I would be posting some information on Acute Pancreatitis today (as requested by some)

I would be posting some information on Acute Pancreatitis today (as requested by some).

Acute Pancreatitis is an inflammatory condition of the pancreas which usually presents with an excruciating upper abdominal pain (usually central in location), radiating to the back. It may be mild, but in severe cases it may have life threatening complications.

Apart from abdominal pain, one may present with severe nausea, vomiting, fever and jaundice (usually gallstone induced). Severe symptoms like abdominal distension and shortness of breath may be the presenting complaints in some.

Common causes of Acute Pancreatitis are alcohol consumption (specifically binge drinking), gallstones, increased triglyceride levels in blood (usually more than 500 mg%), abdominal trauma, intervention procedures like ERCP (which is used to manage common bile duct stones causing obstructive jaundice), abdominal surgery and certain medications ( for eg ART medications like zidovudine). Obesity and genetic disorders like cystic fibrosis may lead to increased risk of Acute pancreatitis

Acute pancreatitis would be clinically diagnosed by your physician by the classical history of pain and combined with relevant physical examination. Certain blood investigations would be needed like amylase and lipase (to establish the diagnosis), Complete blood count (to assess the inflammatory response, not necessarily an infection) and.Liver function test (may be deranged where the cause is gallstone). Blood sugar monitoring is done (as Pancreas secretes Insulin). In severe cases renal function and electrolyte assessment are done to check for any acute kidney involvement. Chest X ray is done at baseline to check for any pleural effusion (fluid accumulation in the outer covering of the lung) or to detect any acute lung involvement (ARDS). Ultrasonography and CECT scan abdomen provides valuable information regarding the type of pancreatitis (specifically the necrotic type and to look for any collection). MRCP may be needed to check for any biliary tract obstruction or underlying pancreatic pathology. Acute lung involvement may occur and hence respiratory parameters are monitored.

Mild cases may recover with supportive care (primarily pain management) and adequate fluid therapy. Severe cases (those associated with other organ failure mainly lungs and kidney) with complications often require intensive care support. Antibiotics are usually not routinely prescribed in an acute pancreatitis except when an underlying sepsis is suspected. Arterial blood gas analysis is frequently done in severe cases. Previously a patient with acute pancreatitis would have complete restrictions of oral feeds. However, currently due to various studies which underline the importance of early oral feeding, elemental feeds are started early under medical supervision and observation for pain or excessive vomiting. Severe cases may need tube feeding (usually a nasojejunal tube - which straightaway passes to the 2 nd part of small intestine, the jejunum) or rarely intravenous nutrition (Total parenteral nutritional).

It is of primary importance to identify the underlying cause of Acute pancreatitis and treat it (if possible) to prevent subsequent attacks. For eg. Avoid alcohol intake, surgical management of gall stone, avoid the inducing medications, management of hypertriglyceridemia. Dietary modifications are required (as the physician/ gastroenterologist) discusses it.

Long term complications of acute pancreatitis may occur like a pseudocsyt formation or necrotic collections which requires opinion from an interventional radiologist or a surgeon.

The management of a severe acute pancreatitis may require involvement of various medical specialists (Gastroenterologist, Intensivist, Nephrologist, Pulmonologist, Surgeon, Radiologist). The outcome may not be satisfactory despite aggressive management.

A complete discussion of Acute pancreatitis is out of scope of a small FB post. It may take weeks. I have not mentioned about chronic pancreatitis as it is an separate entity in itself.

Hope this write up helps to increase awareness and build an idea of this disease.

Thanks and regards