- 1 Introduction
- 2 Causes of Pancreatitis
- 3 Pathophysiology of Pancreatitis
- 4 Symptoms or Clinical features of Pancreatitis
- 5 Acute pancreatitis:
- 6 Differential diagnoses
- 7 Investigations
- 8 Complications of Pancreatitis
- 9 Treatment objectives
- 10 Non-drug treatment
- 11 Drug treatment
- 12 Supportive measures
- 13 Caution
- 14 Prevention
- 15 References
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:
- Alcohol consumption
- Abdominal trauma and surgery
- Some drugs such as angiotensin-converting enzyme (ACE) inhibitors, azathioprine, furosemide, 6-mercaptopurine, pentamidine, sulfa drugs, and valproate
- Family history
- Pancreatic cancer
- Pancreatic injury
- Viruses such as mumps , coxsackie B virus , hepatitis A and hepatitis E , and cytomegalovirus
- Cigarette smoking
- Estrogen use in women with high levels of lipids in the blood
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
- 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
- Peptic ulcer disease.
- Serum amylase: raised in 80% of acute cases.
- Serum lipase: if raised is more specific than serum amylase
- Alanine aminotransferase: a rise above 3-fold
- suggests pancreatitis of gallstone origin.
- CT scan
- Abdominal ultrasound especially in acute case
Complications of Pancreatitis
- Relieve pain
- Prevent complications
- Renal failure: haemodialysis.
- Respiratory failure: mechanical ventilation.
- Gallstones: Endoscopic Retrograde Cholangio Pancreatography (ERCP) with sphincterotomy.
- Pancreatic pseudocyst: surgery
- Treat specific complications
- Bed rest
- Monitor vital signs; fluid intake/output
- Nasogastric tube suctioning.
- Decrease pancreatic inflammation.
- Prevent, identify and treat complications
Avoid narcotic analgesics, which may cause spasm of the sphincter of Oddi and worsen pancreatitis
Control alcohol ingestion