Acute Pancreatitis

Introduction

The pancreas located behind the stomach is responsible for the production of enzymes and hormones such as insulin and glucagon. The enzymes aid in the digestion of food and converting it into fuel required for the body’s cells. Usually, the enzymes that are produced are activated in the small intestine. When the enzymes start getting active in the pancreas itself, they digest the tissue of the pancreas. This leads to haemorrhage and swelling and damages the organ and its blood vessels. This causes acute pancreatitis. There is a sudden inflammation and swelling of the pancreas.

Causes
  • Gallstones
  • Alcohol abuse
  • Metabolic disorders such as hyperlipidemia, malnutrition, hereditary pancreatitis, hypercalcemia
  • Infections like viral hepatitis, mumps and Mycoplasma Pneumoniae
  • Choledochocele
  • Pancreas divisum
  • Cystic fibrosis
  • Injury to the pancreas after an accident or a procedure such as ERCP or EUS with FNA (fine needle aspirate)
  • Damage to pancreas during surgery
Symptoms
  • Severe upper or middle abdominal pain radiating to the back or left shoulder blade: this can worsen within minutes of eating and drinking foods with high fat content
  • Nausea and vomiting
  • Rapid heartbeat
  • Loss of appetite
  • Chills with shivering
  • Fever
  • Indigestion
  • Jaundice: yellowing of skin and white of the eyes
  • Swollen abdomen and gaseous fullness of the abdomen
  • Hiccups
Diagnosis Tests
  • Lab test and blood tests: Lab tests for release of pancreatic enzymes will reveal increase in amylase levels, serum blood lipase levels and urine amylase levels. Blood tests such as CBC and comprehensive metabolic panel are done to detect pancreatitis.
  • CT scan: Abdominal CT scan can reveal the extent of damage and any complications.
  • MRI scan: Several image slices of the belly are put together with a technology that uses magnets and radio waves.
  • Abdominal Ultrasound produces images of the internal organs and structures using sound waves.
Treatments

Severe acute pancreatitis is a medical emergency. Severe acute pancreatitis may cause dehydration and low blood pressure. The heart, lungs, or kidneys can fail. If bleeding occurs in the pancreas, shock and even death may follow. Treatment for acute pancreatitis often involves hospitalization. In acute pancreatitis, the choice of treatment is based on the severity of the attack. If no complications are present, care usually focuses on relieving symptoms and supporting body functions so that the pancreas can recover. Treatment for acute pancreatitis includes intravenous (IV) fluids, and medications for pain, nausea, and vomiting. ICU treatment may also be needed at times. Multiple scans may also be necessary during the treatment of this condition.

Some patients may require surgery. Depending on the severity of the inflammation a variety of surgical options are available which include endoscopic, laparoscopic, and open surgical techniques. Pancreatic necrosectomy is the surgical procedure used in the management of acute necrotising pancreatitis. Pancreatic necrosectomy is traditionally performed via an open surgery with an abdominal incision. However, surgeons with specialized training can perform this procedure laparoscopically.  With the use of laparoscopic ports and camera, the necrotic cavity is accessed. Purulent materials are gently suctioned to minimise the contamination of the abdominal cavity. The pus is also collected as specimen and sent for culture studies to determine the proper antibiotic therapy to be used later. The goal of necrosectomy is to remove all the areas of infection and necrosis. Using forceps, the necrotic pancreatic tissues and debris are removed. Following the procedure, drains are inserted from the pancreatic area to minimise the exposure of the abdominal contents to the pancreatic juice.