Pancreatitis

Pancreatitis is the inflammation of the pancreas, which is a flat, pear-shaped organ, about 6 inches long, lying around the stomach in the abdomen. It plays a vital role in food digestion by releasing enzymes via the pancreatic duct into the gastrointestinal system that help break down the food into smaller particles to make it absorbable. It also secretes important hormones, mainly insulin and glucagon, that have their roles in maintaining sugar levels by controlling sugar absorption and release in the body. 

Pancreatitis can be acute or chronic.  Acute pancreatitis can be mild or severe. Abdominal pain is the cardinal symptom, accompanied by fever, nausea, vomiting. Among some of the causes, the two most common causes are gallstones and alcohol consumption. It is curable, being treated with medicines and surgery if needed. If left untreated, the acute severe cases can be life-threatening. 

There are two types of pancreatitis;

Acute pancreatitis: When pancreatitis happens suddenly and flares up within days, it is called acute pancreatitis. Severe dull abdominal pain boring to the back is accompanied by fever, nausea, vomiting, etc. Pain medications are the cornerstone of the treatment, along with antibiotics. 

Chronic pancreatitis: Pancreatitis that develops gradually over months, with indigestion being the main complaint followed by a weight loss, is called chronic pancreatitis. It may occur due to recurrent pancreatitis if the causative factor is not removed. The cardinal feature is that of smelly bulky stools due to fat indigestion. Abdominal pain may also occur. The most important aspect of treatment is supplementation with pancreatic enzymes to help digestion or provide nutrition via secondary aids. It may lead to diabetes or pancreatic cancer. 

The actual initiating event for pancreatitis is not known however it is believed to be provoked by any factor that brings about the injury or irritation of the cells of the pancreas, resulting in the release of digestive enzymes within the organ, causing widespread inflammation and damage. The provoking factors can be;

• Gallbladder stones
• Alcohol consumption
• Infections: viral (Cytomegalovirus, Hepatitis B, Mumps), bacterial (Mycoplasma, Salmonella), Parasitic (Ascaris, Toxoplasma), Fungi (Aspergillus)
• Some medications (statins, oral contraceptives, ACE inhibitors, etc.)
• The increased amount triglyceride levels in your blood
• The increased levels of calcium in your blood. 
• Pancreatic cancer
• Cystic fibrosis
• ERCP procedure to remove gallstones 
• Abdominal surgery  
• Injury to the abdomen

Between 5 and 80 people per 100,1000 population is affected with pancreatitis worldwide, with the United States having the highest incidence of 40-50 cases per year per 100,000 adults. The cases occur more often in black Americans than in whites, affected age group is between 35-75 years, and the risk increases with age. The cause more often found in males is alcohol, while females have more of the biliary duct and gallstones issues. 

The following factors may increase your risk of having the disease

• Consuming excessive alcohol. 
• Gallstones disease
• Smoking Cigarette 
• Being Obese
• Having diabetes 
• Family history of pancreatitis.

You may exhibit the following signs and symptoms if you have an episode of acute pancreatitis. 

• Abdominal pain can be severe, dull, and radiating to the back. 
• Nausea, vomiting
• Fever
• Increased heart rate
• Lung problems, especially the left one.
• Severe cases can present with shock
• Cullen sign: It’s the bluish discoloration seen around the umbilicus 
• Grey-Turner sign: Reddish discoloration seen at the sides of the body (flanks area)

Typical signs and symptoms and some tests can help make a diagnosis. 

Blood tests: You may need to submit a sample of your blood to evaluate the following parameters that can help diagnose the disease. Increased serum lipase levels are most specifically found in acute pancreatitis. Complete blood count (CBC) and hematocrit, Serum amylase and lipase, C-reactive protein (CRP), liver-associated enzymes, serum lactic dehydrogenase (LDH), Blood urea nitrogen (BUN), creatinine, and electrolytes, Arterial blood gas values, blood glucose, serum cholesterol, and triglyceride.

Imaging: ultrasound abdomen, CT scan abdomen, ERCP, MRCP.

Following disorders can share similar complaints like that of pancreatitis and must be ruled out to make an efficient diagnosis. 

• Cholecystitis
• Peptic Ulcer Disease
• Gastric Cancer
• Myocardial Infarction
• Pancreatic Pseudocysts
• Colon Cancer
• Pancreatic Cancer

Treatment of pancreatitis depends on the severity of the illness. The severe disease has to be treated in hospital with extreme vigilance as the condition can quickly deteriorate. Pain has to be treated with strong analgesics like morphine, no food via the mouth, along with fluid resuscitation, oxygen, and antibiotics (imipenem class). Mild cases can be easily treated. If gall stones cause pancreatitis, then gall bladder removal needs to be performed later. Development of complications like pancreatic necrosis or abscess formation has to be treated by minor surgical procedures or ultrasound-guided drainage. 

For chronic pancreatitis, provision of nutrition and pain control needs to be taken care of. Pancreatic enzymes should be supplemented. It may lead to diabetes or pancreatic cancer. 

Prognosis depends upon how well the case has been managed. Early diagnosis of the disease and differentiating between the severity has resulted in better outcomes. Due to acute pancreatitis, the overall death rate is 10-15%, increasing to 30% for severe disease. Multiorgan failure is the reason behind most deaths in the initial days. 

The following lifestyle changes need to be adopted to prevent the attacks of acute pancreatitis;

• Excessive amounts of alcohol should not be consumed.
• Maintain a healthy weight by taking a balanced diet and regular exercise
• Avoid fat-rich food. 
• Avoid smoking
• Take a generous amount of fluids.

Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on April 22, 2023.

Reference

https://www.mayoclinic.org/diseases-conditions/pancreatitis/symptoms-causes/syc-20360227

https://www.sciencedirect.com/science/article/abs/pii/S014067360313139X