Acute pancreatitis

Definition

Causes, incidence, and risk factors

The chief causes of acute pancreatitis in adults are gallstones , other gallbladder (biliary) disease, and alcohol use . Viral infection ( mumps , coxsackie B, mycoplasma pneumonia , and campylobacter), traumatic injury, pancreatic or common bile duct surgical procedures and certain medications (especially estrogens, corticosteroids, thiazide diuretics, and azathioprine) are other causes.

The mechanism that causes pancreatitis is not well known. It is thought that enzymes normally secreted by the pancreas in an inactive form become activated inside the pancreas and start to digest the pancreatic tissue. This process is called autodigestion and causes swelling , hemorrhage, and damage to the blood vessels. An attack may last for 48 hours.

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
• various viral illnesses
• medications

Symptoms

• abdominal pain that is greatest in the upper abdomen (upper left quadrant or upper middle of the abdomen)
  • persistent or chronic
  • recurrent or with similar pain in the past
  • may be worse lying flat on the back (supine)
  • may radiate to the back or below the left shoulder blade (left scapular area)
  • radiating through to the middle of the back
  • may be worse after eating or drinking (occurs within minutes following meals), especially greasy foods or foods with a high fat content
  • may be worse after drinking alcohol
• nausea
• vomiting
• sweating
• anxiety
• fever
• mild jaundice

Additional symptoms that may be associated with this disease:

• swollen abdomen
• gaseous abdominal fullness
• abdominal indigestion
• hiccups
• skin rash or lesion
• clay-colored stools

Signs and tests

General examination may show low blood pressure and a heart rate above 90 (slightly rapid).

Tests that show release of pancreatic enzymes:

• elevated serum amylase
• elevated urine amylase
• elevated serum lipase

Test that show inflammation of the pancreas:

• abdominal CT scan
• abdominal ultrasound
• abdominal MRI

In other blood tests results:

• CBC shows an elevated WBC count .
• A glucose test may show elevated levels.
• Serum calcium may be decreased.

This disease may also alter the results of the following tests:

• trypsinogen
• serum magnesium - test
• LDH isoenzymes
• LDH
• fecal fat
• CEA
• calcium (ionized)
• AST

Treatment

Treatment is aimed at supportive measures such as fluid replacement by intravenous (IV) infusion, pain relief by analgesics , and withholding food or fluid by mouth to restrict pancreatic activity that makes symptoms worse. Occasionally nasogastric suctioning may be required if there is persistent vomiting or severe pain or if a paralytic ileus develops.

Recurrent attacks may be prevented by treating the underlying condition.

Surgery or endoscopic therapy (using an endoscope, a device with a light that can look inside a body cavity) is indicated in some cases to remove gallstones blocking drainage of the pancreas. In severe cases, the pancreas may be removed.

Expectations (prognosis)

In most cases, the symptoms resolve in a week; however, in some cases, life-threatening illness develops. The death rate is high with hemorrhagic pancreatitis or necrotizing pancreatitis and complications such as liver, heart, or kidney impairment may occur. Recurrences are common.

Complications

• low blood pressure
• heart failure
• kidney failure
• ARDS (adult respiratory distress syndrome)
• ascites , accumulation of fluid in the abdomen
• cysts or abscesses in the pancreas

Calling your health care provider

Call your health care provider if intense, constant abdominal pain is present, or if other symptoms suggestive of acute pancreatitis develop.

Prevention

Prevention of acute pancreatitis is associated with prevention of the causative disorders.

• If you drink alcohol, control alcohol intake.
• Use proper safety precautions to avoid abdominal trauma.
• Genetic counseling may be advised for prospective parents with a family or personal history of cystic fibrosis .
• Cook meat thoroughly (this is one way to reduce the risk of hemolytic uremic syndrome ).
• To reduce the risk of Reye syndrome , avoid aspirin for treatment of fever in children, especially if they may have a viral illness.
• Immunize children against mumps and other childhood illnesses (see Immunizations - general overview ).
  

Update Date: 4/25/2002