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Monday, March 10, 2008

Acute Pancreatitis

What is the pancreas?

The pancreas is an elongated, tapered gland, located behind the stomach. The pancreas produces digestive enzymes needed to break down proteins and carbohydrates. In addition, the organ has specialized endocrine cells that produce insulin and glucagon. The digestive enzymes flow directly into the duodenum, which is the first part of the small intestine. The hormones insulin and glucagon are released into the blood.

Definition of Acute Pancreatitis

Acute pancreatitis is a sudden attack causing inflammation of the pancreas and usually associated with severe upper abdominal pain. The pain may last several days and may be serious.

Symptoms of Acute Pancreatitis

The primary symptom of acute pancreatitis is severe pain in the middle of your upper abdomen, often radiating to the back. Pain is sudden and then steady, and is often aggravated by walking or lying down and relieved by sitting or leaning forward. Other symptoms may include:

  • Nausea
  • Vomiting
  • Diarrhea
  • Bloating
  • Fever
  • Clammy Skin
  • Mild Jaundice

If you have any of these signs with abdominal pain, see your doctor immediately.

Diagnosis of Acute Pancreatitis

Your doctor will ask about your medical history, particularly about how much alcohol you drink and if you have had symptoms of gallstones or common bile duct stones. He or she will examine you and order blood tests to confirm the cause of your symptoms.

Lab tests that may be used for diagnosis are:

• serum amylase and lipase
• liver function tests
• blood calcium test
• blood glucose test
• complete blood count
• urinalysis.

Your abdomen and chest may be x-rayed to confirm whether your symptoms are caused by acute pancreatitis or by other disorders that can cause similar symptoms. In addition, the following tests may be done to detect changes in the size of your pancreas:

• ultrasound exam
• endoscopic retrograde cholangiopancreatography (ERCP), an exam in which the doctor inserts an endoscope, an instrument with a light, into your throat and guides it through your stomach and into your small intestine
• CT (computed tomography) scan.

Causes of Acute Pancreatitis

The chief causes of acute pancreatitis in adults are gallstones, other gallbladder (biliary) disease, and alcohol use. Viral infection (mumps, coxsackie B, mycoplasma pneumonia, and campylobacter), hereditary conditions, traumatic injury, pancreatic or common bile duct surgical procedures and certain medications (especially estrogens, corticosteroids, thiazide diuretics, and azathioprine) are other causes. Pancreatitis without any apparent cause- this is known as idiopathic pancreatitis.

The exact cause of acute pancreatitis may differ among different patients, but in general it is not well understood. It is thought that enzymes normally secreted by the pancreas in an inactive form become activated inside the pancreas and start to digest the pancreatic tissue. This process is called autodigestion and causes swelling, hemorrhage, and damage to the blood vessels. An attack may last several days and the pain may be severe.

Treatment of Acute Pancreatitis

Treatment for acute pancreatitis depends on the severity of the condition. Generally the patient needs hospitalization with administration of intravenous fluids to help restore blood volume. Medication for pain and nausea are provided to ease these symptoms and food is withheld until these symptoms have subsided considerably. Antibiotics are often prescribed in cases of severe acute pancreatitis or if infection occurs. Surgery is sometimes needed when complications such as infection, cysts or bleeding occur.

Prognosis of Acute Pancreatitis

Patients usually recover fully from acute pancreatitis and do not experience recurrence if the cause is removed. Alcohol consumption should be eliminated even if it is not the determined as the cause of the disease. Smoking, which stresses the body's defenses against inflammation, should be stopped. If gallstones were the cause, then removal of the gallbladder is required to prevent further attacks. For those patients in whom a cause is not readily identified, there should be consideration of other diagnostic testing such as endoscopic ultrasound.

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