upper abdomen, usually in the epigastric region, but it may be perceived more on the left or right side, depending on which portion of the pancreas is involved. The pain may radiate directly through the abdomen to the back or left shoulder. May be worse within minutes after eating or drinking at first, especially if foods have a high fat content.

Nausea and vomiting are often present along with accompanying anorexia. Diarrhea can also occur. Positioning can be important, because the discomfort frequently worsens with the patient in the flat position.

Other symptoms that may occur with this disease include inability to pass wind or stools, gaseous abdominal fullness, hiccups, indigestion, mild yellowing of the skin and whites of the eyes (jaundice) & bloated tummy.