Acute Pancreatitis is a condition of the pancreas characterized by an inflammation that affects not only the pancreas but also nearby body organs and tissues. Acute Pancreatitis can be mild or severe depending on the severity and spread of the disease. In a mild case of AP is otherwise referred to as interstitial pancreatitis as per its radiographic manifestation. Severe AP on the other hand suggests complete organ failure, pancreatic necrosis or local complications. As for mild pancreatitis, it implies the blood supply is preserved while in the case of severe pancreatitis, it means the pancreatic blood supply is disrupted, thus culminating to ischemia.
Different settings of acute pancreatitis call for different ways in which the blood is collected including acute pseudocysts, acute fluid collections, and pancreatic abscesses. Acute collection of fluids is seen in the onset stages of acute pancreatitis in the peri-pancreatic regions which are not always covered by a fibrous wall. As for acute pseudocysts, they are well-developed collections of this juice which is covered in a non-epithelialized wall made up of granulation tissue. These will form between 4 and 6 weeks after an AP episode.
An infected pseudocyst is known as a pancreatic abscess, which can also form via encapsulation of regions where pancreatic necrosis is infected. When you get two or more bouts of acute pancreatitis on several occasions as is evidenced by the rise of serum enzyme levels, it is referred to as acute recurrent pancreatitis, which can progress if urgent medical attention is not given to chronic pancreatitis, and what this means is that glandular function will be lost and there will be a high incidence of parenchyma fibrosis.
Prevalence of Acute Pancreatitis
Statistics indicate that 17 in every 100,000 people report to have new cases of AP, and annually it is responsible for over 100,000 hospitalizations. Further, 80% of all cases are mild and interstitial, and the remainder 20% accounts for severe and necrotizing. Circa 2000 patients die every year from Acute Pancreatitis.
Causes of AP
The usual culprits, alcohol and gallstones are responsible for most causes of acute pancreatitis, and actually account for over 80% of all cases of AP. Gallstone pancreatitis is as a result of an obstruction on the duct by tiny stones, otherwise referred to as edema. Some of the notable clinical features of this condition include prior biliary colic, biliary dilation during a gallbladder ultrasound, availability of cholelithiasis, and more importantly abnormalities in tests conducted for liver function. Gallstone AP will rarely recur after endoscopic therapy/ cholecysectomy i.e. the procedure of extracting stone.
As was mentioned previously, Alcohol is another leading cause of not only Acute Pancreatitis but also all other types of pancreatitis, which will start to show its ugly face after periods of an overindulgence drinking. If not treated (where the only effective mode of treatment here is stopping alcohol), recurrent episodes of alcohol acute pancreatitis could lead to chronic pancreatitis.
The Signs and Symptoms of Acute Pancreatitis
AP will manifest itself with an abrupt onset of unbearable epigastirc pain that exudes towards the back, a pain that can be very severe, boring, and deep at the same time. The consumption of food will normally exacerbate the pain, but some short-term relief can be got from bending forward. In a condition aggravated by alcohol, the onset of pain will be hours to several days after a bout of spree drinking. One will also experience some abdominal pains lasting for several days and which is associated with nausea, anorexia, and vomiting.
On physical examination, the patient will show systemic signs like tachycardia, fever, and hypotension. A thorough examination on the abdomen could reveal epigastric but swollen softness, with localized rebound and guarding. Absent or listless bowel movements and sounds could be signs of a coexisting ileum. Although they are less recurrent findings, they may reveal serious underlying conditions such as a clear mass could suggest pseudocyst, Cullen’s or Grey Turner’s could suggest retroperitoneal hemorrhage, and panniculitis could suggest subcutaneous fat necrosis.
Supportive Patient Care
The main goal of therapy in Acute Pancreatitis is to prevent pancreatic necrosis, prevent an infection, give supportive care to the patient, and more importantly prevent organ failure. The most basic form of treatment thus involves analgesia and pancreatic rest, where patients are fed through the IV. The reason behind hospitalization is to ensure patients get care to help in pain control, nutritional support to avoid deficiency of important nutrients, and more importantly to help in fluid resuscitation.
The role that continuous vigorous hydration plays is very critical and has been recognized and appreciate increasingly over time… this is because depletion could lead to hypotension, tachycardia, hemoconcentration, renal failure, and may eventually culminate to circulatory collapse. Patients should also undergo thorough guidance and counseling especially to help with quitting alcohol as it is the top most cause of AP and associated complications that could lead to death.
[Image via AAFP]