Pancreatitis

Pancreatitis is inflammation of the pancreas, a condition that may be acute or chronic. In acute pancreatitis, the pancreas suddenly becomes inflamed, causing severe abdominal pain. This condition can be life-threatening if left untreated. In chronic pancreatitis, the pancreas is persistently inflamed; this condition leads to a progressive loss of function.

Causes

The main causes of acute pancreatitis are alcohol abuse, typically a bout of heavy drinking, and gallstones. Less common causes are injury (such as a violent blow to the abdomen), viral infections (such as mumps), surgery on the biliary system, or certain drugs, such as immuno-suppressants and thiazide diuretic drugs.

Chronic pancreatitis is usually due to long-term alcohol abuse. Less common causes include hyperlipidaemia (a high level of fat in the blood), cystic fibrosis, haemochromatosis (a condition in which there is excess iron in the body), and severe acute pancreatitis.

Symptoms

An attack of acute pancreatitis usually lasts about 48 hours. Symptoms are a sudden attack of severe upper abdominal pain, which may spread to the back, often accompanied by vomiting. Movement often makes the pain worse, but sitting may help to relieve it. In severe cases, inflammation may affect the whole abdomen; there is also a risk of shock (failure of blood circulation), which may be life-threatening.

Chronic pancreatitis usually develops over several years, and may be symptomless in the early stages. When symptoms do appear they are usually the same as those of acute pancreatitis, although the pain may last from a few hours to several days, and attacks may become more frequent over time. If there is no pain, the principal signs may be of malabsorption or diabetes mellitus due to reduced levels of pancreatic enzymes and insulin, respectively.

Complications

Acute pancreatitis may recur repeatedly. Severe acute pancreatitis may damage the pancreas and lead to hypotension (low blood pressure), heart failure, kidney failure, respiratory failure, pancreatitic cysts, and ascites (accumulation of fluid in the abdomen).

Chronic pancreatitis leads to permanent damage to the gland; the tissue is damaged and gradually replaced by scar tissue, and normal function is progressively impaired. Other possible complications include the development of ascites and cysts, as well as bile duct obstruction.

Diagnosis and treatment 

A diagnosis may be made using abdominal X-rays, ultrasound scanning, or CT scanning or MRI (techniques that produce cross-sectional or three-dimensional images of body structures). In addition, blood tests may be used in cases of suspected acute pancreatitis, to detect pancreatic enzymes that have leaked directly into the blood.

Acute pancreatitis is treated with intravenous infusion of fluids and salts and opioid analgesic drugs (painkillers). In some cases, the abdominal cavity may be washed out with sterile fluid; ERCP (an endoscopic X-ray procedure) may be used to find and remove gallstones; or a pancreatectomy (surgical removal of damaged tissue) may be performed.

Treatment for the chronic form is with painkillers, insulin, pancreatin, and, in some cases, pancreatectomy.

Acute pancreatitis - in detail - technical

Acute pancreatitis - a review - technical

Chronic pancreatitis - in detail - technical