Acute Pancreatitis

04 May 2024
Acute Pancreatitis

Acute pancreatitis is usually a sudden and severe illness caused when the pancreas rapidly becomes inflamed. Pancreas enzymes and various poisons (toxins) may enter the blood stream in an acute attack, and injure other organs such as the heart, lungs and kidneys. However, the pancreas can return to virtual normality if the cause of the attack is found and treated.

Unfortunately, with some patients, much of the pancreatic tissue is destroyed with severe inflammation occurring along with leakage of enzymes, fluids and poisons. This condition, known as a "hemorrhagic" pancreatitis, causes the pancreas to become very swollen and slushy which can then develop into a collection of fluid and damaged pancreatic tissue called a "pseudocyst". If a pseudocyst becomes infected, it is called a pancreatic abscess.

Also, severe attacks of hemorrhagic pancreatitis result in lowered blood pressure and poor circulation to the skin and other organs. Kidney failure may occur, requiring dialysis treatment.

Mild forms of pancreatitis (so called edematous pancreatitis) may resolve quite quickly, within a few days, without residual damage to the pancreas or other organs.

Causes of the acute pancreatitis

The two most common causes of acute pancreatitis are:
- gallstones
- excessive consumption of alcohol

Gallstones commonly form in the gallbladder. However, if a stone moves into the bile duct (through the cystic duct), it can become impacted (stuck) at the exit into the duodenum (papilla of Vater). This exit hole is normally shared with the pancreatic duct, so that an impacted stone can block the pancreas … and cause pancreatitis.

Alcohol causes acute pancreatitis by direct poisoning of the gland. Patients (and pancreases) vary in their sensitivity to alcohol. There is no completely safe level of consumption, and yet many people drink heavily for years without ever developing pancreatitis (or other alcohol-related diseases such as liver and heart disease).

We do know that women are more sensitive to alcohol than men, and most authorities recommend three or less drinks per day for men, and two for women. Once pancreatitis has occurred, alcohol should be avoided completely. Alcohol can aggravate pancreatitis even if it has originally been caused by something else.

Other known causes of acute pancreatitis include:
- Poor drainage of the pancreatic duct resulting from partial obstruction — causes of obstruction include small tumors, as well as scarring and spasm of the muscular sphincter (sphincter of Oddi). Some patients are born with unusual drainage systems (i.e. pancreas divisum), which can interefere with drainage.
- A severe blow or direct injury to the upper abdomen, often incurred during a vehicular accident, but occassionally the result of a complication from a medical test or treatment (such as ERCP or surgery)
- A complication of some medicines and/or when the blood contains too much calcium or fat (especially triglycerides).

Pancreatitis can also be caused by tiny stones (sludge or crystals) which cannot be seen on standard X-ray tests and scans. They can be found by special techniques such as placing a tube into the duodenum (duodenal drainage) and stimulation of gallbladder contraction, or during an ERCP examination. When stones, sludge or crystals are found, the gallbladder should be (almost always) removed via cholecystectomy.

When the cause of pancreatitis cannot be determined, it is referred to as "idiopathic".

Symptoms of the acute pancreatitis

Common symptoms of acute pancreatitis can include:

- sudden severe upper abdominal pain (often referred to as epigastric pain)
- severe pain that might also be felt in the back
- nausea and vomiting
- diarrhea
- fever and chills
- racing of the heart (also known as tachycardia)

Symptoms are often severe enough as to require immediate medical attention and usually admission to hospital for pain medicines (analgesics) and intravenous (IV) fluids.

Diagnosis of the acute pancreatitis

Typical acute pancreatitis is usually easy to recognize:
- pain is located in a specific area
- onset of pain is sudden
- degree of pain is such that a person seeks immediate medical assistance
- an increased number of white blood cells in the blood stream (which is normal with all types of inflammation)
- markedly elevated levels of amylase and sometimes lipase —two enzymes produced by the pancreas— can be found in the blood stream

Normal levels of amylase and lipase do not completely rule out pancreatitis, especially when the pancreas has been damaged beforehand (and therefore cannot produce much amylase or lipase).

A couple of acute abdominal conditions that can mimic pancreatitis include:
- impacted gallstones (biliary colic)
- gastric perforation or duodenal ulcer

More rarely, a similar clinical presentation can result from sudden loss of the blood supply to the intestines (intestinal ischemia).