Pancreatitis is a painful and potentially fatal condition affecting many people yearly. When most people think of pancreatitis, they imagine a person lying in a hospital bed hooked up to tubes and machines. However, many people don’t realize that pancreatitis can affect anyone, regardless of age or health.
In this article, we’ll take a look at pancreatitis, including its signs and symptoms, lab tests, and how frequent and dangerous it is, among other questions people usually need to ask.
How common is pancreatitis in the United States?
According to recent studies in the United States, acute pancreatitis is a growing cause of hospitalization, with over 275,000 cases in 2009. Nowadays, it has an incidence of 40 to 50 cases per 100,000 adults in the United States. Chronic pancreatitis statistics are also increasing in the United States, but they are very similar to other parts of the world. An average of 87,000 cases are diagnosed with pancreatitis every year in the United States alone.
In other parts of the world, the incidence goes from 8 to 80 cases per 100,000 adults, which shows that it is more common in some countries than others, and the United States are on the average incidence. The highest incidence is found in Finland, with 73.4 cases per 100,000 adults.
What is pancreatitis?
Pancreatitis is a condition that affects the pancreas, the organ that sits behind the stomach and helps the body digest food. Pancreatitis means inflammation of the pancreas, which occurs when the ducts that carry digestive enzymes from the pancreas to the body become inflamed and swollen.
The condition causes severe abdominal pain and can lead to vomiting. If left untreated, it can lead to pancreatic cancer, kidney failure, and life-threatening electrolyte imbalances. Pancreatitis usually may sometimes occur after eating fatty and fried foods, especially when the patient has a medical history of gallstones, pancreatic cancer, or HIV.
Pancreatitis is treated with medication or surgery. Surgery is the only option in some cases, especially when the condition has advanced to pancreatic cancer or when it is caused by an obstruction of the bile ducts.
Types of pancreatitis
Pancreatitis can be an acute or chronic condition. In other words, you can start having pancreatitis symptoms suddenly, but it can be an ongoing condition that accompanies you for a long time.
1. Acute pancreatitis is more common than chronic pancreatitis. Acute pancreatitis is caused by a blockage of the pancreatic ducts, usually by gallstones. It is usually severe, causing potentially life-threatening complications, such as kidney failure, cholangitis, and septic shock. The symptoms of acute pancreatitis include abdominal pain, bloating, nausea, vomiting, and fever. Severe acute pancreatitis can be associated with acute respiratory distress syndrome.
2. Chronic pancreatitis can be caused by autoimmune destruction of the pancreas, and alcohol abuse, among other causes. In some cases, the cause of chronic pancreatitis is unknown. Symptoms of chronic pancreatitis are similar, including pain in the upper abdomen, nausea, vomiting, weight loss, and jaundice. Chronic pancreatitis can also lead to pancreatic cancer.
What causes acute pancreatitis?
Acute pancreatitis is an inflammatory process that occurs when the pancreas becomes inflamed. It can be caused by either biliary or nonbiliary causes. Biliary pancreatitis is most commonly caused by gallstones, but it can refer to anything related to the liver and its association with the pancreas. Nonbiliary causes are independent of the liver and the gallbladder. There is a wide variety of causes, including:
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- Alcoholism: Up to 25% of cases of acute pancreatitis are caused by heavy drinking. And many more cases happen in patients who frequently engage in binge drinking.
- Gallstones: They can travel through the biliary ducts and become stuck in the common duct shared by the gallbladder and the pancreas. When this happens, pancreatic juice activates the digestive enzymes, and pancreatitis ensues.
- Hypercalcemia: When calcium levels are very high, it can trigger pancreatitis, but it is rare.
- Medications: Some medications can trigger or activate acute pancreatitis. For example, statins, tetracyclines, and valproate have been found to trigger pancreatitis in some cases.
- Trauma: When you receive a high-energy trauma in your abdomen, and the pancreas is involved, you can also develop inflammation in the organ.
What causes chronic pancreatitis?
Chronic Pancreatitis is an inflammatory disorder of the pancreas that, instead of happening suddenly, is ongoing and continuous for an extended period. The exact cause of chronic pancreatitis is unknown, but some contributing factors may include the following:
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- Alcohol abuse: Alcohol changes the way the pancreas works and increases the protein secretion of acinar cells in the pancreas. The fluid becomes viscous and can form debris that clogs the pancreatic duct and triggers chronic pancreatitis.
- Recurrent acute pancreatitis: When you have many episodes of acute pancreatitis, ongoing inflammation can trigger changes in the pancreas that leads to chronic pancreatitis. You can also have an underlying problem that leads to both conditions.
- Autoimmune disorders: In some cases, pancreatitis is triggered by an autoimmune condition that affects the pancreas progressively over time.
Is pancreatitis a dangerous or lethal disease?
The pancreas is an organ behind the stomach and is responsible for producing enzymes that aid in the digestion of fats, proteins, and carbohydrates. When it becomes inflamed, the enzymes begin to digest the pancreas itself, causing severe pain and damaging the underlying tissue. This can become a life-threatening problem with severe consequences if not treated promptly.
Acute pancreatitis is more dangerous than chronic pancreatitis. The overall mortality of acute pancreatitis is up to 15%, reaching 30% when other organs are involved. Compared to that, the overall survival rate of chronic pancreatitis is 70% at ten years and 45% at 20 years. After 20 years of chronic pancreatitis, the risk of pancreatic cancer is 4%.
Complications of pancreatitis
Acute pancreatitis is a severe inflammation of your pancreas, and it comes on suddenly. Chronic pancreatitis is a more severe disease that occurs over an extended period. However, both conditions can have complications.
The most common complication in acute pancreatitis is an electrolyte imbalance. Patients start having pH abnormalities in the blood that is very difficult to correct in some cases. Another serious complication is a multi-organ failure, which is one of the most common causes of death in acute pancreatitis.
In chronic pancreatitis, pancreatic cancer is one of the complications, as mentioned above. These patients may also form a pseudocyst, a pleural effusion, or pancreatic ascites. Bile obstructions and duodenal obstructions can also happen in some patients.
Symptoms of pancreatitis
Pancreatitis is a severe condition that can last for several days, weeks, or years if we’re talking about chronic pancreatitis. Therefore, it is essential to be aware of the symptoms of pancreatitis and seek medical attention immediately if you experience any of the following issues.
The most common symptoms of acute pancreatitis include abdominal pain and tenderness. Other symptoms are nausea, vomiting, fever, low back pain, chills, and bloating. Severe cases of acute pancreatitis can trigger shock and organ failure. But let’s describe a few of the most important symptoms briefly:
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- Fever: It is a common symptom of pancreatitis. This is because damaged pancreatic tissue produces inflammation, which can raise body temperature.
- Headache: The inflammation in the pancreas may interfere with your circulation, release inflammatory cytokines and induce headaches when they reach the brain centers.
- Digestive discomfort: Pancreatitis can cause you to experience severe digestive discomfort, especially if you continue to consume fatty foods. You may experience diarrhea or bloating. You may also experience gas and heartburn due to problems with the digestive system.
- Moderate to severe abdominal pain: This is one of the most critical signs of pancreatitis, and pain is usually located at the center of the abdomen, below the ribs. This pain may worsen over time. You may also experience a burning sensation in the stomach or abdomen.
Signs of pancreatitis
The difference between signs and symptoms is that symptoms are felt by patients, and signs can be measured by the doctor. Thus, fever in pancreatitis is considered both a sign and a symptom because the patient or their caregivers can feel it, but it can also be measured and monitored in the hospital.
There’s also a sign called muscular guarding, which is found by doctors in their physical exam when touching the abdomen. There’s a defense mechanism in the abdomen in response to pain that is almost involuntary.
Another sign is jaundice, which is visible by both patient and doctor and involves a yellowish color of the skin and mucosa. It is not always present because it only happens when the bile ducts are affected.
Other signs of pancreatitis include abdominal distension, dyspnea, hematemesis, muscle spasms, the Cullen sign, and the Grey-Turner sign, which only happens in severe and complicated cases of pancreatitis.
How is pancreatitis diagnosed?
The symptoms of pancreatitis are similar to those of other diseases affecting the pancreas. In fact, as many as 20 to 40 percent of people with pancreatitis are initially misdiagnosed with intestinal disorders or even pancreatic cancer.
The disease is diagnosed using a physical examination, a medical history, and specific tests. A medical record, including family history, may be done to rule out other diseases and detect congenital cases of pancreatitis and bile duct problems. A physical exam is then made to detect the signs mentioned above and others.
The doctor may ask for blood, urine, and stool tests to confirm their findings on the physical exam. Blood tests may check for abnormal enzymes called transaminases, serum lipase, and amylase. These enzymes released from the damaged liver and pancreatic cells circulate through the blood and appear in different places depending on the organs they damage. Urine and stool tests may check for enzymes released when pancreatic juice spills into the blood.
Non-surgical treatment of pancreatitis
Treatment for acute pancreatitis focuses on managing symptoms. People with acute pancreatitis should rest, eat soft foods, and avoid drinking alcohol or smoking.
Medical treatment includes:
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- Antibiotic therapy: If there is evidence of infection (fever, chills, leukocytosis, elevated C-reactive protein), antibiotics are indicated.
- Supportive Care: Supportive care may be provided in an intensive care unit (ICU) or a step-down unit. Intravenous fluids are administered to prevent dehydration. Pain medications may be prescribed, and other infusions are administered to correct electrolyte imbalances if present.
- Emerging pharmacologic treatments: Depending on each case, patients may need other medicines, including crystalloids and colloids in case of shock and nutritional supplementation in cases of chronic pancreatitis.
Surgical treatment of pancreatitis
Surgery may be performed if there is evidence of complications, such as infection or bleeding. The most common is a cholecystectomy in the case of gallstone pancreatitis, which removes the affected gallbladder and clears the bile ducts from gallstones. There are many other procedures, depending on the type of complication the patient has:
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- Pancreatic ductal stents: A tube placed to drain fluid and bile from the pancreas into the duodenum. Stents are used when pancreatitis causes damage to the pancreatic duct. Pancreatic ductal stents can be temporary (removed after 3 to 6 months), permanent (removed after several years), or semi-permanent (removed at a later date).
- Percutaneous aspiration of pancreatic pseudocyst: Pancreatic pseudocysts develop when there is an infection in the pancreas and fluid collects around the inflamed area. When the pseudocyst grows very large, percutaneous aspiration is recommended to reduce the pressure in the area.
Prevention of pancreatitis
The most important way to treat acute pancreatitis is to prevent it from occurring in the first place. People who drink alcohol excessively or abuse drugs have a higher risk of developing acute pancreatitis. People who are obese are also at higher risk. Thus, part of preventing pancreatitis is reducing the risk by drinking alcohol moderately or abstaining from it, keeping a healthy weight, and living a healthier lifestyle.
In patients with known gallstones, one way to prevent pancreatitis is to perform a cholecystectomy and remove the gallbladder before it starts causing trouble. Otherwise, the gallstones may become stuck in the common duct, where the pancreatic juice and the bile are spilled to the duodenum, and pancreatitis ensues.
Conclusion
Pancreatitis is an acute or chronic condition that involves inflammation of the pancreas and the pancreatic ducts, which can be triggered by many things, including gallstones stuck in the common bile duct, heavy alcohol drinking, some medications, and trauma. It is more common in heavy drinkers and obese people with dyslipidemia.
Acute pancreatitis can be life-threatening, especially when complicated by multi-organ failure or electrolyte imbalances. It requires hospitalization, and patients usually need to undergo extensive monitoring in the ICU.
Chronic pancreatitis is a progressive disease with a longer life expectancy. However, it can trigger pancreatic cancer and causes recurrent symptoms that should be addressed promptly to prevent complications.
References:
https://emedicine.medscape.com/article/181364-overview
https://emedicine.medscape.com/article/181554-overview