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What Is Acute Pancreatitis? What Causes Acute Pancreatitis?
What Is Acute Pancreatitis? What Causes Acute Pancreatitis?
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Pancreatitis means inflammation of the pancreas that can appear in two very different
ways. Acute pancreatitis is sudden while chronic pancreatitis is recurring or
persistent. Some cases of pancreatitis may be mild and go away on their own and do
not require treatment. However, severe cases can lead to potentially fatal complications.
Acute pancreatitis is uncommon. According to the National Health Service (NHS), UK,
less than 1 in every 100,000 people develops acute pancreatitis each year. It is slightly
more common in men than in women.
The pancreas is a long, flat gland located behind the stomach in the upper abdomen. It
produces digestive enzymes and hormones which regulate how the body processes
glucose.
Leaning forward or assuming a fetal position (curling up) may help lessen the pain
slightly. Anybody who experiences constant pain should seek medical attention.
Nausea.
Diarrhea.
Loss of appetite.
Blood pressure may drop or rise, but will fall when the patient stands, sometimes
causing faintness.
Alcohol misuse - we know that alcohol misuse can cause trypsin to become active
inside the pancreas, but scientists are not sure why? Scientists say that ethanol
molecules affect the pancreas cells, triggering them to activate trypsin prematurely.
Approximately 10% of people with chronic alcohol misuse develop acute pancreatitis.
Chronic alcohol misuse means medium- or long-term consumption of at least 10 units
of alcohol daily - the equivalent of over four pints of lager (beer) or five glasses of
wine.
Gallstones - these are little pebble-like formations that develop in the gallbladder if
there is too much cholesterol in the bile. Sometimes the gallstones can be dislodged
and make their way out of the gallbladder, blocking the ducts to the pancreas. The
blockage undermines the normal workings of the pancreas which sometimes activate
the trypsin prematurely, while it is still inside the pancreas, causing it to become
irritated and inflamed.
Idiopathic - about 15% of all cases of acute pancreatitis are termed idiopathic
pancreatitis. This means that no obvious cause was identified.
Blood tests - if blood levels of amylase and lipase are higher than normal, the patient
will most likely be sent to hospital. The pancreas produces elevated levels of both
chemicals during acute pancreatitis. However, blood tests are only useful early on
because amylase and lipase levels increase on the first day of illness and then return to
normal within 3 to 7 days.
In order to find out how inflamed the pancreas is, which helps doctors determine the risk
of complications, the following tests may be performed:
An ERCP (endoscopic retrograde cholangio-pancreatography) scan - an
endoscope (thin, flexible tube with a camera at the end) is inserted into the digestive
system. The doctor uses ultrasound to guide the endoscope through. An ERCP can
help the doctor determine the exact location of a gallstone. Sometimes surgical
instruments are threaded through the endoscope, which is hollow like a drinking
straw, so that the gallstone can be removed.
Chest X-ray - the doctor may order a chest x-ray to check for areas of collapsed lung
tissue, or accumulation of fluid in the chest cavity.
The aim of treatment here is to make sure the body is working properly, as well as to
ease symptoms while the pancreas is repairing itself. This will include:
Treatment for pain - mild acute pancreatitis can be moderately or severely painful.
The patient may be given painkillers.
Treatment for nausea, vomiting - this may include medication to control nausea and
vomiting.
Feeding tubes - the pancreas needs to rest while it recovers. Patients may be fed by
the way of feeding tubes so that nutritiongoes straight to the blood, rather than the
digestive system which would create more work for the pancreas. In some cases,
though, feeding is via a nasogastric tube as well (through the nose and into the
stomach).
Severe acute pancreatitis usually results in some tissue necrosis - some of the pancreas
tissue dies. Tissue necrosis carries a very high risk of sepsis - a severe bacterial
infection which gets into the bloodstream, causing multiple organ failure.
Severe acute pancreatitis can also cause hypovolemic shock - severe blood and fluid
loss, which makes the heart unable to pump enough blood to the body. Parts of the body
can become rapidly oxygen-deprived; a life-threatening situation.
Patients will be placed in an ICU (intensive care unit) and injected with antibiotics to
stop any infection that could develop from the dead tissue.
The patient will also receive intravenous fluids to maintain hydration and prevent
hypovolemic shock.
Some patients may require help breathing and will be connected to ventilation
equipment.
When doctors are sure the patient is out of danger, i.e. the risk of organ failure,
hypovolemic shock, and sepsis have passed, the patient will be taken out of the ICU.
This could take two weeks, and sometimes longer.
Treating gallstones
As soon as the patient is recovered and doctors have determined that gallstones caused
the acute pancreatitis, the patient will have to undergo surgery. After the gallstones are
removed the he/she may be advised to follow a special diet to lower blood cholesterol.
Gallstones are caused by excess cholesterol.
If doctors determine that alcohol misuse was the underlying cause of the acute
pancreatitis, the patient may be offered a treatment program for alcohol misuse.