Acute Pancreatitis
By Douglas Pleskow, M.D.
The pancreas is an organ located well within the abdominal cavity (in the reproperitoneum) and is therefore well protected from injury. The pancreas however is susceptible to several disease processes, including acute and chronic pancreatitis.
Acute pancreatitis is a condition in which the pancreas becomes inflamed. By convention, acute disease is characterized by a normal pancreas that becomes inflamed prior to the attack and once the attack resolves the pancreas returns to normal. Acute disease can be mild or can be life threatening in severity.
The cases of acute pancreatitis are numerous. The most common causes include gallstone disease and alcohol. The frequency with which these factors cause the disease are dependent upon the patient population that is being studied. Alcohol abuse is much more common within the inner city and therefore this accounts for a majority of the causes of pancreatitis within the urban areas. Gallstone disease is the most frequent cause of episodes of pancreatitis in rural and suburban locations. The other causes of acute pancreatitis include medications, sphincter of Oddi dysfunction, infections, trauma, surgery, endoscopic retrograde cholangiopancretagraphy (ERCP) and metabolic diseases such as hyperlipidemia. Approximately 15% of the cases have no cause determined, so-called idiopathic pancreatitis. This latter condition is an exciting area of clinical research. Several investigators have postulated that a majority of the causes of idiopathic pancreatitis is due to a mutation of the Cystic Fibrosis gene.
The symptoms of pancreatitis include abdominal pain, nausea, and vomiting. The abdominal pain starts gradually and builds in intensity. The pain begins in the upper abdomen and spreads through to the back. Patients also report that the pain is better leaning forward or lying on the side with their knees drawn upwards. The vomiting that occurs does not relieve the pain. Due to the severity of these symptoms patients generally are hospitalized. Most patients recover without any clinical sequelae and return to normal. Rarely complications of the disease occur, but they include pseudocysts, abscess and death.
Treatment of acute pancreatitis is directed at eliminating the causes of the disease and supporting the patient. Hospitalization is often necessary. Pain control is important and narcotics are generally required. Intravenous fluids and nutrition are important in maintaining homeostasis. In the most severe cases of pancreatitis patients may require admission to the intensive care unit. Rarely pancreatitis leads to death. Complications of severe disease include respiratory failure, hypotension, renal failure and death. The fortunately are quite rare.
The prognosis for acute pancreatitis is good. Patients generally recover without significant sequelae of disease. Recurrence of symptoms is frequent if the underlying etiology is not treated or eliminated.
A significant amount of research is currently under way to detect the cause of idiopathic pancreatitis, and to determine newer ways of treating this disease.
Dr. Douglas Pleskow, a gastroenterologist with Beth Isreal Deaconess Hospital, Boston, is Executive Director of the National Pancreas Foundation.
