Acute Pancreatitis
Acute Pancreatitis is swelling over Pancreas which develops rapidly (over few hours or days to weeks). Under intensive care and adequate treatment, it usually settles in few days, but can sometimes become severe leading to serious and critical condition. Most common causes are alcohol and tobacco, gall stones among various others.
What are the symptoms of acute pancreatitis?
- Tummy/Abdominal pain, just below ribs in the middle is usually the main symptom. It is severe, and can be felt spreading to the back. It can start suddenly over few hours or slowly after food intake and gradually worsening. In people with diabetes or kidney problems, there might not be much pain in acute pancreatitis occasionally.
- Vomiting, fever, dehydration, BP fluctuations
- Decreased appetite, swelling of abdomen, inability to pass stools or gas
- In severe cases, other organs like kidneys, lungs, heart may get affected.
What to do when suffering from such symptoms?
Contact doctor immediately, you may require admission. Blood tests, ultrasound scan and occasionally other scans are necessary for correct diagnosis. On its basis, further treatment is planned.
What causes Acute Pancreatitis?
8 out of 10 cases are generally due to Gallstones or Alcohol/tobacco
Gallstones – Most common cause of acute pancreatitis. Gallstones pass through bile duct, and become stuck near opening of bile duct and pancreatic duct into the small intestine. There is blockage of pancreatic duct, causing enzymes to digest own cells in pancreas.
Alcohol/tobacco – Around 30% cases due to this. Direct connection is unclear. But alcohol intake makes patients more sensitive for pancreas damage due to smoking, high fat content in body, infections.
High fat content in body (hypertriglyceridemia) – around 4% cases of acute pancreatitis occur due to this.
Other causes –
1. Viral infections
2. Some medicines
3. Injury to Pancreas/ Trauma
4. Parasite infections
5. High blood calcium levels
6. High Parathyroid hormone levels
7. Abnormal structure of Pancreas (Birth defect)
8. Hereditary problem (passed from parents)
9. Autoimmune – Body’s immunity fighting against Pancreas
10. Unknown – No cause found.
What happens in body during the attack of acute pancreatitis?
Digestive juices (enzymes) are activated and start to digest parts of pancreas. This causes sweeling over pancreas.
Most cases, inflammation is mild and subsides without permanent damage in few days.
In few cases, patient’s condition quickly worsens, when parts of pancreas and surrounding tissue are destroyed by the digestive juices. These juices may leak out, damaging other organs in abdomen. Chemicals released in blood may damage other organs in body, leading to multi-organ failure. This serious condition can be fatal.
How do we treat this condition?
It depends on how bad the attack is. Treatment is mainly based over pain management, adequate oxygenation and hydration of patient. Nutrition has a major role in early recovery.
- Medications for pain relief
- Oxygen support
- Fluids given through IV for Hydration
- A tube passed through the nose into stomach for nutrition may be required if persistent vomiting present
- Urinary Catheter for monitoring urine output and kidney function
- Intensive care monitoring and special attention to hygiene (as patient’s immunity gets low during attack)
- Occasionally, some procedure may be required to be done to remove source of pancreatitis after attack subsides (like removal of gall bladder/ removal of gall stones stuck in bile duct)
- Antibiotics are only required if pancreas or surrounding tissue gets infected
Can we expect good recovery in this patient?
In mild attacks, result is very good and usually there is full recovery
In severe attacks, some complications may develop. Despite intensive care and best supportive treatment, around 20% patients may die.
Does it occur again and again?
Yes, unless the cause of pancreatitis is removed, it can occur multiple times.
- If gallstones caused pancreatitis, surgery to remove gall bladder is suggested and should be done at the earliest
- If alcohol is the cause, patient should stop drinking completely
- High fat content (High triglyceride levels) should be treated with appropriate medicines
- If it is the side effect of some ongoing medication, it should be stopped and alternative medication should be started.
- Calcium and parathyroid levels should be normalised if abnormal
- Structural abnormalities causing pancreatitis should be corrected if considered necessary by the specialist after ruling out other causes.
