Diagnosing And Managing Acute Pancreatitis As A Medical Emergency

The pancreas is a flat, elongated gland present just behind the upper region of the stomach. It plays an important role in various regulatory processes, like the synthesis of digestive enzymes and critical hormones like insulin. Ever wondered what happens if this apparently tiny but extremely important organ becomes inflamed?

Known as acute pancreatitis, a sudden inflammation of the pancreas can be extremely discomforting and potentially a medical emergency. Therefore, it is extremely important to learn how to recognize it and treat it in time, or possibly avoid it in the first place.

This article will shed light on acute pancreatitis, its common symptoms, diagnosis, and management plan.

Acute Pancreatitis Symptoms 

Let’s look at the symptoms of acute pancreatitis one by one.

Abdominal Pain 

Abdominal pain is the earliest and the most common symptom of acute pancreatitis. The pain radiates to the back in almost half of the patients. In case it is secondary to gallstones, the pain has a sudden onset and acquires maximum intensity within minutes. When alcohol is the triggering factor, it takes a few days for the pain to develop and intensify. Irrespective of the cause, the pain tends to be steady and severe with a penetrating nature. It is normally aggravated by deep breathing, movement, and coughing whereas leaning forward or sitting upright provides some degree of relief. In some cases, the pain is so severe that it triggers nausea and vomiting in people.

Abdominal Swelling

A person suffering from acute pancreatitis may develop a swelling in the upper part of the abdomen. This happens mostly because of stagnation of the intestinal contents, leading to swelling.

Miscellaneous

People with acute pancreatitis look sick and extremely sweaty with a very fast pulse rate. The breathing can be shallow and extremely rapid. The body temperature might be normal in the beginning but may increase up to 101° F. Blood pressure tends to be on the lower side, especially when a person stands, leading to lightheadedness.

What Causes Acute Pancreatitis?

What causes acute pancreatitis?

Alcohol misuse and gallstones are the top causes of acute pancreatitis. Let’s briefly look at each one of them.

Gallstones

Gallstones refer to the presence of small structures in the gallbladder that closely resemble pebbles. It often occurs in people with extremely high cholesterol levels. In some cases, these stones move to the bile ducts and get lodged, blocking the pancreas. This hinders it from releasing its juice and enzymes into the digestive system.

Alcohol Misuse

Abusing alcohol has been linked to a variety of diseases, one of them being acute pancreatitis. While the exact connection still remains unknown, it is speculated that alcohol increases the synthesis of compounds that damage the pancreatic tissue and inflames it.

Miscellaneous Causes

In addition to the two major causes mentioned above, the following can also contribute to acute pancreatitis:

  • Hypercholesterolemia
  • Certain genetic mutations
  • Infections
  • Use of certain medications
  • Trauma to the pancreas
  • Presence of an autoimmune disease, like lupus

Acute Pancreatitis Diagnosis

The diagnosis of pancreatitis includes a stepwise approach that normally begins with a brief history followed by an examination of the abdomen. In acute pancreatitis, certain areas of the abdomen are tender to touch. Moreover, the abdominal wall muscles are usually rigid which blocks the intestinal sounds.

Once history and examination are completed, a doctor may order one or more of the following tests.

Blood Tests

Blood might be drawn to check the levels of lipase and amylase. Abnormally high values of these enzymes are a big clue to acute pancreatitis. This is because the pancreas is responsible for producing these enzymes as a response to tissue damage.

However, it is not recommended to rely on these tests alone as they might be inaccurate, especially when performed after the first 48 hours of illness.

Ultrasonography

An ultrasound scan might be ordered to form an image of the gallbladder, pancreas, and the structures surrounding them to detect the cause and check the extent of the damage.

Contrast-enhanced CT scan

This test takes pictures of the pancreas from different angles to form a 3D image. It can be used to confirm inflammation of the pancreas as well as any changes in its density.

Chest X-ray

A chest x-ray might be ordered to look for accumulation of fluid in the chest or any collapse in the lung tissue to rule out other causes.

ERCP

This procedure involves using a thin, flexible tube called an endoscope with a camera attached to its end. It is used to visualize the gut and check if there are any gallstones causing acute pancreatitis.

Treating Acute Pancreatitis

The treatment plan for acute pancreatitis varies, depending on the severity of each case. In mild cases where the risk of complications is low, bed rest and conventional treatment are recommended. However, in severe acute pancreatitis with a high risk of complications, a full protocol is followed.

Mild Acute Pancreatitis Treatment

The goal of the treatment is to ease the symptoms and maintain bodily functions while allowing the pancreas to heal itself. Such a treatment plan includes:

  • Nil Per Oral (NPO) protocol: To give some rest to the gastrointestinal tract for a few days, the doctors advise taking no food or drink through the mouth for a few days.
  • Nasogastric tubes: These tubes are used to get rid of extra air and liquid so that nausea and vomiting can be relieved.
  • Painkillers: To relieve the abdominal pain commonly associated with acute pancreatitis.
  • Intravenous Fluids: To prevent dehydration from pancreatitis, a healthcare professional may recommend intravenous fluid for 24-48 hours.

Mild cases of acute pancreatitis usually resolve in about 5 to 7 days after which the patient can be safely discharged.

Severe Acute Pancreatitis Treatment

Severe cases of acute pancreatitis often lead to complications like tissue necrosis and death. This, in turn, increases the risk of experiencing sepsis, a condition in which a localized bacterial infection spreads to the whole body, leading to multiorgan failure. Therefore, it is imperative to start aggressive treatment for severe acute pancreatitis right away. The usual treatment plan may include:

  • Admission to the ICU: Severe cases of acute pancreatitis warrant admission to the ICU where injectable antibiotics are readily available to control the risk of sepsis from dead tissue.
  • Intravenous fluid: This is given for a few days to prevent dehydration and the risk of going into fluid deficiency.
  • Feeding tubes: These tubes are inserted to maintain good nutritive health.
  • Surgery: In some cases, surgical removal of the dead pancreatic tissue becomes necessary to save a life.

The patient continues to stay in the ICU until the risk of complications is considerably reduced.

Complications of Acute Pancreatitis

Mentioned below are the complications of acute pancreatitis that must be watched for and avoided:

Breathing problems

Acute pancreatitis often leads to changes in chemicals in your body that directly alter your lung function and reduce the concentration of oxygen in the blood. This triggers extreme shortness of breath.

Kidney Failure

Acute pancreatitis can cause kidneys to stop working. Dialysis might be required if the failure is persistent and severe.

Malnutrition

Both acute and chronic pancreatitis interferes with the pancreatic function to produce digestive enzymes. As a result, the nutrients from food are not processed by the body properly, leading to malnutrition and weight loss. These effects can be significant even if you continue to maintain your old dietary habits.

 Pseudocyst

Acute pancreatitis causes debris and fluid to collect in your pancreas, leading to the formation of a pseudocyst. This cyst can burst at any time, triggering infection and internal bleeding.

Necrotizing Pancreatitis

In severe cases of acute pancreatitis, some parts of the pancreas begin to die. Moreover, the body fluid starts escaping from vessels to the abdominal cavity, reducing the volume of blood and can lead to a drastic drop in blood pressure. These conditions greatly increase the risk of inducing shock.

Diabetes

The pancreas is the primary organ responsible for regulating blood sugar levels by secretion of a hormone called insulin. In acute pancreatitis, the pancreatic cells secreting this hormone get damaged, affecting the ability of the body to process blood sugar. This puts the patient at a high risk of developing diabetes in the long run.

Organ Failure

Organ failure can occur as a complication of acute pancreatitis mainly because a damaged pancreas releases toxins and activated enzymes into the bloodstream. These toxins cause a drop in the blood pressure while damaging other organs like the kidneys and lungs.

 Bottom Line

Acute pancreatitis refers to a sudden inflammation of the pancreas, an important digestive enzyme that plays a critical role in nutrient absorption and blood sugar regulation. Characterized by severe abdominal pain that radiates to the back, fever, and abdominal swelling, it normally resolves with conventional treatment within 5 to 7 days. However, in severe cases, admission to the intensive care unit is warranted to reduce the risk of complications.

Despite being one of the most common factors for hospitalization in the United States, acute pancreatitis is manageable and complications can be avoided with timely interventions.

To Your Health and Happiness, Doctor Danielle

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