From the Guidelines
Acute pancreatitis is a sudden inflammation of the pancreas that can range from mild discomfort to a severe, life-threatening condition, with the most recent guidelines suggesting that it occurs when digestive enzymes become activated while still in the pancreas, causing irritation and damage to the organ's tissues 1.
Causes and Symptoms
The condition can be caused by various factors, including gallstones and excessive alcohol consumption, as well as medications, high triglyceride levels, infections, and certain procedures like ERCP 1. Symptoms typically include:
- Severe upper abdominal pain that may radiate to the back
- Nausea and vomiting
- Fever
- Tenderness when touching the abdomen
Treatment and Management
Treatment usually involves hospitalization for a few days to manage pain with medications like morphine or hydromorphone, intravenous fluids to prevent dehydration, and fasting to rest the pancreas 1. In mild cases, patients can usually resume eating when pain subsides and laboratory values improve, starting with clear liquids and advancing to a low-fat diet. Severe cases may require:
- Intensive care
- Nutritional support through feeding tubes
- Sometimes surgical intervention The underlying cause, such as gallstone removal, should be addressed to prevent recurrence.
Outcome and Prognosis
Most people recover completely from mild acute pancreatitis, but severe cases can lead to complications like pseudocysts, infection, or organ failure 1. It is essential to diagnose and manage the condition promptly to prevent these complications and improve patient outcomes.
From the Research
Definition and Overview of Acute Pancreatitis
- Acute pancreatitis is an inflammatory condition of the exocrine pancreas that is a common indication for hospital admission and has had an increasing incidence in the last few decades 2.
- It is one of the leading causes of hospital admission from gastrointestinal diseases, with approximately 300 000 emergency department visits each year in the United States 3.
Diagnosis of Acute Pancreatitis
- The diagnosis of acute pancreatitis requires the satisfaction of two out of three criteria:
- Abdominal pain radiating to the back
- Serum lipase or amylase levels three or more times the upper limit of the normal level
- Findings indicating pancreatitis obtained via a computed tomography (CT) scan or magnetic resonance imaging (MRI) 2.
- Initial investigation includes serum amylase and lipase analysis, a lipid panel including triglycerides, analysis of immunoglobulins, a full blood count, electrolyte analysis, a hemoglobin A1c test, a complete metabolic panel, and transabdominal ultrasound 2.
Causes and Risk Factors of Acute Pancreatitis
- The different etiologies include gallstones, autoimmune disorders, alcohol abuse, smoking, hypertriglyceridemia, obesity, drugs, and post-endoscope retrograde cholangiopancreatography (ERCP) 2, 4.
- The underlying etiology of acute pancreatitis should be sought in all patients, and risk-reduction strategies, such as cholecystectomy and alcohol cessation counseling, should be used during and after hospitalization for acute pancreatitis 3.
Management and Treatment of Acute Pancreatitis
- Early and aggressive fluid resuscitation and early enteral nutrition are associated with lower rates of mortality and infectious complications 3.
- Initial priorities are intravenous fluid resuscitation, analgesia, and enteral nutrition, and when necessary, critical care and organ support, parenteral nutrition, antibiotics, pancreatic exocrine and endocrine replacement therapy 4.
- Lactated Ringer's solution reduces systemic inflammation compared with saline in patients with acute pancreatitis 5.
- Recent advancements in management have primarily focused on the development of early phase medical interventions targeting inflammatory pathways, optimisation of supportive treatment, and the necessity of follow-up for long-term complications 6.
Complications of Acute Pancreatitis
- Some complications of acute pancreatitis are necrosis, infection, insulin resistance leading to diabetes mellitus, and pancreatic exocrine insufficiency requiring enzyme supplementation 2.
- Patients with local complications should be referred to specialist tertiary centres to guide further management, which may include drainage and/or necrosectomy 4.