Acute pancreatitis is the sudden inflammation of the pancreas. Pancreas is part of the body situated in the abdomen, adjacent to the liver and gall bladder. It helps in converting food into fuel for utilisation by the body and also aids in regulating the blood glucose by secreting insulin.
The most common cause for acute inflammation of the pancreatic tissue and its necrosis is alcohol. In the United States about 60 per cent of cases of acute pancreatitis, occur due to alcohol use. It can also be due to viral infections like coxsackie B virus, mumps virus, viral hepatitis, e.t.c., parasitic infections like ascaris, liver fluke, e.t.c. Gall stones can also cause acute pancreatitis. Abdominal trauma, penetrating ulcers also cause acute pancreatitis as one of the manifestations. It can occur due to some metabolic conditions like hereditary pancreatitis, elevated triglycerides, severe malnutrition, e.t.c. It occurs as adverse effect of drugs like diuretics (thiazides, frusemide), gliptins which are used in diabetes treatment , antibiotics like sulphonamides, tetracyclines, NSAID like salicylates, corticoids, e.t.c. Cancer of the head of pancreas and any other part can cause inflammation and necrosis of the pancreatic tissue and acute pancreatitis. It can be a sequel to radiation therapy. Peop
le indulging in repeated long distance marathon running can suffer from acute pancreatitis. Sometimes it can occur during pregnancy.
A typical attack of acute pancreatitis manifests as severe pain in the upper abdomen, which is relieved by bending forwards. It may be accompanied by nausea and or vomiting. In mild forms there is inflammation and swelling of pancreatic cells. Majority of cases of acute pancreatitis do recover. Some may develop duodenal obstruction or pseudocyst, among other complications. Secondary infection can set in causing abscesses and complicating the clinical picture. In severe forms, there is necrosis and death of cells of pancreatic tissues. This can lead to shock and electrolyte imbalance, adult respiratory distress syndrome and multi organ failure. Disseminated intravascular coagulation can occur leading to uncontrolled bleeding. Diagnosis of acute pancreatitis is based on clinical features. It is substantiated by blood tests, estimation of pancreatic enzymes, computerised tomography and magnetic resonance imaging. Endoscopic ultrasound is also helpful. Biopsy of the pancreas reveals the ongoing inflammation. It
has to be differentiated from other causes of severe abdominal pain like acute cholecystitis and perforated peptic ulcers.
Treatment consists of rest to the bowels and pancreas by being nil orally, intravenous fluids and pain control. Antibiotics are used, if there is any evidence or strong suspicion or bacterial infection. Surgical intervention is done in case of severe necrosis or other complications.
As majority of cases of acute pancreatitis occur due to alcohol consumption, avoidance of alcohol and a healthy life style are helpful in prevention of acute pancreatitis. Avoiding alcohol or limiting its consumption can help prevent liver cancer, which can cause acute pancreatitis. A healthy balanced diet including lots of fresh vegetable, fruits is useful in preventing gall stones,which is yet another cause of acute pancreatitis. Whole grains like oats, whole meal bread and wheat also help in preventing gall stones. Nuts provide nutrients and also have anti oxidant properties, which helps in preventing breakdown of body cells and help in regeneration as well. Hence eating nuts regularly is also beneficial. High fatty diet is also a risk factor for gall stones. It should be avoided.
Regular physical exercise prevents obesity and also helps in preventing gall stones as well as acute pancreatitis.
It is also important to be aware about acute pancreatitis. A sudden severe upper abdominal pain may be mistaken for indigestion or simply as pain due to,” much acid”, by the sufferer. He/she resorts to some home remedies to, “cure”, it. Precious time is wasted, where treatment could have been taken in early stages and helped.
Dr Rachna Pande,
Specialist, internal medicine