What Is Acute Pancreatitis?: Symptoms, Causes, Treatment

What Is Acute Pancreatitis?

The inflammation or infection in the pancreas is called ‘pancreatitis.’ Pancreatitis is a large sizeable abdominal gland that is next to the upper part of the small intestine. 

The gland secretes the digestive enzymes in the small intestine; if any inflammation occurs in the pancreas, it causes acute or chronic pancreatitis.

Acute Pancreatitis icd 10

icd-10 code K85. 90 for Acute Pancreatitis without infection, undefined is a medical classification as listed by WHO under the range of Diseases digestive system.

acute pancreatitis
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Table of Contents

What is the difference between acute and chronic pancreatitis?

Acute Pancreatitis  

The acute inflammatory process involving pancreatitis.  

Injury to acinar cells & premature activation of the enzyme trypsin necrosis or autodigestion.

  • Usually painful and self-limited.
  • Isolated event or a recurring illness.
  • Pancreatic function and morphology return to normal after (or between) attacks.

Chronic Pancreatitis

Chronic pancreatitis is an inflammation in your Pancreas that causes progressive destruction of the gland. This can cause permanent damage.

Associated terms

  • Cholelithiasis
  • Ethanol abuse
  • Idiopathic
  • Medications
  • Hyperlipidemia
  • ERCP
  • Trauma
  • Pancreatin divisum
  • Hereditary
  • Hypercalcemia
  • Viral infections
  • Mumps
  • Coxsackievirus
  • End-stage renal failure
  • Penetrating peptic ulcer

Signs and symptoms of acute pancreatitis

Acute pancreatitis if you feel,

  • Abdominal pain.
  • Mid epigastria to the rt. Upper quadrant.
  • Radiates to the back.
  • Worse in the supine position.
  • Nausea and vomiting(protracted worsened with ingestion of food) with restlessness.
  • Diarrhea, melena, and hematemesis.
  • Abdominal tenderness is joint.
  • Fever
  • Jaundice-biliary disease.
  • Grey Turner’s sign: a blue- red-purple or green, brown discoloration of flank.
  • Cullen’s sign: faint, blue-tinged discoloration around the umbilicus.
  • Occurs in about 1% of cases and is associated with a poor prognosis.
  • Decrease urine output-body attempt to conserve intravascular volume.

What can cause acute pancreatitis?

 Causes of acute pancreatitis include:

  • Sudden immune system attacks on the Pancreas, Pancreatitis
  • Indirect causes of Acute Pancreatitis include
  • By consuming too much alcohol
  • Cystic fibrosis, a severe condition that affects your lungs, liver, and Pancreas
  • Kawasaki disease, a disease that occurs in young children
  • Viral infections such as bacterial infections such as mycoplasma
  • Reye’s syndrome, a complication with a virus that can also affect the liver
  • Due to certain medications containing estrogen, corticosteroids, or certain antibiotics

Causative drugs

AIDS therapy: Didanosine, pentamidine.

Anti-inflammatory: Sulindac, salicylates.

Antimicrobials:  Metronidazole, sulfonamides, tetracycline, nitrofurantoin.

Diuretics:  Furosemide, thiazides.

Immunosuppressives:  Azathioprine, 6-mercaptopurine.

Neuropsychiatric:  Valproic acid.

Other:

  • Calcium, estrogen, tamoxifen, ACE-I.
  • Hereditary Pancreatitis.
  • Autosomal dominant with 80% phenotypic penetrance.
  • Recurrent acute pancreatitis, chronic pancreatitis, and 50-fold increased risk of pancreatic cancer.
  • Mutation in cationic trypsinogen gene (R122H).

Pathogenesis of acute pancreatitis

Stage 1:

  • Pancreatic Injury
  • Edema
  • Inflammation

Stage 2:

  • Local Effects
  • Retroperitoneal edema
  • Ileus 

Stage 3:

  • Systemic Complications
  • Hypotension/shock
  • Metabolic disturbances
  • Sepsis/organ failure

Risk for acute pancreatitis

Drinking too much alcohol can cause pancreatic inflammation.

Smoking increases your chances of getting Acute Pancreatitis. Smoking and drinking are similar among Americans, but the likelihood of developing acute pancreatitis is more than double that of Black Americans. A family history of cancer, inflammation, or pancreatic condition can also put you at risk.

Complications of acute pancreatitis

A Pancreatitis can cause pseudocysts in your Pancreas. Fluid-filled sacks also cause infection and even internal bleeding. 

Acute pancreatitis can disrupt the balance of body chemistry. This can lead to more complications.

In some people, acute pancreatitis may be a sign of pancreatic cancer. Contact your doctor about the diagnosis and the treatment for acute pancreatitis. Quick and effective treatment significantly reduces your risk of complications.

Also read: 

Diagnosis acute pancreatitis

How to test for acute pancreatitis?

Gallstones: abnormal LFTs & sonographic evidence of cholelithiasis .

Hyperlipidemia: lipemic serum, Tri>1,000.

Hypercalcemia: elevated Ca.

Trauma: history.

Medications: history, temporal association.

How to treat acute pancreatitis?

Often you will be hospitalized for testing and usually intravenously to make sure you get enough fluids. Your doctor may order medications to treat possible infections to reduce pain. If these treatments do not work, you will need surgery to drain the fluid or correct the blocked ducts. Maybe gallbladder problems have occurred, so you may need surgery to remove the gallbladder. 

If your doctor can tell that a medicine is causing your acute pancreatitis, you should stop using that medicine immediately. 

If an injury is a cause of pancreatitis, avoid it until you are completely cured with treatment. Before start, the activity, first, checks with your doctor. 

Treatment of mild pancreatitis

  • Pancreatic rest.
  • Supportive care.
  • Fluid resuscitation – watch BP and urine output.
  • Pain control.
  • NG tubes and H2 blockers or PPIs are usually not helpful.
  • Refeeding (usually 3 to 7 days)
  • Nearly pain-free (off IV narcotics).
  • Amylase & lipase not very useful here.

Treatment of severe pancreatitis

  • Pancreatic rest & supportive care.
  • Fluid resuscitation* – may require 5-10 liters/day.
  • Careful pulmonary & renal monitoring – ICU.
  • Maintain hematocrit of 26-30%.
  • Pain control – opioids .
  • Correct electrolyte derangements (K+, Ca++, Mg++).
  • Rule-out necrosis.
  • Contrasted CT scan at 48-72 hours.
  • Prophylactic antibiotics if present.
  • Surgical debridement if infected.

Conclusion

Incidence

It is reported that India’s south  state has incidences of pancreatitis, ranging from 114-200/100,000 population. The rest of the globe reports 1.4-27 cases per 100,000 populations.

Death Rate

However, mild acute pancreatitis becomes self-limiting and has a death rate of less than 1% (13, -14), whereas severe acute Pancreatitis, or hemorrhagic Pancreatitis, is related to mortality ranging from 10–30% (15– 18).

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