Pancreatitis: Symptoms, Causes, and Effective Treatments

Pancreatitis: Inflammation, Causes, and Care

Acute Pancreatitis

Acute pancreatitis is a sudden inflammation of the pancreas that can range from mild to life-threatening, though it usually subsides. Gallstones and alcohol abuse are responsible for approximately 80% of cases. It is more frequently caused by gallstones or obstruction of the pancreatic duct by a gallstone lodged in the sphincter of Oddi, interrupting the flow of pancreatic juice. However, if the obstruction persists, activated enzymes accumulate in the pancreas and begin to digest its cells, causing severe inflammation.

Symptoms of Acute Pancreatitis

• A belt-like, intense abdominal pain in the upper abdomen, typically below the sternum. When pancreatitis is caused by gallstones, the pain often starts suddenly and reaches its maximum intensity within minutes.
• Nausea
• Vomiting and retching
• Abdominal distention

Signs of Acute Pancreatitis

• Systemic inflammatory reaction
• Tachycardia (rapid heart rate)
• Hypotension (low blood pressure)
• Cullen's sign (bluish discoloration around the navel)
• Shock (severe hypotension due to hypovolemia)
• Lung complications

Diagnosis of Acute Pancreatitis

Diagnosis is based on the clinical picture and laboratory tests. Key findings include:

• Elevated serum amylase and lipase levels, typically rising within 48 to 72 hours and remaining elevated for 7 to 14 days.
• Increased leukocyte (white blood cell) count.
• Elevated AST (Aspartate Aminotransferase) and ALT (Alanine Aminotransferase) levels.
• High LDH (Lactate Dehydrogenase) levels.
• Hyperbilirubinemia (elevated bilirubin levels).

Prognostic Factors in Pancreatitis

Factors affecting survival include:

1. Patients over 70 years of age.
2. Body Mass Index (BMI) of 30 or higher.
3. Organ failure, indicated by:
   • Respiratory failure (oxygen pressure < 60 mmHg)
   • Tachycardia
   • Renal failure

Complications of Pancreatitis

Local Complications:

• Necrosis (tissue death)
• Pancreatic abscess (often due to bacterial infection)
• Pseudocyst formation
• Pancreatic ascites (fluid accumulation in the abdomen)

General Complications:

• Lung issues: abscess, pneumonitis, pleural effusion
• Disseminated Intravascular Coagulation (DIC)
• Gastrointestinal bleeding
• Kidney failure

Approximately 85-90% of acute pancreatitis cases resolve spontaneously within 3 to 7 days.

Treatment for Acute Pancreatitis

Key management points include:

1. Analgesics: For pain relief.
2. Fluid Replacement: Intravenous fluids to maintain hydration and blood pressure.
3. Fasting: Initially, patients may need to avoid eating or drinking to allow the pancreas to rest. For mild to moderate pancreatitis, a liquid diet may be started, followed by a gradual return to a regular diet as tolerated.

Fulminant Pancreatitis

Fulminant pancreatitis involves extensive necrosis, and the pancreas is often enlarged. Treatment typically includes:

• Surgical intervention
• Total Parenteral Nutrition (TPN)
• Antibiotics
• Papillotomy (a procedure to widen the opening of the pancreatic duct)

Chronic Pancreatitis

Chronic pancreatitis is a progressive inflammatory process characterized by irreversible damage to the pancreas. This involves chronic inflammation, fibrosis (scarring), and the destruction of both exocrine (digestive enzyme-producing) and endocrine (hormone-producing) tissue.

Etiology of Chronic Pancreatitis

Alcohol abuse is a significant cause, leading to an increased and sustained inflammatory response. However, in some instances, the exact cause of chronic pancreatitis remains unknown.

Treatment for Chronic Pancreatitis

Overall management aims to alleviate symptoms and manage complications. This includes:

• Pain Management: Analgesics are crucial.
• Pancreatic Enzyme Replacement Therapy (PERT): To aid digestion and nutrient absorption.
• Lifestyle modifications, such as alcohol cessation and dietary changes.