Pancreatitis

Acute pancreatitis describes a sudden inflammatory process of the pancreas which occurs as an isolated or potentially recurrent event.

The pancreas is an organ responsible primarily for blood sugar control and digestion.

What are the symptoms?

The main symptoms include central or upper abdominal pain which classically spreads to the back.

Additional symptoms include nausea, vomiting, diarrhoea and feeling feverish.

What is the cause?

The primary causes of acute pancreatitis include gallstones, alcohol, a raised blood calcium or lipid level, drugs such as steroids or azathioprine, bacterial or viral infections and post surgical intervention.

However in some cases there may not be a cause.

How is it diagnosed?

The gold standard diagnosis of acute pancreatitis is an elevated blood amylase level, an enzyme that is involved in the break down of starch into simple sugars.

In addition there may be an elevation in blood lipase levels, an enzyme which helps to break down fats.

In addition to blood tests, radiological investigations can be beneficial in confirming such a condition.

A chest x-ray is often performed to rule out a perforated peptic ulcer which can present in a similar fashion.

An abdominal ultrasound scan is also useful in detecting the presence of gallstones which, as mentioned previously, are a common cause of acute pancreatitis.

More advanced investigations include a CT or MRI scan to exclude the presence of fluid build up around the pancreas or evidence of dead tissue within the pancreas, commonly known as necrosis.

How is it treated?

In the acute setting, individuals should be managed in the hospital where they are kept fasted and given fluids intravenously.

A tube inserted into the stomach via the nose helps to prevent further vomiting and stomach distension.

Pain relief is key and individuals are often treated with strong analgesia.

As oral diet is restricted patients often require feeding via other means, either into the blood stream directly but in the vast majority of cases via a tube inserted into the portion of the intestine via the nose.

In order to reduce spread of infection and further inflammation antibiotics are key and help improve overall outcome.

In cases of pancreatic necrosis, surgery may be indicated particularly if there is evidence of fluid build up.

What are the complications?

The major complications of the disease include an elevated blood glucose level or hyperglycaemia, with a potential risk of diabetes due to impaired insulin production from the pancreas.

Additional complications include renal failure, respiratory failure or in severe cases multiorgan failure.

What is the prognosis?

Prognosis in acute pancreatitis is variable with a mortality rate of 10-15%.

Individuals with associated organ failure demonstrate an increased mortality rate of approximately 35%.

Written by Dr Neel Sharma