Acute Pancreatitis
Acute pancreatitis is a sudden inflammation of the pancreas that is usually associated with severe upper abdominal pain. There are an estimated 50,000 to 80,000 cases in the United States each year. The most common cause is gallstones. Other causes include alcohol abuse, hereditary conditions, trauma, medications, infections, electrolyte abnormalities, high lipid levels and hormonal abnormalities. In approximately 15% of cases, the cause of acute pancreatitis is unknown.
Acute pancreatitis generally starts with a pain in the upper abdomen. The pain can be severe, radiate to the back and may last for several days. Relief of pain by sitting up and bending forward is characteristic of pancreatic pain. The pain is often accompanied by nausea and vomiting. Other symptoms include diarrhea, bloating and fever. Damage to the pancreas may occur when digestive enzymes it produces are activated and begin attacking the organ. In severe cases the pancreas may become infected and antibiotics will be necessary.
Occasionally the patient may develop a pancreatic abcess or a pseudocyst. A pancreatic abcess is an ill-defined liquid collection of pus that evolves over a period of 4 to 6 weeks after the onset of acute pancreatitis. These occur in only 3 to 4 % of patients with acute pancreatitis, usually in the most severe cases. Surgical or CT scan guided drainage is sometimes needed. Pseudocysts of the pancreas are collections of tissue, fluid debris, pancreatic enzymes and blood which develop over a period of one to four weeks after the onset of acute pancreatitis and form in about 15% of patients with this disease. They sometimes resolve on their own but they can persist and require surgical or CT scan guided drainage.
Diagnosing acute pancreatitis is often difficult because of the deep location of the pancreas. A physical exam and blood tests to determine the levels of amylase and lipase are often the first tools used to begin the diagnosis. When radiography is necessary, state-of-the-art techniques and equipment is recommended for accurate diagnosis. An imaging team may use one or more modalities to make a diagnosis including ultrasonic imaging, CAT scan, MRCP (magnetic resonance cholangiopancreatogragphy) or ERCP (endoscopic retrograde cholangiopancreatography).
Treatment for acute pancreatitis depends on the severity of the condition. Sometimes the patient needs hospitalization with administration of intravenous fluids to help restore blood volume. Antibiotics are often prescribed if infection occurs and pain medications are often used to provide relief. Surgery is sometimes needed when complications such as infection, cysts or bleeding occur.
Patients usually recover fully from acute pancreatitis and do not experience recurrence if the cause is removed. Alcohol consumption should be eliminated even if it is not the determined cause of the disease. Smoking, which stresses the body’s defenses against inflammation, should be stopped. A trial and error approach to specific foods is usually indicated. Patients often find high-fat foods difficult to digest.
