Acute Pancreatitis

Acute pancreatitis is a sudden inflammatory condition of the pancreas that can cause severe abdominal pain and other complications. The inflammation can range from mild and self-limiting to severe and life-threatening, with pancreatic necrosis and systemic complications.

Epidemiologically, acute pancreatitis is a common condition with an increasing incidence in developed countries. The annual incidence ranges from 13 to 45 cases per 100,000 people, with the most common causes being gallstone disease and alcohol abuse. Other causes include iatrogenic interventions, hypercalcemia, hypertriglyceridemia, certain medications, and infections.

The pathophysiology of acute pancreatitis involves the premature activation of pancreatic enzymes within the pancreas, leading to pancreatic tissue autodigestion. This causes inflammation, edema, and potentially necrosis of the pancreas. Releasing enzymes and inflammatory cells can cause a systemic inflammatory response, leading to multiple organ failure.

The causes of acute pancreatitis primarily include gallstone disease, alcohol abuse, and hypertriglyceridemia. Gallstones obstruct the common bile duct, leading to bile reflux and activation of pancreatic enzymes. Alcohol abuse directly affects pancreatic cells and promotes the production of inflammatory mediators. Other causes include surgical procedures, trauma, infections, metabolic disorders, and genetic factors.

Symptoms of acute pancreatitis include severe abdominal pain radiating to the back, nausea, vomiting, fever, and tachycardia. The pain usually worsens after eating and may be accompanied by abdominal distention and tenderness.

The differential diagnosis of acute pancreatitis includes excluding other conditions that cause acute abdominal pain, such as cholecystitis, peptic ulcer disease, bowel obstruction, mesenteric ischemia, and ruptured abdominal aortic aneurysm. Diagnosis is based on clinical findings, laboratory tests, and imaging studies.

Complications of acute pancreatitis can be local or systemic. Local complications include pseudocysts, pancreatic necrosis, pancreatic abscess, and venous thrombosis. Systemic complications include acute respiratory distress syndrome (ARDS), renal failure, sepsis, and multiple organ failure.

Treatment of acute pancreatitis aims to relieve symptoms and prevent complications. Initial management includes fasting to reduce pancreatic stimulation, intravenous hydration to restore fluid balance, and analgesia to relieve pain. Admission to the intensive care unit (ICU) may be necessary in severe cases. Antibiotics are used only in cases of infection or necrotizing pancreatitis. Surgical intervention may be required to remove necrotic tissue or manage complications such as pseudocysts or pancreatic abscesses.

Laboratory tests are critical for diagnosing and monitoring acute pancreatitis. Key tests include measuring pancreatic enzymes (amylase and lipase) in the blood, which are usually elevated. The increase in these enzymes is indicative of pancreatic inflammation. Other blood tests include a complete blood count to detect leukocytosis, electrolytes, calcium levels, creatinine to assess renal function, and liver function tests.

Elevated lactate dehydrogenase (LDH) concentrations and Interleukin 6 (IL-6) are associated with a worse prognosis in specific clinical circumstances. High C-reactive protein (CRP) concentrations within 48 hours after disease presentation suggest acute necrotizing pancreatitis. Procalcitonin measurement may help differentiate between mild and severe disease and should be obtained early in the illness. Trypsin levels are indicative of pancreatic damage. Concentrations are significantly elevated in acute pancreatitis.

Imaging testing such as ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) are essential for evaluating the pancreas and surrounding structures, identifying gallstones, and detecting complications such as necrosis and pseudocysts. Endoscopic ultrasound and endoscopic retrograde cholangiopancreatography (ERCP) may be used for diagnostic and therapeutic purposes, particularly in cases of gallstone disease.

Monitoring patients with acute pancreatitis involves regular clinical assessments and repeated laboratory tests to track disease progression and detect complications. Continuous evaluation of pancreatic enzyme levels, electrolytes, and renal and liver function is necessary. Additionally, imaging studies may be repeated to assess pancreatic inflammation and complications.

This article belongs to a new series on our blog that covers all fields of health! We present information on the most frequent pathological conditions in a comprehensive, clear, understandable, but always scientifically documented way so you can know and protect the most crucial good: your health!

Ioannis Sideris, Medical Doctor