Acute Pancreatitis - Causes, Symptoms, & Diagnosis

Acute pancreatitis (AP) is a sudden inflammation of the pancreas resulting from an auto-digestion of the gland. It affects men more often than women. Recognizing patients with severe acute pancreatitis as soon as possible is critical for achieving optimal outcomes.

In 75–80% of cases acute pancreatitis is a self-limiting disease, but 20–25% of acute pancreatitis are severe, characterized by the development of pancreatic or peri-pancreatic necrosis, resulting in general and local complications responsible for a mortality rate of 8 to 35%.

Acute pancreatitis is initiated by premature activation of pancreatic enzymes. the release of active pancreatic enzymes directly causes local or distant tissue damage. Pancreatic infection is the major cause of death and may result from increased intestinal permeability and translocation of colonic bacteria.

Signs and symptoms
  • Severe pain (“knife-like”) in the upper abdomen occurs in 95% of patients and is usually sudden in onset, gradually becoming more severe and often radiating to the upper quadrants or back.
  • Nausea and vomiting occur in 85% of patients and usually follow the onset of pain.
  • Clinical signs associated with widespread pancreatic inflammation and necrosis include marked epigastric tenderness, abdominal distention, hypotension, fever. In severe disease, bowel sounds are diminished or absent. Dyspnea and tachycardia are signs of acute respiratory complications.

Diagnosis
  • The diagnosis of acute pancreatitis is usually easy: rapid onset of unremitting abdominal pain radiating to the back, associated with vomiting.
  • Physical examination often finds a moderate abdominal tenderness.
  • An increase of serum pancreatic enzymes (amylase, lipase) is usually present. The serum amylase concentration usually rises 4 to 8 hours after symptom onset, peaks at 24 hours, and returns to normal over the next 8 to 14 days. Serum amylase concentrations greater than three times the upper limit of normal are highly suggestive of AP. The increases of serum lipase persist longer than serum amylase elevations and can be detected after the amylase has returned to normal.

Causes: In most cases, acute pancreatitis is caused by gallstones or heavy alcohol use.
  • Alcohol: Acute pancreatitis typically requires 5 to 8 drinks per day for 5 or more years.
  • Gallstones: Acute pancreatitis develops when the gallstones travel out of the gallbladder into the bile ducts, where they block the opening that drains the common bile duct and pancreatic duct
  • Other causes include medications, infections, abdominal trauma, High blood levels of triglycerides, congenital anomalies (pancreas divisum), autoimmune problems, pancreatic cancer and surgery (postoperative pancreatitis).
  • In up to 30% of people with acute pancreatitis, the cause cannot be identified in some patients (idiopathic pancreatitis).

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