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According to a report in the journal of the American Pancreatic Association, Pancreas, the estimated worldwide incidence of acute pancreatitis is between 4.9 and 73.4 cases per 100,000 population.
According to an article in the American Family Doctor journal, mild acute pancreatitis has a very low mortality rate of below 1%.
According to a report in the journal of the American Pancreatic Association, Pancreas, mortality in patients with severe acute pancreatitis is approximately 10%7, but may be as high as 30% in patients with infected necrosis according to an article in the American Family Doctor journal.
Acute Pancreatitis is an acute inflammation of the pancreas. The risk factors for acute pancreatitis include smoking and genetic factors such as hereditary pancreatitis and cystic fibrosis. Gallstones, alcoholism and Endoscopic retrograde cholangiopancreatography (ERCP) (a procedure used to treat gallstones) are the most common causes. Some cases may also be idiopathic.
In acute pancreatitis, pancreatic enzymes digest the pancreas. This happens for one of two reasons, either the enzymes reflux back into pancreatic duct or the enzymes are incorrectly activated within the pancreatic duct.
Symptoms of acute pancreatitis include pain in the upper abdomen that spreads to the back. Jaundice, nausea, vomiting and a fever may also be present. Methods used to diagnose acute pancreatitis include patient history and physical examination, laboratory tests, particularly pancreatic and liver enzyme tests, and imaging tests such as an abdominal ultrasound or a CT scan of the pancreas.
Treatment of acute pancreatitis in hospitals is usually supportive in nature. It may involve intravenous fluids, pain management and oxygen. ERCP can be used to remove gallstones. Removing the pancreas may be necessary for severe or gangrenous cases. Most cases of acute pancreatitis recover without complications. Severe cases may have serious complications such as pancreatic infection, pseudocyst abscesses and multi-organ failure.
Prevention of further episodes of acute pancreatitis depends on determining the cause. In patients with gallstone pancreatitis, and those with idiopathic recurrent pancreatitis, cholecystectomy (removal of the gall bladder) is recommended6. Providing support for alcoholic patients to overcome their addiction is another prevention method.
According to a report in the journal of the American Pancreatic Association, Pancreas, the estimated worldwide incidence of acute pancreatitis is between 4.9 and 73.4 cases per 100,000 population.
According to an article in the American Family Doctor journal, mild acute pancreatitis has a very low mortality rate of below 1% 8.
According to a report in the journal of the American Pancreatic Association, Pancreas, mortality in patients with severe AP is approximately 10%7, but may be as high as 30% in patients with infected necrosis according to an article in the American Family Doctor journal.
Acute Pancreatitis is the inflammation of the pancreas that appears abruptly and lasts for a short time, usually a few days.
The most common causes of acute pancreatitis are gallstones and alcoholism.
Endoscopic retrograde cholangiopancreatography (ERCP), a procedure used to treat gallstones, may also cause acute pancreatitis.
Several drugs and toxins can lead to acute pancreatitis, such as steroids, azathioprine (an immunosuppressant used to treat rheumatoid arthritis among other diseases), thiazide diuretics (used to treat hypertension), estrogen supplements and valproic acid. Hypothermia can also trigger acute pancreatitis.
Less common causes of acute pancreatitis include: viral infections with mumps, measles and cytomegalovirus, hypercalcemia (elevated blood levels of calcium), surgery or trauma to the abdomen, very high lipid (triglyceride) levels, tumors of the pancreatic duct, exposure to organophosphate insecticide, scorpion and snake bites, and vascular abnormalities. It may also rarely result as a complication of cystic fibrosis and rare conditions such as hyperparathyroidism.
Acute pancreatitis may also be idiopathic (have no known cause).
The risk factors for acute pancreatitis include smoking and genetic factors such as hereditary pancreatitis and cystic fibrosis.
Obesity, being above 70 years of age, consuming too much of alcohol and smoking are risk factors for severe acute pancreatitis.
In acute pancreatitis, the pancreatic enzymes digest the pancreas. This happens either because the enzymes reflux back into pancreatic duct after they have been activated or because the enzymes are incorrectly activated within the pancreatic duct. These enzymes destroy the pancreatic cells, causing hemorrhage and ischemia (a restriction in blood supply leading to a lack of oxygen and nutrients).
The most common presenting symptom in patients with acute pancreatitis is epigastric (upper abdomen) pain that spreads to the back.
Patients may also complain of jaundice caused by initial pancreatic swelling. Nausea, vomiting and a fever may also be present.
Other symptoms may include:
Patients may present with signs and symptoms of peritoneal irritation in advanced cases. The peritoneum is the membrane that forms the lining of the abdominal cavity.
Patient history and physical examination:
Patient history and physical exams rarely produce conclusive evidence of pancreatitis, however they are still essential parts in the diagnosis.
The physical exam will usually reveal a fever, tachycardia, abdominal tenderness, muscular guarding (tensed or stiff abdominal muscles), abdominal distention and sometimes hypotension.
On physical examination you may notice ascites (abnormal accumulation fluid in the abdominal cavity).
Periumbilical ecchymosis (Cullen sign) and flank ecchymosis (Gray Turner sign) usually indicate severe necrotizing pancreatitis.
Laboratory tests:
Certain blood tests to measure digestive enzymes may be carried out. Particularly, elevated levels of lipase are a good indicator of pancreatitis. Elevated levels of amylase may be found in acute pancreatitis, however levels of amylase may also be increased by other disorders like renal failure, intestinal obstruction and appendicitis.
Decreased serum calcium usually occurs in acute pancreatitis usually due to precipitation of calcium.
Stool maybe tested to measure the level of the pancreatic enzyme elastase.
A lot of serum samples are also used to indicate the presence or severity of acute pancreatitis and these are usually combined in Ranson criteria.
Liver function tests are also important and could point towards gallstone pancreatitis.
Imaging tests:
An ultrasound (Ultra sonography) of the abdomen may be helpful to rule out gallstones and may demonstrate acute pancreatitis.
Endoscopic Ultrasound (Endoscopic ultrasonography) A scope with a light is inserted down the throat and into the stomach, allowing the doctor to see the pancreas and abdominal organs. This test shows if gallstones are present and may be useful in diagnosing severe pancreatitis.
A CT scan of the pancreas is used to check for complications such as pancreatic edema (swelling) or infection, fluid collection, or pancreatic necrosis.
ERCP is required in selected cases such as in suspected cholangitis (infection of the bile duct) and cases that do not improve. A tube is inserted down the throat into the stomach and small intestine. Using a contrast dye and an x-ray, images of the pancreas and bile duct appear.
Acute pancreatitis is treated in a hospital2. Treatment is usually supportive in nature, such as intravenous fluid, pain management and oxygen.
Severe cases of pancreatitis may cause multiple organ failure and require systemic monitoring and management.
ERCP can be used to remove gallstones that may be blocking the bile duct or to treat cholangitis (infection of the bile duct).
Gallstone pancreatitis should undergo a cholecystectomy (surgical removal of the gall bladder).
Surgical removal of the pancreas may be necessary for severe or gangrenous cases.
Most cases of acute pancreatitis recover without complications. Severe cases may have serious complications. These complications may include pancreatic infection, pseudocyst abscesses and multi-organ failure.
When the cause of pancreatitis can be determined, prevention relies on stopping the causative agent from inducing further episodes.
In patients with gallstone pancreatitis, and those with idiopathic (unknown cause) recurrent pancreatitis, cholecystectomy (removal of the gall bladder) is a necessary method of preventing future episodes of acute pancreatitis.
In alcoholic patients, help must be provided to assist these patients in overcoming their addiction.
When an uncommon cause of pancreatitis is ascertained, prevention is specific to the cause.
Mild acute pancreatitis has a low mortality rate. Patients with severe acute pancreatitis have a higher risk of complications and as a result have a higher mortality rate.
According to a report in the journal of the American Pancreatic Association, Pancreas, the estimated worldwide incidence of acute pancreatitis is between 4.9 and 73.4 cases per 100,000 population.
According to an article in the American Family Doctor journal, mild acute pancreatitis has a very low mortality rate of below 1%.
According to a report in the journal of the American Pancreatic Association, Pancreas, mortality in patients with severe acute pancreatitis is approximately 10%7, but may be as high as 30% in patients with infected necrosis according to an article in the American Family Doctor journal.
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