Acute pancreatitis

Pancreatitis is the acute inflammation of the pancreas. A distinction is made between acute and chronic forms. Below is information about acute pancreatitis. This is defined as a sudden onset of inflammation of the pancreas, which may occur once or even several times.

Gallstones as causes of acute pancreatitis

The cause of acute pancreatitis is that the digestive enzymes produced by the pancreas become active in the pancreas itself (instead of in the gut) and attack the tissue. It practically comes to the self-digestion of the organ.

Most commonly, acute pancreatitis is caused by gallstones. The excretory duct of the gallbladder (ductus choledochus) joins the duct of the pancreas (pancreatic duct) into the duodenum (duodenum).

When gallstones leave, they can clog the passage, causing a backlog of pancreatic secretions. Since the bile can also backlog, jaundice (jaundice) is also possible.

Other possible triggers

Another common cause is alcohol abuse.

Rarer causes of acute inflammation of the pancreas are:

  • Injuries to the pancreas
  • Infections (mumps and other viral diseases)
  • Disorders in fat metabolism or mineral balance
  • drugs
  • vascular
  • Malformations or mechanical obstructions (tumor or stenosis at the point of opening, scars, ascarids)

Acute pancreatitis: course

The backlog of the secretion activates the enzymes that would normally be released into the intestine in the wrong place. These enzymes are said to break down nutritional components. The premature activation causes the pancreatic cells to be digested. Blood vessels can also be attacked and bleeding can occur. Through these processes, the body loses a lot of protein-rich fluid and blood and can become shocked.

In addition, the activated enzymes can enter the bloodstream. They are distributed in the body and can cause damage to other organs. In the abdominal cavity irritation of the intestine to the paralytic ileus and peritonitis arise.

In the pancreas itself, there is an edema of the tissue or even necrosis. At 60 percent, the most common form is the edematous form. Partial necrosis occurs in 30% of cases, complete necrosis in 10% of cases. The more pronounced the necroses are, the more complications occur and the higher the risk of dying from pancreatitis.

After the acute phase, the cause of pancreatitis must be eliminated to prevent re-inflammation (for example, removal of the gallbladder if gallstones were the cause).

Symptoms of acute pancreatitis

Acute pancreatitis manifests as an "acute belly". Typical symptoms of acute pancreatitis are:

  • sudden severe pain in the upper abdomen (often belt-shaped with a radiation in the back)
  • Vomit
  • nausea
  • bloating
  • reddened face

Palpitations, accelerated pulse, drop in blood pressure, and weakness are signs of a beginning shock.

The patients look seriously ill, the abdomen is plump-elastic and tender. With simultaneous ileus, the bowel sounds are reduced. The conjunctiva of the eye may be yellowish in color as an expression of concomitant jaundice. In blood serum, the pancreatic enzymes a-amylase and lipase are increased.

Diagnosis of acute inflammation of the pancreas

The diagnosis is usually made by ultrasound: The pancreas is swollen; possibly existing gallstones are recognizable. If the ultrasound is not enlightening enough, a contrast-enhanced CT can be performed.

To exclude other possible causes of an acute abdomen, an x-ray of the chest and abdomen is created. If gallstones are detected, an ERC will be performed early.

Healing chances and prognosis

The more severe necrosis and complications occur, the more difficult it is.

In the edematous form without complications, the mortality is five percent. In partial necrosis and one or two complications, the mortality is already between 25 and 50 percent. With total necrosis and three to four complications, the mortality increases to 80 to 100 percent.

If the acute pancreatitis is overcome and the triggering cause eliminated, the disease usually heals. However, scars and cysts may remain and restrict the function of the organ.

Complications of acute pancreatitis

The possible complications of acute pancreatitis are manifold and dreaded:

  • Shock due to fluid loss
  • acute kidney failure
  • acute lung failure
  • sepsis
  • Formation of an abscess
  • Necrosis on adjacent organs
  • Bleeding in the gastrointestinal tract (blood that flows from the pancreas into the intestine, stress bleeding in the stomach)

Treatment of acute pancreatitis

The treatment of acute pancreatitis must be done in the hospital, in severe cases even in the intensive care unit, as the patients must be carefully monitored.

The therapy consists in bed rest and prohibition of food and fluid intake. In vomiting, ileus and complications, a nasogastric tube is placed. Patients receive painkillers, if necessary antibiotics. In severe cases, surgery to remove dead tissue may be necessary.

When a patient with acute pancreatitis may eat again, is different. It starts slowly with tea and rusks, followed by light food (no fat, coffee, alcohol).

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