Acute pancreatitis is the swelling of the pancreas due to diverse causes. This disease can be fatal if it is not taken care of properly.
This article will discuss the pancreas and how it gets sick, which are the disease’s symptoms and the risk factors for getting pancreatitis.
We will also be discussing about how to diagnose this disease and how to treat it. Continue reading to get the information you need to know directly from a doctor.
What is the pancreas? What does it do?
The pancreas is a gland located in the abdomen between the stomach, the liver, and the duodenum. The latter is the first portion of the intestines; it begins after the stomach and has an intimate relationship with the pancreas.
Between them exists the ¨pancreatic duct¨, which is in charge of transporting secretions coming from the pancreas. There’s also the bile duct, which transports bile from the liver. Those two ducts join together for discharging their elements into the duodenum.
Bile is a greenish-yellowish secretion the liver secrets and is fundamental in the digestion of fat. This anatomic relation is really important since what happens to one of these organs could affect the other.
The pancreatic acinar cells produce pancreatic enzymes that are later secreted to the duodenum with pancreatic fluid. These pancreatic digestive enzymes, along with the bile, help the digestion of proteins, fat, and carbohydrates in the small intestine.
The pancreas has another group of cells that are in charge of the control of glucose blood levels. These are set as islets with different types of cells; alpha cells and beta cells. Alpha cells secrete glucagon, a hormone in charge of increasing glucose blood levels when we haven’t eaten. Beta cells secrete insulin, a hormone in charge of using glucose when we eat to produce energy. Damage in the pancreas could affect any of the groups of cells present.
What happens in acute pancreatitis?
Acute pancreatitis is an inflammation of the pancreas that causes reversible damage in its tissue. In this, the pancreatic enzymes activate inside the organ instead of within the duodenum; they swell and destroy pancreatic tissue.
The pancreas can slowly regenerate itself, but it becomes chronic pancreatitis when the damage happens frequently or is too large. When pancreatic enzymes affect the pancreatic tissue, it also activates an acute immune response that brings pro-inflammatory cells.
These cells secrete proteins that contribute to acute pancreatitis since they can cause cellular death and, therefore, pancreatic necrosis. This term refers to an unexpected cellular death since other types of cell death are normal.
There different things that can cause acute pancreatitis, but the most common ones are:
- Biliary tract disease: In this disease, the bile duct suffers from obstruction or a duct’s narrowing. The pancreatic fluid, along with the bile, comes out through a tube that passes through the pancreas as well. Finally, they reach together a sphincter, but in this case. The way out into the duodenum is blocked due to the stones that are coming from the gall bladder. There is an increase of pressure that eventually causes damage to the acinar cells and a premature release of pancreatic enzymes that leads to pancreatic necrosis.
- Alcohol: The heavy ingestion of alcohol during 5 to 15 years makes the patient more susceptible to acute pancreatitis. This happens because ethanol leads to accumulation and premature release of enzymes. It also makes the patient more predisposed to obstructions because of changes in the composition of pancreatic juice.
- Endoscopic retrograde cholangiopancreatography (ERCP): This is a procedure that studies the pancreas, and it usually doesn’t cause problems. Sometimes, when a health care professional perform this procedure, it can damage the sphincter or ducts.
What are the symptoms of acute pancreatitis?
The patient who suffers from acute pancreatitis undergoes a set of particular symptoms, being abdominal pain the most common.
Patients describe the pain as a dull one, and it usually presents itself in the upper part of the abdomen. The onset of this pain is critical since it appears suddenly and progresses fast from mild to severe pain.
The abdominal wall becomes really sensitive to touch and often distended and hardened. It can also radiate from the upper part of the abdomen to the patient’s back. Something characteristic of this pain is that it decreases temporarily when the patient bends forward while sitting up.
Other common symptoms associated with mild acute pancreatitis to severe pancreatitis are nausea, vomiting, and diarrhea. These gastrointestinal symptoms can happen because of the dysregulation of digestive enzymes and bile as it causes indigestion. This means that the previously mentioned symptoms can get worse after eating foods high in fat.
In most cases, fever and tachycardia (accelerated heart rate) are present. This is because of the exacerbated inflammatory response that occurs in the pancreas, affecting all the systems in the body.
Some patients can have their skin, eyeballs, and mouth mucosa turn to a yellowish color, which is called jaundice. It’s important to know this isn’t a main sign of pancreatitis as various diseases can cause it as well.
Another not so common symptom is difficult to breathe or dyspnea. This happens because the patient suffers from a pleural effusion, which means liquid in the tissues surrounding the lungs. The liquid causes the lung not to expand easily; therefore, the patient has difficulty breathing.
How common is acute pancreatitis? Who is at risk for acute pancreatitis?
Acute pancreatitis is a relatively common disease, more on males than on females. When males in their 40s have acute pancreatitis is more likely due to alcohol ingestion. On the other hand, when females in their 40s have acute pancreatitis is more likely due to gallstone pancreatitis.
It is fundamental to know the history of the person that has pancreatitis symptoms. These can orientate the cause of the disease and, therefore, the most appropriate treatment. For example, if a person has had a high alcohol intake for several years and shows the probable symptoms. Or, a patient who already had gallstone pancreatitis and later have an ERCP study prompting even more symptoms; then, the procedure is the cause. Other factors, such as drug intake, trauma, or infections, can represent risks necessary to know for a precise diagnosis and treatment.
Other risk factors that aren’t as common as the previous is if other people in the family suffered from pancreatitis. A small percentage of the people that get the disease is because of hereditary pancreatitis. In these cases, a faulty gene causes the pancreatic enzymes to be released out of time. As we already discussed, this leads to the damage of the pancreatic tissue and a proinflammatory response.
Another form of the disease is idiopathic pancreatitis. In this case, there is no precise cause or risk factor to pinpoint, becoming idiopathic. Nowadays, scientists know that this happens because of micro-stones from the gall bladder, which break the acinar cells. Now it is biliary pancreatitis in some way, although there are still studies to be made.
Cystic fibrosis of the pancreas is another genetic disease that affects the pancreas. In this, the tubes that excrete the pancreatic juice become obstructed with mucous, causing damage to acinar cells.
How serious is acute pancreatitis?
This disease can have some severe complications really fast if the patient does not receive any medical care. The pancreas can undergo a fluid collection that turns into a pancreatic pseudocyst. The previous amount of liquid stays in the pancreas in particular zones because of the inflammatory response.
Most of the time, this does not represent a significant threat to a person’s life and regresses without treatment. Complications appear when an infection occurs, and it becomes a pancreatic abscess. These are collections of pus confined in the pancreatic tissue, and if they break, they can extend the pancreatic infection. When an infected liquid pours into the abdomen, it can cause a septic shock and even lead to organ failure.
In severe cases, necrotizing pancreatitis, which means the death of pancreatic cells, is a leading cause of death for patients. In this complication, the patient can also easily suffer from hemorrhagic pancreatitis, losing a high blood volume. Abscesses frequently occur in acute necrotizing pancreatitis, making it easy to infect, complicating the disease.
When acute pancreatitis becomes frequent, or the damage is too vast, it turns into chronic pancreatitis. In this complication, the changes in the tissue are permanent as it is its functionality. The patient has to learn to live with the disease its whole life, carrying a limited lifestyle weight. Permanent medication is a must as it is daily life changes in foods and habits. This is because there’s a compromise of the digestive process. Many of the enzymes aren’t longer available or are diminished.
How is acute pancreatitis diagnosed?
An essential factor in the diagnosis is the development of the symptoms and the clinical history of the patient. These could be enough to make an accurate diagnosis, although other studies must confirm the disease.
In most cases, they are essential for measuring the severity of pancreatitis or the most suitable treatment. The two primary laboratory test done for this condition are serum amylase and serum lipase. They are enzymes that the pancreas produces, and when there is damage to the tissue, they increase in the blood. Other tissues in the body make these enzymes, too, although the pancreas is the one that produces lipase the most.
It’s fundamental to test both, and if the elevation is three times over the average value is acute pancreatitis. Liver related enzymes (ALT, AST) are also essential to test as they can reveal if the cause is gallbladder related.
Imaging studies are now a procedure that most doctors do to detect the precise cause of pancreatitis or complications. Abdominal radiography is a simple method that isn’t functional in this disease as it can only identify calcifications and enlargement.
Abdominal ultrasonography is the most functional non-invasive imaging study there is, as it can easily identify gallbladder stones. A CT scan can highlight pancreatic tumors or the level of necrosis in the pancreas in necrotizing pancreatitis.
When the cause of the pancreatitis is not clear, doctors use more invasive imaging studies to assert the diagnosis. Endoscopic ultrasound studies can distinguish damages in the sphincter. ERCP studies are of last resort since they can damage the pancreatic ducts, leading to acute pancreatitis. It studies the pancreatic ducts and detects if they are narrower in some parts more than others, affecting the pancreatic cells.
How is acute pancreatitis treated?
The treatment of acute pancreatitis will depend on the cause of the disease and the severity of it. Fluid resuscitation is the primary treatment for mild pancreatitis because much of the body’s fluids go into the abdomen. The way professionals proportionate it is through intravenous fluids since orally the patient is susceptible to vomiting.
The patient also gets medication for pain; meanwhile, amylase and lipase levels decrease, and other studies are done. Antibiotic use to treat acute pancreatitis is not primary except in some cases like not-infected necrotizing pancreatitis. In this case, doctors use a prophylactic antibiotic, which means its function is to prevent possible future infections.
Does it require surgery?
Surgery is a requirement in specific pancreatitis cases depending on the cause of it as well.
In patients with gallstone pancreatitis, a cholecystectomy is a main and definitive treatment. This is the gallbladder extraction in which there is a removal of gallstones that usually form and cause obstructions in the ducts. It is a necessary procedure since the disease usually appears again with time, causing acute pancreatitis again.
On the other hand, with a pancreatic pseudocyst or abscess, an aspiration of the area would be the standard procedure. The importance of this is to prevent infections inside the abdomen, which could even be fatal. Infected necrosis on the pancreas needs to go to surgery, too, as they do not respond well to antibiotics.
Do you have symptoms of this disease?
This is an Acute Pancreatitis Symptoms Checker. It gathers the most important signs, symptoms, and risk factors for this disease. Therefore, it would tell anybody who uses it the likelihood of their symptoms because of acute pancreatitis. Using this tool is free and would only take a few minutes.