Acute Pancreatitis: What You Need To Know About Symptoms, Causes And Treatment

Acute pancreatitis is an acute inflammation of the pancreas which may range from mild to life-threatening. It is usually associated with necrosis of the pancreas and the surrounding tissue, and can also involve other body systems, leading to systemic complications.

Due to its severe complications, acute pancreatitis should be diagnosed and treated as quickly as possible. The treatment mainly involves supportive measures to prevent complications. 

Acute Pancreatitis: Causes

Acute inflammation in the pancreas is triggered by its own enzymes: trypsin, lipase and amylase. Normally, these enzymes lie dormant inside the pancreas until they are released in order to aid food digestion. In acute pancreatitis, these enzymes are somehow activated prematurely inside the pancreas and start “digesting” pancreatic tissue.   

Common causes of acute pancreatitis are alcohol abuse, gallstones, trauma, infections and hypercalcemia. All these factors somehow activate the pancreatic enzymes before they are even released, leading to acute inflammation. This inflammation is accompanied by necrosis of the pancreas and peri-pancreatic fat.

Recognizing Acute Pancreatitis: Symptoms To Watch Out For

The hallmark symptom of acute pancreatitis is upper abdominal pain. This pain is dull or vague in nature and radiates towards the back. It is accompanied by fever, nausea, vomiting and sweating however the pain is the chief symptom that brings most patients to the hospital.

The complications of acute pancreatitis can be very dangerous and should be dealt with immediately. These include acute respiratory distress syndrome (ARDS), hypovolemic shock, disseminated intravascular coagulation (DIC), hypocalcemia and ultimately multiple organ failure which may cause death.

Diagnosing Acute Pancreatitis 

A diagnosis is made by looking at a patient's medical history and performing a clinical examination. Serum levels of amylase and lipase (pancreatic enzymes) are used to confirm the diagnosis. Their levels are raised in acute pancreatitis because they leak into the blood from inflammed pancreas. In addition, patients may undergo CT and MRI scans to localize the disease.

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One popular criterion is the Ranson Score, in which the severity is predicted on a scale of 0 to 11. Lower scores mean mild acute pancreatitis and higher scores predict a severe or even fatal attack of pancreatitis. Milder forms of acute pancreatitis are generally treated successfully with only supportive measures, whereas severe acute pancreatitis may even necessitate surgery.

Acute Pancreatitis Treatment

The management of acute pancreatitis usually comprises supportive and symptomatic treatment along with close monitoring to prevent complications. Specific treatment will vary on a case-by-case basis, depending on the cause and severity, but the general management protocol essentially remains the same.

Fluid Restoration

Fluid replacement is done immediately after the admission of the patient by maintaining an IV line (Intravenous line). The patient may be given 250-500 ml of fluid per hour for the first 24 hours. Early aggressive intravenous hydration is very important because the patient is often dehydrated because of vomiting and sweating. More importantly, rehydration protocols prevent hypovolemic shock, which is a fatal complication of severe acute pancreatitis.

NPO And Nutritional Support

Most acute pancreatitis patients are kept NPO (nothing per oral), that is they should not eat anything for a few days. This is advised because food intake can stimulate the release of even more pancreatic enzymes.

Nutritional support is therefore very important in this case. The doctor will insert a feeding tube through your nose and then endoscopically guide it to the small intestine. This is called Naso-enteric feeding. Total Parenteral Nutrition (TPN) is another method of feeding, in which all the nutrients are directly injected into the blood, bypassing the digestion. This method is becoming less popular due to chances of infection.

Pain Control

This is the most important part of the management, because most patients are in continuous agonizing pain. Terrible pain is the most predominating symptom of acute pancreatitis, and therefore it should be managed immediately with strong analgesics.

Parenteral narcotics like opioids are the generally used for this purpose. These drugs are usually administered intravenously. Patient-controlled analgesia pumps are often used, especially in case of severe pain. Examples of commonly used opioid analgesics in acute pancreatitis are meperidine, fentanyl, morphine and hydromorphone. Fentanyl and meperidine are more commonly used now days due to their slightly better safety profile.

When the symptoms start to improve after the initial aggressive treatment, the dose of the opiates is gradually tapered off and then Non-steroidal anti-inflammatory drugs (NSAIDs) are used for pain relief.

Antibiotics

Antibiotics are only advised if an extra-hepatic infection is suspected. Otherwise, the use of antibiotics is not recommended. If the cultures are negative and no infection is suspected, antibiotics should be discontinued.

After the initial supportive and symptomatic treatment, a specific cause of pancreatitis is determined and further treatment is planned accordingly. The most common causes of acute pancreatitis are gallstones and alcohol abuse.

ERCP

Endoscopic Retrograde Cholangiapancreatography or ERCP is a procedure in which an endoscope is used to have a look at your bile ducts and pancreatic ducts. ERCP has both diagnostic and therapeutic purposes. It is performed to confirm the presence of gallstones, and can also be used to remove small gallstones.

Surgery

If the cause of pancreatitis turns out to be gallstones, a surgery is performed to remove your gallbladder (cholecystectomy). This surgery is be performed during your stay at the hospital. Surgery is also indicated in severe cases of infected necrotizing pancreatitis in which the necrotic debris (dead tissue) is removed (Necrosectomy).

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Other Measures

If the cause of acute pancreatitis is alcohol abuse, the patient is asked to completely avoid alcohol after the treatment. The patient may be advised counseling and support groups because abstinence from alcohol is very important in these cases.

In short, acute pancreatitis is a common condition that can be managed successfully in cases of early diagnosis and treatment. Because it can indeed be fatal if left untreated, it is important to seek medical treatment if you notice symptoms.