Acute inflammation of the pancreas (pancreatitis) is a serious illness that can be life-threatening and requires urgent treatment. In most cases, the extremely severe abdominal pain causes those affected to seek help quickly. More about symptoms, causes, diagnosis, treatment, and prevention of acute pancreatitis. Acute pancreatitis is an acute inflammation of the pancreas. The pancreas is the Latin name for pancreas, hence the disease name pancreatitis. Chronic pancreatitis is distinguished from acute pancreatitis.
The most common cause of acute inflammation of the pancreas is biliary tract diseases such as gallstones. For example, if a stone clogs the end of the bile duct, it creates a blockage of bile in the direction of the liver and, at the same time, a blockage of digestive secretion in the pancreas. The digestive secretion cannot drain away, it accumulates there, irritates, and damages the tissue. Inflammation is the result. This is when the pancreas begins to digest itself.
Acute pancreatitis can be life-threatening. The earlier the – often intensive medical – treatment begins in a hospital, the better the chances of recovery.
Structure And Function Of The Pancreas
The pancreas is located across the upper abdomen on the posterior abdominal wall. It is around 15 centimeters long and weighs around 100 grams. Medical professionals divide the pancreas into the head, body, and tail. The head of the pancreas is adjacent to the duodenum, and the tail of the pancreas is adjacent to the spleen. Very close to the pancreas are the colon, liver, gallbladder, stomach, and kidneys.
The pancreas produces up to 2 liters of digestive secretion every day, which it releases into the small intestine. The digestive secretion consists of enzymes such as protein-splitting proteases (for example trypsin and chymotrypsin), starch-splitting amylases, and fat-splitting lipases. These enzymes are needed to absorb food components from the small intestine into the blood. The secretion also contains alkaline bicarbonate, which neutralizes the acidic gastric juice as soon as it enters the intestine.
In addition to the enzymes, the pancreas produces important hormones, for example, insulin, which lowers blood sugar, and its counterpart, glucagon, which increases blood sugar levels. Both hormones are produced in the so-called islets of Langerhans.
The incidence of acute pancreatitis is around 5 to 10 cases per 100,000 population. Inflammation of the pancreas is most common between the ages of 40 and 60. Women are more often affected because they more often suffer from biliary tract diseases.
The main symptom of acute pancreatitis is a sudden, belt-shaped, severe pain in the upper abdomen. Often this pain radiates to the back, sometimes to the chest. The pain can last for minutes. Many of those affected describe it as the pain of annihilation. Relief is often only brought about by a gentle posture with knees drawn up while sitting or lying down.
Another symptom of acute inflammation of the pancreas is what doctors refer to as the “elastic, elastic belly”. The stomach feels similar to an inflated air mattress. The abdominal wall is tense, but not very hard.
If the bile ducts are also affected, which often happens due to the proximity of both organs, the skin and mucous membranes (especially the conjunctiva) turn yellow. Doctors call this jaundice. In addition, the urine turns dark and the stool light.
Other typical symptoms of acute pancreatitis are:
- Nausea and vomiting
- Low blood pressure (hypotension) up to circulatory shock
- Fear of death or fear of not being able to survive the pain.
If pancreatic tissue dies due to inflammation and the dead tissue is then colonized by bacteria, accumulations of pus in the abdomen or even blood poisoning (sepsis) are the result. In severe cases, the heart, lungs, and kidneys can fail completely.
Gallstones are the leading cause of pancreatitis.
Alcohol consumption is the cause of acute pancreatitis in a good 30 percent. It does not have to be alcoholism or alcohol abuse. Not all heavy drinkers develop pancreatitis. But the other way round also applies: In correspondingly sensitive people, even small amounts of alcohol can trigger acute pancreatitis.
Rare causes of pancreatitis
- certain medications (such as pain relievers, diuretics, beta-blockers, ACE inhibitors, lipid-lowering drugs, antibiotics, and cytostatics)
- Smoking and other drugs
- Viral infections (e.g. mumps), bacteria (e.g. salmonella), and worm diseases (e.g. ascariasis and clonorchiasis)
- Lipid metabolism disorders (especially increased triglyceride levels)
- Overactive parathyroid glands.
A certain genetic component is also discussed. In some people, however, no cause of acute pancreatitis can be determined.
Rapid diagnosis of acute pancreatitis is particularly important because the inflammation is severe and can be fatal. The typical severe pain usually quickly steers the suspicion in the right direction. The suspected diagnosis after the first physical examination and the taking of the medical history is followed by further diagnostic procedures.
For example, blood tests are used to check whether certain enzyme levels and/or the number of white blood cells is increased. If a gallstone triggers the inflammation, increased bilirubin, ASAT, gamma-GT, and alkaline phosphatase values can be detected. In severe cases, an increased blood sugar concentration is noticeable.
Urine and stool examinations can further substantiate the diagnosis of acute pancreatitis. As a rule, increased enzyme concentrations can be detected in the urine. The amount of the enzyme elastase is usually measured in the stool. A noticeably decreased amount of enzyme suggests that the pancreas is no longer producing enough digestive enzymes.
Cholangiography And Other Imaging Tests
The suspected diagnosis of acute pancreatitis is confirmed almost exclusively with imaging diagnostics. These primarily include ultrasound and X-ray examinations of the chest and abdomen. Computed tomography can determine the severity of the inflammation.
If gallstones cause pancreatitis, endoscopic retrograde cholangiography (ERC) can provide more precise information. An endoscope is pushed through the esophagus to the small intestine. Contrast media in the bile ducts make constrictions or blockages, for example, due to stones, visible. The bile and pancreatic ducts can also be assessed with magnetic resonance cholangiopancreatography (MRCP).
Acute pancreatitis can be difficult, and sometimes life-threatening. That is why the therapy will be carried out in an inpatient setting, i.e. in a clinic. Often it is even necessary to stay in the intensive care unit.
The main aim of drug therapy for acute pancreatitis is to relieve severe pain and combat inflammation. Pain relievers such as tramadol, buprenorphine, piritramide, and pethidine as well as antibiotics such as metronidazole, carbapenems, and fluoroquinolones are used. In addition, those affected usually receive plenty of fluid through the veins in order to stabilize the circulation.
If the pancreas can no longer produce enough insulin due to acute pancreatitis, this deficiency is also compensated with medication in order to avoid hypoglycemia or diabetes.
Various surgical procedures can be considered for the removal of gallstones. If possible, gallstones are now removed with an endoscopic procedure. A tube is inserted into the abdominal cavity through a small incision, through which the surgeon grabs the gallstones with a pair of pliers and pulls them out. Large gallstones can be shattered with sound waves during this procedure.
But there are also gallstones that cannot be reached or removed with this minimally invasive procedure. Then the abdominal cavity has to be opened in the classic way (laparotomy). More about gallstone treatment
Rinse Out Sources Of Inflammation
Sometimes the cavities in the pancreas also become inflamed. Pancreatic secretions and pus can accumulate there. The doctor can remove such foci of inflammation during an endoscopy via a thin connecting tube between the cavity and the small intestine or the stomach. In addition, an irrigation catheter can be inserted from the outside under an X-ray view. In this way, the cavities are emptied (drained). Sometimes an operation is also necessary.
Food Abstinence In Acute Pancreatitis
In the case of acute pancreatitis, the patient is not allowed to eat anything; absolute so-called food abstinence must be observed. Of course, drinking alcohol or smoking is also not allowed. If necessary, artificial food must be given through the veins or through a tube that opens directly into the small intestine. When the signs of inflammation subside, a careful diet is built up with easily digestible foods.
Basically, to prevent pancreatitis, a healthy lifestyle with sufficient exercise and a varied, healthy diet is recommended. The following also applies:
- Have triggers eliminated, for example, surgical removal of gallstones or a gallbladder containing stones
- Refrain from alcohol and nicotine, especially if you have a family predisposition to pancreatitis
- reduce increased blood lipid levels
- Get treatment for parathyroid disorders
- Have your doctor replace drugs that promote pancreatitis with other drugs.