Acute pancreatitis is the sudden inflammation of pancreas. The causes are usually gall stones in women and alcoholism in men. Other causes include medical procedures likeERCP , trauma during surgery on stomach,duodenum, gall bladder or bile ducts. During pancreatitis the pancreatic juice which is usually secreted into duodenum is released locally in the pancreas and this digests the local tissues in the peritoneal cavity like omentum, peritoneum etc. This in turn causes acute inflammation of the peritoneal cavity. Peritonitis due to pancreatitis is conspicuous by the presence of fatty acids, soaps and calcium deposits in the abdominal cavity and presence of exudate with excess of amylase enzyme.
Clinical
features:
Acute pancreatitis presents as severe acute pain in upper mid abdomen which may radiate to the back and associated with vomitings. There may be lowering of blood pressure. The pain is excruciating and increases with movement.The patient may develop fullness of the upper abdomen due to ileus. In a severe form of pancreatitis called acute hemorrhagic pacreatitis there may be bleeding into
the abdominal cavity, otherwise just inflammatory fluid gets collected in the abdominal cavity (ascites). Many patients develop a reduction in serum calcium levels.
Management:
Diagnosis of acute pancreatitis is by the history. Presence of gall stones or a history of alcoholism may be corroborative. The abdomen is distended due to ileus or fluid collection , there may be guarding of the upper abdomen or whole of the abdomen.Tenderness may be present. Increase in the serum levels of amylase and lipase will be present for the first week.
Ultrasound scanning may show edema of the pancreas, collection of fluid in the abdomen or gall stones. CT scan will be diagnositc in pancreatitis.Serum calcium levels may decrease.
Treatment
is mainly supportive. The patient is hospitalised , and nothing should be given orally for a few days to a few weeks, nasogastric suction is initiated to give rest to pancreas. Intravenous fluids, glucose, minerals and vitamins are given.Oxygen and analgesics are administered. All the vital functions are monitered closely. Antibiotics may be administered if infection of the pancreas is suspected. This intensive treatment may be necessary for a few days to a few weeks.. If the pancreatitis is due to gall stones, they are removed by surgical procedures.Acute pancreatitis may be life threatening in its severe form. Complications of acute pancreatitis are pseudocyst formation and recurrence.