The clinical term “Pancreatitis” refers to the acute and chronic inflammation of the pancreatic gland as a result of its enzymatic autodigestion. Pancreatitis is one of the leading cause of gastrointestinal mortality and morbidity among hospitalized patients.
Patients suffering from acute or chronic pancreatitis may commonly present with the following symptomatology:
The following diagnostic modalities and tests are being used to work up patients with pancreatitis:
Patients initially diagnosed with pancreatitis are usually hospitalized for stabilization and treatment. Initially, patients are asked to fast (NPO) until the pancreatic inflammation subsides. When the pancreatic inflammation is controlled, patients may be started on clear liquids and low fat diets . Patients are placed in intravenous resuscitation to address dehydration and institute Intravenous analgesics to control pain symptoms. Non-medical approach to pancreatitis include biliary repair of obstruction using ERCP, cholecystectomy if bile stones are formed from the gallbladder , and pancreatic drainage of fluids and necrotic debris.
A great majority of pancreatitis cases is self-limiting without the need for surgery and medical interventions. Although, severe cases may lead to significant morbidity and mortality in 10 to 15% of cases. Patients with primary biliary problems are more associated with a worse prognosis compared to the alcohol induced form which has a lower morbidity rating. The advances in the medical health care delivery and supportive management have significantly reduced the morbidity and mortality ratings of pancreatitis in general. However, in patients seen in the emergency room presenting with organ failure, the mortality rate will rise to 30% in these cases .
The following systemic manifestations are among the serious systemic manifestations of pancreatitis: Acute renal failure, acute respiratory distress syndrome (ARDS), cardiac insufficiency, hypovolemic shock, and hemorrhage. An increase in the neutrophil lymphocytic ratio (NLR) observed within the first 48 hours of pancreatitis is associated with a severe form of pancreatitis and a poor prognosis .
Pancreatitis is commonly caused by obstructive biliary stones and chronic alcoholic intake . An estimated 10-30% of pancreatitis cases have an unknown or idiopathic etiology. Some diagnostic modalities like the endoscopic retrograde cholangio-pancreatography (ERCP) can cause pancreatitis among patients after the procedure. The pathology in this complication is the eminent dysfunction of the sphincter of Oddi during and after the procedure. Blunt abdominal trauma and penetrating injuries to the abdomen can cause direct damage to the pancreatic gland and cause pancreatitis, this is seen in approximately 1.5% of cases. Less common causes of pancreatitis like viral infection has been documented especially with mumps, coxsackie, cytomegalovirus, Epstein-Barr, varicella, rubella and hepatitis virus infections. Accounting for 2% of cases of pancreatitis are drug-induced, the following drugs are proven to cause pancreatitis among susceptible patients:
In the United States, there is an estimated 40 cases of pancreatitis per 100,000 adults per year . In 1998 alone, an estimated 183,000 cases of acute pancreatitis have been admitted in the hospitals, and the trend has continually increased in the following decades . The worldwide incidence of pancreatitis is between 5 to 80 cases per 100,000 population, with the highest incidence noted in the United States and Finland . In the United States, the majority of cases of pancreatitis is alcohol induced while European countries and Hong Kong has a predominance of microlithiasis induced type of pancreatitis.
The relative median age of onset for pancreatitis is dependent on its etiology . For example alcoholic pancreatitis which peaks at 39 years old, biliary pathology which are more prone by 69 years old, and drug induced types of pancreatitis that occurs at a mean age of 42. There is a male predominance over its female counterpart for pancreatitis. A racial predilection among the black population is notably observed over the light skinned races.
During the process of normal digestion, the inactivated enzymes from the exocrine pancreas traverse to the intestinal lumen where they are activated to digest the food contents of the small intestine. In the actual pancreatitis, these enzymes are activated within the gland causing cellular autodigestion, irritation, and inflammations. Acute inflammation will convey the usual signs and symptoms of acute pancreatitis. When recurrent bouts of acute pancreatic inflammation occurs in a long standing period, this is now referred to as chronic pancreatitis. The post inflammatory scarring of the pancreatic tissues will cause a subsequent loss of function of the gland causing digestion problems and diabetes consequently.
One of the corner stone in the control of pancreatitis is the eventual control of alcohol dependence. Smoking can also impair digestion and advertently cause pancreatitis; thus, abstinence from this vice can prevent the inflammation. The dietary modifications of a low fat diet can reduce the incidence of pancreatitis, and reduce its digestive menace. Adequate hydration can help keep the pancreas hydrated and safe.
Pancreatitis is a clinical disease characterized by the inflammation of the exocrine pancreas which may lead to autodigestion of the gland itself. Pancreatitis is generally classified as acute which presents suddenly and resolves in days, and chronic which presents in the course of many years. In most mild cases of pancreatitis, the inflammation subsides spontaneously even without treatment but in some occasion pancreatitis can be very severe that it can cause life threatening complications.
Pancreatitis is a clinical disease characterized by the inflammation of the exocrine pancreas which may lead to auto digestion of the gland.
Pancreatitis is primarily caused by alcohol binge drinking and biliary microlithiasis obstructions. Less common causes include: Viral infection, abdominal trauma, hereditary, and diagnostic procedures like ERCP.
Blood test with alkaline phosphatase, ERCP, Ultrasound, CT scan and MRI.
Treatment and follow-up
Patients are asked to fast with intravenous fluid support. Pain management and surgical correction of underlying pathology. Patients are advised to refrain from alcohol intake to prevent recurrence.