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Pancreatitis, ac...

 

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Acute pancreatitis

Definition

Acute pancreatitis is swelling (inflammation) of the pancreas. The pancreas is a gland located behind the stomach. It releases digestive enzymes and the hormones insulin and glucagon.

Causes

The main causes of acute pancreatitis in adults are:

• Alcohol use
• Gallbladder (biliary) disease
• Gallstones

Other causes include:

• Certain medications (especially estrogens, corticosteroids, thiazide diuretics, and azathioprine)
• Common bile duct surgical procedures
• Surgery to the pancreas
• Traumatic injury
• Viral infection (mumps, coxsackie B, mycoplasma pneumonia, and campylobacter)

Acute pancreatitis may also be caused by:

• An abnormal structure of the pancreas
• Complications of cystic fibrosis
• Genetic factors (hereditary pancreatitis)
• High lipid levels in the blood (hypertriglyceridemia)

What exactly causes pancreatitis is not well known. It is thought that enzymes the pancreas normally releases in an inactive form become activated inside the pancreas and start to digest the pancreatic tissue. This process is called autodigestion. It causes swelling, bleeding (hemorrhage), and damage to the blood vessels.

The disease affects men more often than women. Alcohol abuse is an important risk factor.

In children, this disorder may be associated with:

• Abdominal trauma
• Cystic fibrosis
• Hemolytic uremic syndrome
• Kawasaki disease
• Mumps
• Reye syndrome
• Some medications
• Various viral illnesses

Symptoms

• Abdominal pain that is greatest in the upper abdomen (upper left quadrant or upper middle of the abdomen)
  • Is persistent or chronic
  • May be worse lying flat on the back
  • May spread (radiate) to the back or below the left shoulder blade
  • May be worse after eating or drinking (occurs within minutes following meals), especially foods with a high fat content
  • May be worse after drinking alcohol
• Anxiety
• Fever
• Mild jaundice
• Nausea and vomiting
• Sweating

Other symptoms that may occur with this disease:

• Abdominal indigestion
• Clay-colored stools
• Gaseous abdominal fullness
• Hiccups
• Skin rash or lesion
• Swollen abdomen

Exams and Tests

An examination may show:

• Fever
• Low blood pressure
• Rapid heart rate
• Rapid breathing (respiratory) rate

Tests that show release of pancreatic enzymes:

• Elevated serum amylase
• Elevated serum lipase
• Elevated urine amylase

Test that show inflammation of the pancreas:

• Abdominal CT scan
• Abdominal MRI
• Abdominal ultrasound

Other blood tests:

• CBC
• Glucose test
• Serum calcium

Treatment

Treatment is aimed at supportive measures, such as:

• Relieving pain
• Replacing fluids by intravenous (IV) infusion
• Withholding food or fluid by mouth to limit the activity of the pancreas

Occasionally a tube will be inserted through the nose or mouth to remove the contents of the stomach (nasogastric suctioning). This may be done if there is persistent vomiting or severe pain, or if a paralytic ileus develops.

Treating the condition that caused the problem can prevent recurrent attacks.

In some cases, radiologic or endoscopic therapy is needed to:

• Drain fluid collections in or around the pancreas
• Remove gallstones
• Relieve blockages of the pancreatic duct

In the most severe cases, surgery is necessary to remove dead, infected pancreatic tissue.

Outlook (Prognosis)

Most cases go away in a week. However, some cases develop into a life-threatening illness.

The death rate is high with:

• Hemorrhagic pancreatitis
• Liver, heart, or kidney impairment
• Necrotizing pancreatitis

It is common for the condition to return.

Possible Complications

• Acute respiratory distress syndrome (ARDS)
• Build-up of fluid in the abdomen (ascites)
• Cysts or abscesses in the pancreas
• Heart failure
• Kidney failure
• Low blood pressure

When to Contact a Medical Professional

Call your provider if:

• You have intense, constant abdominal pain
• You develop other symptoms of acute pancreatitis

Prevention

To protect against acute pancreatitis, prevent the disorders that cause it:

• Avoid aspirin when treating a fever in children, especially if they may have a viral illness, to reduce the risk of Reye syndrome.
• Do not abuse alcohol.
• Get genetic counseling if you would like to have children and you have a family or personal history of cystic fibrosis.
• Immunize children against mumps and other childhood illnesses (see: immunizations - general overview).
• Use proper safety precautions to avoid abdominal trauma.

If you develop acute pancreatitis as a result of alcohol use, avoid all alcohol in the future. If you develop acute pancreatitis as a result of a medication, avoid the medication in the future.

References

Banks PA, Freeman ML; Practice Parameters Committee of the American College of Gastroenterology. Practice guidelines in acute pancreatitis. Am J Gastroenterol. 2006 Oct;101(10):2379-400.

Frossard JL, Steer ML, Pastor CM. Acute pancreatitis. Lancet. 2008;371:143-152.

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