Pancreatitis

Introduction

The pancreas is a large gland behind the stomach and close to the first part of the small intestine. It secretes digestive juices into the small intestine through a tube called the pancreatic duct. It also releases the hormones insulin and glucagon into the bloodstream. Pancreatitis is a state of inflammation of the pancreas. Pancreatitis can be acute or chronic.
Pancreatitis is idiopathic in as many as 20-30% people. Its ocurrence is worldwide, but commoner in areas of the world where gallstones and alcohol consumption are common.

Causes of Pancreatitis

The causes of Pancreatitis include:

  1. Gallstones
  2. Alcohol consumption
  3. Abdominal trauma and surgery
  4. Infections
  5. Some drugs such as angiotensin-converting enzyme (ACE) inhibitors, azathioprine, furosemide, 6-mercaptopurine, pentamidine, sulfa drugs, and valproate
  6. Family history
  7. Pancreatic cancer
  8. Pancreatic injury
  9. Viruses such as mumps , coxsackie B virus , hepatitis A and hepatitis E , and cytomegalovirus
  10. Cigarette smoking
  11. Estrogen use in women with high levels of lipids in the blood
  12. Hypertriglyceridemia
  13. Hypercalcaemia

Pathophysiology of Pancreatitis

Autolysis of pancreatic tissue by pancreatic enzymes as a result of “secretory block” in the pancreatic bed (often caused by stones).

Symptoms or Clinical features of Pancreatitis

Acute pancreatitis:

  • Epigastric pain which may radiate to the back
  • Nausea and vomiting
  • Abdominal distension
  • Severe abdominal tenderness with features of hypovolaemia in severe cases
  • Pain that worsens after eating
  • Chills and fever
  • Lethargy and weakness

Differential diagnoses

  • Peptic ulcer disease.
  • Cholecystitis

Investigations

  1. Serum amylase: raised in 80% of acute cases.
  2. Serum lipase: if raised is more specific than serum amylase
  3. Alanine aminotransferase: a rise above 3-fold
  4. suggests pancreatitis of gallstone origin.
  5. CT scan
  6. Abdominal ultrasound especially in acute case

Complications of Pancreatitis

Hypovolaemic shock

Treatment objectives

  • ┬áRelieve pain
  • Prevent complications

Non-drug treatment

  • Renal failure: haemodialysis.
  • Respiratory failure: mechanical ventilation.
  • Gallstones: Endoscopic Retrograde Cholangio Pancreatography (ERCP) with sphincterotomy.
  • Pancreatic pseudocyst: surgery

Drug treatment

  • Analgesics
  • Treat specific complications

Supportive measures

  • Bed rest
  • Monitor vital signs; fluid intake/output
  • Nasogastric tube suctioning.
  • Decrease pancreatic inflammation.
  • Prevent, identify and treat complications

Caution

Avoid narcotic analgesics, which may cause spasm of the sphincter of Oddi and worsen pancreatitis

Prevention

Control alcohol ingestion

References

  1. Medline Plus: Pancreatitis
  2. Merck Manual: Pancreatitis