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Acute Pancreatitis

Acute Pancreatitis

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An overview on pancreatitis, its types, symptoms and treatments.
An overview on pancreatitis, its types, symptoms and treatments.

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Published by: Vytheeshwaran Vedagiri on Jul 08, 2007
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10/26/2012

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 ACUTE PANCREATITIS 
INTRODUCTION
The pancreas is an elongated organ that lies in the back of the mid-abdomen. It isresponsible for producing digestive juices and certain hormones, including insulin,the main hormone responsible for regulating blood sugar.
Acute pancreatitis refers to inflammation of the pancreas and is associated withsudden onset of severe abdominal pain.
It usually develops as a result of passage of gallstones through the common bile ductor after regular consumption of alcohol for a number of years.
Several additional causes of acute pancreatitis have been described due to a variety of medications, genetic diseases, infectious agents, postoperative states, endoscopic procedures involving the pancreatic and bile ducts, and other types of injury to the pancreas.
Most attacks of acute pancreatitis do not lead to complications, and most peoplerecover uneventfully with supportive medical care.
However, in a small proportion of people, acute pancreatitis takes a more seriouscourse that requires intensive medical care. In all cases, it is essential to determine theunderlying cause of acute pancreatitis and, if possible, to treat this condition to prevent a recurrence.
Because the severity and course of acute pancreatitis can vary widely from person to person, the treatment of this condition is individualized.
CAUSES OF ACUTE PANCREATITIS
There are many possible underlying causes of acute pancreatitis, but 60 to 75 percentof all cases are caused by gallstones or alcohol abuse.
Gallstone pancreatitis
 — Because the gallbladder and pancreas share a drainage duct,gallstones that lodge in this duct can prevent the normal flow of pancreatic enzymesand trigger acute pancreatitis.
Gallstone pancreatitis is more common in women than in men.
 Alcoholic pancreatitis
 — Alcohol is also a common cause of acute pancreatitis.
Alcoholic pancreatitis is more common in men, and usually occurs in individuals withlong-standing alcohol abuse.
 Drug-induced pancreatitis
 — A large number of drugs used to treat medicalconditions can trigger acute pancreatitis; for example, dideoxyinosine, DDI (used for treating AIDS), 6-mercaptopurine, 6-MP (an immunosuppressant drug), andangiotensin-converting enzyme (ACE) inhibitors (used for treating high blood pressure).
 Post-ERCP 
 — Endoscopic retrograde cholangiopancreatography (ERCP) is anendoscopic test that involves the injection of dye into the bile duct and pancreaticduct.
Acute pancreatitis develops in about 3 to 5 percent of people who undergo ERCP.
Certain characteristics of the patients, such as female sex and younger age, makethem more prone to develop this complication.
 
Certain types of procedures also may increase the risk, particularly complicated procedures that can cause trauma to the pancreatic duct. Most cases of ERCP-induced pancreatitis are mild.
 Hereditary conditions
 — Acute pancreatitis can be caused by hereditary conditions,for example, familial hypertriglyceridemia (high blood triglyceride levels) andhereditary pancreatitis.
The genetic basis for hereditary pancreatitis is rapidly being uncovered, and somespecific tests are already available. These conditions may cause acute pancreatitis inchildren.
 Idiopathic
 — No underlying cause can be identified in about 20 percent of peoplewith acute pancreatitis. This condition is called idiopathic pancreatitis.
Only about 3 percent of people will experience additional attacks over time, acondition called idiopathic recurrent pancreatitis.
Other causes
 — In rare cases, acute pancreatitis is caused by infections, such asmumps or viral hepatitis, or by abdominal injury.
SYMPTOMS
Sudden, constant pain in the upper part of the abdomen is a hallmark of acute pancreatitis, although other medical conditions can also cause this pain pattern.
In about half of all people who experience pain during acute pancreatitis, the painwraps around the trunk and also involves the back in a band-like pattern.
The pain typically lasts days and is often relieved by leaning forward. In mild cases of acute pancreatitis, the pain may be limited to slight abdominal tenderness, and about5 to 10 percent of people with acute pancreatitis do not experience any pain at all.
In people with gallstone pancreatitis, gallbladder pain may occur before pancreatic pain.
Gallbladder pain (referred to as biliary colic) is typically described as a moderatelysevere pain in the right upper region of the abdomen extending to the back and rightshoulder.
The pain gradually rises in intensity and may be accompanied by nausea andvomiting.
Although the term "colic" implies that the pain is intermittent, it typically is steady.
Gallbladder pain lasts six or eight hours at most and often follows a meal.
In people with alcoholic pancreatitis, the symptoms of acute pancreatitis often occur one to three days after an alcohol binge or after stopping drinking.
The pain of acute pancreatitis is accompanied by nausea and vomiting in about 90 percent of people. In severe cases of acute pancreatitis, the initial symptom may beshock or coma.
DIAGNOSIS
The diagnosis of acute pancreatitis can be challenging because the signs andsymptoms of other medical conditions can mimic those of pancreatitis.
 
The diagnosis is usually based upon careful consideration of a person's medicalhistory, the signs and symptoms noted during a physical examination, and the resultsof specific diagnostic tests.
Once a diagnosis of acute pancreatitis is made, additional tests are used to determinethe underlying cause.
This step ensures that a person will receive the correct treatment to prevent pancreatitis from recurring.
Additional tests also help predict the likely course of pancreatitis over time. This stepis important because in a small percentage of people with acute pancreatitis, thecondition will progress to a more serious condition called severe acute pancreatitis,often referred to as "necrotizing pancreatitis".
If tests suggest that necrotizing pancreatitis is likely, early intensive medical treatmentmay help improve the prognosis.
 Medical history
 — A medical history often provides clues about the underlying causeof acute pancreatitis.
Your doctor will ask about any previous symptoms of gallstones and about your alcohol intake because these two factors account for the majority of cases of acute pancreatitis.
Your doctor will also ask if you have other medical conditions, if you take anymedications, and if any family members have experienced similar symptoms.
 Physical examination
 — Your doctor will perform a physical examination to check for the signs and symptoms of acute pancreatitis.
These signs and symptoms vary with the severity of the attack, and their number andextent can help predict the course of pancreatitis.
Your doctor will ask about abdominal pain, nausea, and vomiting, and will check for other signs and symptoms of acute pancreatitis, including fever, rapid heart rate, andshallow breathing or difficulty breathing. You will also be checked for less commonsigns and symptoms, including bruise-like areas on the stomach or back, jaundice(yellowish discoloration of the skin), red nodules under the skin, inflammation of theleg veins, and pain and inflammation of the joints.
DIAGNOSTIC TESTS
Diagnostic tests help confirm the presence of acute pancreatitis and predict the likelycourse of the condition. It is important to discuss the timing, usefulness, and risks of various tests with your doctor.
The extent of testing is usually tailored to the severity of acute pancreatitis and themost likely underlying causes.
 Pancreatic enzymes
 — During acute pancreatitis, enzymes that normally flow fromthe pancreas into the digestive tract leak out of the pancreas and into the bloodstream.Tests can detect two of these enzymes—amylase and lipase—in the blood.
 Serum amylase
 — A serum amylase test determines levels of amylase in a bloodsample. Marked increase (more than three times the upper limit of normal) in thelevels of amylase strongly suggest the diagnosis of acute pancreatitis. This is the mostcommonly used test to aid the diagnosis of acute pancreatitis. Levels of amylase in

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