From the Guidelines
Acute pancreatitis is primarily caused by bile stones or excessive use of alcohol, leading to premature activation of digestive enzymes within the pancreas, resulting in autodigestion and inflammation. The symptoms of acute pancreatitis can vary from mild to severe and include abdominal pain, nausea, and vomiting. According to the 2019 WSES guidelines for the management of severe acute pancreatitis 1, the disease can be classified into two phases (early and late) and severity can be classified as mild, moderate, or severe.
Causes of Acute Pancreatitis
The most common causes of acute pancreatitis are:
- Bile stones
- Excessive use of alcohol Other causes may include:
- Certain medications
- Infections
- Trauma to the abdomen
- Genetic disorders
Symptoms of Acute Pancreatitis
The symptoms of acute pancreatitis can include:
- Abdominal pain
- Nausea and vomiting
- Fever
- Abdominal tenderness
- Guarding (muscle tension)
Classification and Severity
The 2012 revision of the Atlanta classification and definitions based on international consensus 1 is the most commonly used classification system for acute pancreatitis. This classification identifies two phases (early and late) and classifies severity as mild, moderate, or severe. The severe form of the disease, comprising about 20-30% of patients, is a life-threatening condition with hospital mortality rates of about 15% 1.
Management and Treatment
Treatment of acute pancreatitis typically involves hospitalization for pain management, intravenous fluid resuscitation, and bowel rest. Most patients can begin oral feeding within 24-48 hours once pain improves and inflammatory markers decrease. Nutrition should start with clear liquids and advance to a low-fat diet as tolerated. Severe cases may require intensive care monitoring, nutritional support via nasojejunal tube feeding, and possibly antibiotics if infection is suspected. The underlying cause must be addressed, and complications such as pseudocysts, necrosis, and organ failure must be monitored. Enteral nutrition is preferred over parenteral nutrition in acute necrotizing pancreatitis, as it has been shown to be superior 1.
Recovery and Prognosis
Recovery from acute pancreatitis typically takes 5-7 days for mild cases, while severe cases may require weeks of hospitalization. The mortality rate in patients with infected necrosis and organ failure can be as high as 35.2% 1, highlighting the importance of prompt and effective treatment.
From the Research
Causes of Acute Pancreatitis
- The exact causes of acute pancreatitis are not explicitly stated in the provided studies, but it is mentioned that the condition is a common inflammatory disorder of the pancreas resulting in considerable morbidity and mortality 2, 3, 4.
Symptoms of Acute Pancreatitis
- The symptoms of acute pancreatitis are not directly mentioned in the provided studies, but it is discussed that the condition can lead to fluid sequestration, decreased peripheral vascular tone, and systemic inflammation 2, 3, 4, 5, 6.
- Early elevated hematocrit, blood urea nitrogen, or creatinine can be indicators of the severity of pancreatitis and should prompt clinicians to institute more intensive early resuscitation measures 2.
Fluid Resuscitation in Acute Pancreatitis
- Aggressive intravenous fluid resuscitation is generally recommended in all patients with acute pancreatitis 2, 3, 4, 6.
- Crystalloids, such as lactated Ringer's solution or normal saline, are commonly used for fluid resuscitation in acute pancreatitis 2, 3, 5.
- Recent studies suggest that lactated Ringer's solution may be superior to normal saline in reducing systemic inflammation in patients with acute pancreatitis 5.
- The optimal rate, type, and goal of fluid resuscitation remain unclear, and current studies are underway to determine the best approach 2, 3.