Pancreatitis

Pancreatitis is inflammation of the pancreas. It is often divided into two categories, acute pancreatitis and chronic pancreatitis.

It is said that pancreatitis (acute pancreatitis or chronic pancreatitis) accounts for 3% of all cases of abdominal pain in the U.K. It can be a serious condition, with very significant mortality figures if it is severe.

Table of contents

1 Acute Pancreatitis 1.1 Features 1.2 Causes 1.3 Pathogenesis 1.4 Diagnosis 1.5 Treatment 2 Chronic pancreatitis

Acute Pancreatitis

Features

• Severe abdominal pain often radiating through to the back.
• Nausea, vomiting and loss of appetite.
• Severe illness, sometimes requiring admission to intensive care and sometimes fatal.
• Recovery may be followed by development of pancreatic pseudocyst, pancreatic dysfunction (malabsorption) and diabetes.

Causes

• Gallstones
• Alcohol
• Mumps
• Hypercalcaemia
• Idiopathic (unknown)
• Fat necrosis

The most common causes of pancreatitis, accounting for more than 85% of all cases of pancreatitis in Western countries are chronic alcoholism and gallstones. Other causes include trauma (such as from a steering wheel in an automobile accident), infection (the mumps virus being the most common), drugs (lasix and thiazides are the most common ones) and cancer.

Gallstones that travel down the common bile duct and which subsequently get stuck in the Ampulla of Vater can cause obstruction in the outflow of pancreatic juices from the pancreas into the duodenum. The backflow of these digestive juices causes lysis of pancreatic cells and subsequent pancreatitis.

Pathogenesis

The exocrine pancreas produces a variety of enzymes that breakdown food tissues, such as proteases, lipases and saccharidases. In acute pancreatitis, the worst offender among these enzymes may well be the protease trypsinogen which converts to the active trypsin which is most responsible for auto-digestion of the pancreas which causes the pain and complications of pancreatitis.

Diagnosis

Important biochemical markers for pancreatitis are serum amylase and lipase levels. Amylase and lipase levels can rise to more than a hundred times normal levels in cases of acute pancreatitis.

Treatment

• Supportive for shock.
• Pain relief
• Enzyme inhibitors are not proven to work.
• While often severe, the disease is essentially self limiting.

In the management of acute pancreatitis, the treatment is to stop feeding the patient and make him/her nil by mouth, instead giving intravenous fluids to prevent dehydration. As the pancreas is stimulated to secrete enzymes by the presence of food in the stomach, having no food pass through the system allows the pancreas to rest.