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Acute Pancreatitis

There are many possible causes of acute pancreatitis, but 60-75 % of the patients develop the condition due to gallstones or excessive alcohol consumption.

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The pancreas is an organ in the back of the upper abdomen behind the stomach. It produces and releases enzymes essential for food digestion and hormones controlling blood glucose levels. When it is inflamed, it can cause abrupt and severe abdominal pain radiating to the back. The two most common causes of acute pancreatitis are gallstone and alcohol abuse. 

Causes
There are many possible causes of acute pancreatitis, but 60-75 % of the patients develop the condition due to gallstones or excessive alcohol consumption.

  • Gallstone pancreatitis occurs when gallstones or bile sludge from the gallbladder block a common drainage duct of bile and pancreatic secretion, obstructing the flow of pancreatic enzymes. The blockage can trigger acute pancreatitis.
  • Alcoholic pancreatitis is the most common cause in people who are alcohol abusers.
  • Hypertriglyceridemia, especially for patients whose triglycerides level is higher than 500 mg/dL
  • Drug-induced pancreatitis, g., certain antibiotics or chemotherapy
  • Post-ERCP pancreatitis can develop in 3-5% of patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) for bile duct or pancreatic disease treatment, but the symptoms are usually not severe.
  • Hereditary pancreatitis can occur in children and young adults.
  • Idiopathic pancreatitis, around 20% of the people with acute pancreatitis have no identifiable cause.

Symptoms
Most patients with acute pancreatitis may experience:

  • Sudden onset of severe pain in the upper abdomen.
  • Abdominal pain radiating to the back.
  • Abdominal pain alleviated by leaning forward.

People with gallstone pancreatitis may have preceding gallstone-related symptoms:

  • Pain in the right upper abdomen, radiating to the right back, scapula, or right shoulder.
  • The pain is colicky and intense.
  • Nausea and vomiting.
  • Abdominal pain after a meal, especially a fatty meal.

Diagnosis
Because the symptoms of acute pancreatitis are similar to other medical conditions, it can be hard to make a diagnosis. Your doctor will evaluate and check

  • Characters of abdominal pain.
  • Pancreatic enzyme level in the blood.
  • Evidence of pancreatic inflammation by imaging tests such as CT scans or MRI.

Once you are confirmed to have acute pancreatitis, additional tests to pinpoint the underlying cause and prevent a recurrence are:

  • Imaging tests such as an abdominal ultrasound, CT scan, or MRI to check the structure of the pancreas, the tissues surrounding the pancreas, the gallbladder, and the common bile duct
  • Blood for triglyceride level
  • Genetic testing, in the case of suspected hereditary pancreatitis

Treatment
Hospital admission for a couple of days is usually necessary; however, severe cases require more hospital stays. The treatment aims to relieve the inflammation of the pancreas and treat the root cause.

  • Mild pancreatitis. Vital sign monitoring, pain relievers, and intravenous fluids are sufficient treatments.
  • Moderately severe to severe acute pancreatitis. Patients with moderately severe to severe acute pancreatitis are at higher risk of life-threatening complications such as heart, lung, and kidneys damages. ICU admission may be required. Patients may not be able to eat anything initially, requiring intravenous fluids and tube feeding until the bowel function returns. If the pancreas is extensively damaged, leading to pancreatic necrosis or infection, IV antibiotics and an endoscopic necrosectomy may be necessary.
  • Gallstone pancreatitis. Around 30-50% of patients with gallstone pancreatitis will have a recurrence. Patients with gallstone pancreatitis should have a cholecystectomy on the same admission.

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Published: 20 Oct 2022

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