From the Guidelines
Pancreatitis is a life-threatening condition that requires prompt medical attention, and the primary cause of acute pancreatitis is gallstones or excessive alcohol use, while chronic pancreatitis is most commonly caused by long-term alcohol abuse. Here's a comprehensive overview:
Causes and Risk Factors:
- Gallstones (most common cause of acute pancreatitis) 1
- Alcohol abuse (most common cause of chronic pancreatitis) 1
- High triglyceride levels
- Certain medications (e.g., steroids, diuretics)
- Genetic factors
- Autoimmune conditions
- Smoking
Preventive Measures:
- Limit alcohol consumption
- Maintain a healthy diet low in fat and high in fruits, vegetables, and whole grains
- Quit smoking
- Manage underlying conditions like high triglycerides or gallstones
- Stay hydrated
Signs and Symptoms:
- Severe upper abdominal pain that may radiate to the back
- Nausea and vomiting
- Fever
- Rapid pulse
- Swollen, tender abdomen
- Unintentional weight loss (in chronic pancreatitis)
Treatment:
- Acute pancreatitis:
- Fasting to rest the pancreas
- Intravenous fluids
- Pain management (e.g., morphine)
- Treating underlying cause (e.g., gallstone removal)
- Chronic pancreatitis:
- Pain management (e.g., acetaminophen, NSAIDs, or opioids if severe)
- Enzyme replacement therapy (e.g., pancrelipase) 1
- Dietary changes (low-fat diet)
- Insulin for diabetes management if needed In severe cases, hospitalization may be required, and surgery might be necessary for complications or to address underlying causes, with a mortality rate of 35.2% in patients with infected necrosis and organ failure 1. Early diagnosis and treatment are crucial to prevent complications and manage symptoms effectively. Additionally, patients with chronic pancreatitis should be considered at risk for malnutrition and osteoporosis, and preventive measures should be taken 1.
From the Research
Causes and Risk Factors of Pancreatitis
- The main causes of acute pancreatitis are gallstone migration and alcohol abuse 2
- Other causes of pancreatitis include toxic/metabolic, idiopathic, genetic, autoimmune, recurrent and severe acute pancreatitis, and obstruction 3
- Hypertriglyceridemia, which can be primary or secondary due to genetic defects, poorly controlled diabetes, obesity, and high-fat diets, can also precipitate episodes of acute pancreatitis 4
- Pancreas divisum is a cofactor for all forms of pancreatitis 2
- Post-endoscopic retrograde cholangiopancreatography acute pancreatitis is a complication of endoscopic retrograde cholangiopancreatography 2
Preventive Measures
- No specific preventive measures are mentioned in the studies, but managing risk factors such as hypertriglyceridemia and alcohol abuse may help prevent pancreatitis 4, 2
- Dietary restrictions and lifestyle modifications may be recommended for patients with pancreatitis to manage symptoms and prevent complications 3, 4
Signs and Symptoms
- The most common symptom of chronic pancreatitis is pain localized to the upper-to-middle abdomen, along with food malabsorption, and eventual development of diabetes 3
- Acute pancreatitis typically presents with epigastric or right upper quadrant pain 5
- Chronic pancreatitis may also present with signs and symptoms of pancreatic endocrine and exocrine insufficiency 5
Treatment Options
- Treatment strategies for acute pancreatitis include fasting and short-term intravenous feeding, fluid therapy, and pain management with narcotics or nonsteroidal anti-inflammatories 3
- Patients with chronic disease and symptoms require further care to address digestive issues and the possible development of diabetes, including dietary restrictions, enzyme replacement, and vitamin supplementation 3
- Surgical or endoscopic methods may be used to achieve more definitive outcomes, depending on the role of the pancreatic ducts in the manifestation of disease 3
- There is no specific treatment for acute pancreatitis, but early supportive treatments and interventions may be beneficial 6