Acute Pancreatitis
May 24, 2009
Inflammation of the pancreas may be acute or chronic. Acute pancreatitis is characterized by sudden inflammation and oedema of the pancreas with auto-digestion by the pancreatic enzymes.
The incidence of acute pancreatitis is rising. The incidence is higher in people with high alcohol intake. In women and older people, biliary tract obstruction or dysfunction is the usual cause.
Although, a number of cases of pancreatitis are idiopathic (with unknown cause), the precipitating causes can usually be identified.
Gallstones account for majority of cases. Excessive alcohol intake is also a major cause, especially in young men. Pancreatitis may also be associated with some drugs (diuretics, steroids), trauma, hypertriglyceridaemia, hypercalcaemia (in hyperparathyroidism), viral infection (such as mumps), dysfunction and obstruction of some parts of the body, diabetes mellitus and hypothermia. Though rarely, the condition may be acquired genetically.
Acute pancreatitis presents with severe colicky abdominal pain (epigastric region), nausea, vomiting, and diarrhoea with fever. Stools are pale and bad smelling. The acute pain may be mistaken as myocardial infarction. Signs and symptoms of the underlying cause (such as jaundice) may also be the presenting complaints. Epigastric tenderness is also an important sign. Hemorrhagic discolouration of umbilicus (Cullen’s sign) and flanks (Grey Turner’s sign) is seen in severe disease.
The most important diagnostic feature of acute pancreatitis is the presence of markedly elevated serum amylase and lipase. Elevated white blood cell count, blood glucose level and blood urea nitrogen (BUN), hypoxia, low albumin and low calcium signify severe disease. Abdominal X-ray, Endoscopy, CT scan, MRI may also be used as investigative procedures.
In severe cases, complications including paralytic ileus and cardiovascular collapse may occur. Recurrent relapse of pancreatitis is common.
Treatment includes fluid replacement and analgesic drugs (painkillers). Surgery may be the choice of treatment in case of emergency. Mortality is high in severe cases with abscess formation.
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