An Overview of Acute Pancreatitis and Its Management

Pancreatitis is a condition wherein the pancreatic enzymes automatically digest the gland thereby causing an inflammatory response. Normally, the pancreas heals by itself without any impairment or major morphologic changes. However, pancreatitis occur intermittently causing subsequent functional changes and impairment in the gland. Recognizing symptoms of severe acute pancreatitis as soon as possible can lead to optimal outcomes.

The pancreas

The pancreas in the gland is located in the upper posterior abdomen. It is responsible for the production of insulin and glucagon as well as in the manufacturing and secreting of the digestive enzymes necessary to metabolize carbohydrates, fats and proteins. After the enzymes are produced, they are secreted into the small intestine via the pancreatic duct to begin the digestive process. The enzymes that are produced in the pancreas are not yet activated unless they reach the intestines and feedback mechanisms occur in normal circumstances to prevent premature activation of pancreatic enzymes. Once the disruption of such mechanisms occurs, intracellular enzyme activation takes place as well as pancreatic autodigestion resulting to an acute pancreatitis.

What are the causes of acute pancreatitis?

Biliary stone that can cause pressure to the pancreas

A number of factors are involved in acute pancreatitis. The two most common causes of the condition are alcohol abuse and biliary tract disease but numerous factors are also known. Studies show that long standing alcoholism is a significant risk factor of acute pancreatitis.  Obstructive biliary stones are also known to be responsible for the increase in pressure, causing injury to pancreatic cells. Other less common causes of acute pancreatitis include trauma, drugs, toxins, surgical procedures and autoimmune problems.

Identifying the symptoms of acute pancreatitis

The cardinal symptom of acute pancreatitis is abdominal pain which can be described as dull, boring and steady. The pain can be felt in the upper left or middle area of the abdomen. This can also be aggravated after few minutes of eating especially with high fat content consumption. The pain may occur or worsen for several days and can also be aggravated by lying flat on the back. In some cases, the pain radiates to the back or below the left shoulder-blade. A person with pancreatitis will usually have fever, nausea, vomiting and sweating. Other symptoms particular to the disease include clay-colored stools, gaseous abdominal fullness, hiccups, indigestion, jaundice and increased abdominal girth.

Diagnostic measures

Once the diagnosis is established to be an acute pancreatitis, laboratory examination is performed to support the clinical impression. The laboratory evaluation is also obtained to define the etiology and monitor complications. Enzyme determination, complete blood count and inflammatory markers are usually part of the laboratory work-up. Although unnecessary, imaging studies are helpful in the visualization of inflammation and providing morphologic confirmation of the diagnosis. Image-guided aspiration may be useful in differentiating infected from sterile necrosis.

Management program for acute pancreatitis

Management of acute pancreatitis depends on the clinical presentation and severity of the condition. Treatment is relatively straightforward and requires intensive care. The medical goals in the management of acute pancreatitis include aggressive supportive care, alleviate inflammation, to limit infection and to identify and treat complications as necessary. Initial management of acute pancreatitis includes fluid resuscitation as patients with acute pancreatitis lose large amounts of fluids. Nutritional support is also necessary in the initial phase or as soon as the patient is stable hemodynamically. Antibiotics, usually the imipinem class, are given to patients particularly with pancreatitis complicated by pancreatic necrosis. Surgical intervention may be deemed necessary when anatomic complication arises and needs mechanical solution. Some of the conditions relevant to acute pancreatitis that may need surgical intervention include gallstone pancreatitis, pancreatic duct disruption, pseudocysts, infected pancreatic necrosis and pancreatic abscess. Once the patient is stable, the condition is then continuously monitored for complications.

Make an appointment to your doctor immediately if you experience any of the symptoms of an acute pancreatitis to obtain prompt diagnosis and treatment.

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