Pancreatitis

Source: Wikipedia, the free encyclopedia.
Pancreatitis
pain medication, antibiotics[1]
Frequency8.9 million (2015)[6]
Deaths132,700 (2015)[7]

Pancreatitis is a condition characterized by inflammation of the pancreas.[1] The pancreas is a large organ behind the stomach that produces digestive enzymes and a number of hormones.[1] There are two main types: acute pancreatitis, and chronic pancreatitis.[1]

Signs and symptoms of pancreatitis include

diabetes mellitus, or problems with other organs.[1]

The two most common causes of acute pancreatitis are a

tumors.[1] Chronic pancreatitis may develop as a result of acute pancreatitis.[1] It is most commonly due to many years of heavy alcohol use.[1]

Other causes include

high blood calcium, some medications, and certain genetic disorders, such as cystic fibrosis, among others.[1] Smoking increases the risk of both acute and chronic pancreatitis.[3][4] Diagnosis of acute pancreatitis is based on a threefold increase in the blood of either amylase or lipase.[1] In chronic pancreatitis, these tests may be normal.[1] Medical imaging such as ultrasound and CT scan may also be useful.[1]

Acute pancreatitis is usually treated with

pancreatic enzyme replacement may be required.[1] Occasionally, surgery is done to remove parts of the pancreas.[1]

Globally, in 2015 about 8.9 million cases of pancreatitis occurred.[6] This resulted in 132,700 deaths, up from 83,000 deaths in 1990.[7][8] Acute pancreatitis occurs in about 30 per 100,000 people a year.[3] New cases of chronic pancreatitis develop in about 8 per 100,000 people a year and currently affect about 50 per 100,000 people in the United States.[9] It is more common in men than women.[1] Often chronic pancreatitis starts between the ages of 30 and 40 and is rare in children.[1] Acute pancreatitis was first described on autopsy in 1882 while chronic pancreatitis was first described in 1946.[9]

Signs and symptoms

The most common symptoms of pancreatitis are severe

pancreatic enzymes hindering digestion.[citation needed
]

Complications

Early complications include

fluid leaking into the abdominal cavity (ascites) can lead to kidney failure. Respiratory complications are often severe. Pleural effusion is usually present. Shallow breathing from pain can lead to lung collapse. Pancreatic enzymes may attack the lungs, causing inflammation. Severe inflammation can lead to intra-abdominal hypertension and abdominal compartment syndrome, further impairing renal and respiratory function and potentially requiring management with an open abdomen to relieve the pressure.[10]

Late complications include recurrent pancreatitis and the development of pancreatic pseudocysts—collections of pancreatic secretions that have been walled off by scar tissue. These may cause pain, become infected, rupture and bleed, block the bile duct and cause jaundice, or migrate around the abdomen. Acute necrotizing pancreatitis can lead to a pancreatic abscess, a collection of pus caused by necrosis, liquefaction, and infection. This happens in approximately 3% of cases or almost 60% of cases involving more than two pseudocysts and gas in the pancreas.[11]

Causes

Eighty percent of cases of pancreatitis are caused by alcohol or gallstones. Gallstones are the single most common cause of acute pancreatitis.[12] Alcohol is the single most common cause of chronic pancreatitis.[13][14][15][16][17] Triglyceride levels greater than 1000 mg/dL (11.29 mmol/L) is another cause.[18]

Medications

There are seven classes of medications associated with acute pancreatitis:

hypercalcemia, where the latter is the risk factor for pancreatic stones.[citation needed
]

HIV infection itself can cause a person to be more likely to get pancreatitis. Meanwhile, antiretroviral drugs may cause metabolic disturbances such as hyperglycemia and hypercholesterolemia, which predisposes to pancreatitis. Valproic acid may have direct toxic effect on the pancreas.[19] There are various oral hypoglycemic agents that contributes to pancreatitis including metformin. But, glucagon-like peptide-1 (GLP-1) is more strongly associated with pancreatitis by promoting inflammation.[20]

Atypical antipsychotics such as clozapine, risperidone, and olanzapine can also cause pancreatitis.[21]

Infection

A number of infectious agents have been recognized as causes of pancreatitis including:[22][23][24]

Other

Other common causes include

Diabetes mellitus type 2 is associated with a 2.8-fold higher risk.[25]

Less common causes include

blood vessels in the pancreas), and porphyria—particularly acute intermittent porphyria and erythropoietic protoporphyria.[citation needed
]

There is an

autodigestion. Involved genes may include trypsin 1, which codes for trypsinogen, SPINK1, which codes for a trypsin inhibitor, or cystic fibrosis transmembrane conductance regulator.[27]

The

valproic acid, liraglutide).[28]

Diagnosis

Acute exudative pancreatitis on CT scan
Calcified pancreatic duct stones with some free intra-abdominal fluid

The differential diagnosis for pancreatitis includes but is not limited to

mesenteric ischemia.[29]

Diagnosis
requires 2 of the 3 following criteria:

Amylase and lipase are 2 enzymes produced by the pancreas. Elevations in lipase are generally considered a better indicator for pancreatitis as it has greater

anti-nuclear antibody.[31]

For imaging, abdominal ultrasound is convenient, simple, non-invasive, and inexpensive.[32] It is more sensitive and specific for pancreatitis from gallstones than other imaging modalities.[30] However, in 25–35% of patients the view of the pancreas can be obstructed by bowel gas making it difficult to evaluate.[29]

A contrast-enhanced CT scan is usually performed more than 48 hours after the onset of pain to evaluate for pancreatic necrosis and extrapancreatic fluid as well as predict the severity of the disease. CT scanning earlier can be falsely reassuring.[33]

ERCP or an endoscopic ultrasound can also be used if a biliary cause for pancreatitis is suspected.[citation needed]

Treatment

The treatment of pancreatitis is supportive and depends on severity. Morphine generally is suitable for pain control. There are no clinical studies to suggest that morphine can aggravate or cause pancreatitis or cholecystitis.[34]

The treatment for acute pancreatitis will depend on whether the diagnosis is for the mild form of the condition, which causes no complications, or the severe form, which can cause serious complications.[citation needed]

Mild acute pancreatitis

The treatment of mild acute pancreatitis is successfully carried out by admission to a general hospital ward. Traditionally, people were not allowed to eat until the inflammation resolved but more recent evidence suggests early feeding is safe and improves outcomes, and may result in an ability to leave the hospital sooner.[35]

Due to inflammation occurring in pancreatitis, proinflammatory

supplemental oxygen
is occasionally delivered through breathing tubes that are connected via the nose (e.g., nasal cannulae) or via a mask. The tubes can then be removed after a few days once it is clear that the condition is improving.

Dehydration may result during an episode of acute pancreatitis, so fluids will be provided intravenously.

Opioids may be used for the pain. When the pancreatitis is due to gallstones, early gallbladder removal also appears to improve outcomes.[36]

Severe acute pancreatitis

Severe pancreatitis can cause

hypovolemic
shock. Hypovolemic shock can be life-threatening as it can very quickly starve the body of the oxygen-rich blood that it needs to survive. To avoid going into hypovolemic shock, fluids will be administered intravenously. Oxygen will be supplied through tubes attached to the nose and ventilation equipment may be used to assist with breathing. Feeding tubes may be used to provide nutrients, combined with appropriate analgesia.

As with mild acute pancreatitis, it will be necessary to treat the underlying cause—gallstones, discontinuing medications, cessation of alcohol, etc. If the cause is gallstones, it is likely that an ERCP procedure or removal of the gallbladder will be recommended. The gallbladder should be removed during the same hospital admission or within two weeks of pancreatitis onset so as to limit the risk of recurrent pancreatitis.

If the cause of pancreatitis is alcohol, cessation of alcohol consumption and treatment for alcohol dependency may improve pancreatitis. Even if the underlying cause is not related to alcohol consumption, doctors recommend avoiding it for at least six months as this can cause further damage to the pancreas during the recovery process.[37]

Oral intake, especially fats, is generally restricted initially but early enteral feeding within 48 hours has been shown to improve clinical outcomes.

intravenously. Nutritional support is initiated via tube feeding to surpass the portion of the digestive tract most affected by secreted pancreatic enzymes if there is no improvement in the first 72–96 hours of treatment.[39]

Prognosis

Severe acute pancreatitis has mortality rates around 2–9%, higher where necrosis of the pancreas has occurred.[40]

Several scoring systems are used to predict the severity of an attack of pancreatitis. They each combine demographic and laboratory data to estimate severity or probability of death. Examples include APACHE II, Ranson, BISAP, and Glasgow. The Modified Glasgow criteria suggests that a case be considered severe if at least three of the following are true:[41]

This can be remembered using the mnemonic PANCREAS:

The BISAP score (blood urea nitrogen level >25 mg/dl (8.9 mmol/L), impaired mental status, systemic inflammatory response syndrome, age over 60 years, pleural effusion) has been validated as similar to other prognostic scoring systems.[42]

Epidemiology

Globally the incidence of acute pancreatitis is 5 to 35 cases per 100,000 people. The incidence of chronic pancreatitis is 4–8 per 100,000 with a prevalence of 26–42 cases per 100,000.[43] In 2013 pancreatitis resulted in 123,000 deaths up from 83,000 deaths in 1990.[8]

Costs

In adults in the United Kingdom, the estimated average total direct and indirect costs of chronic pancreatitis is roughly £79,000 per person on an annual basis.[44] Acute recurrent pancreatitis and chronic pancreatitis occur infrequently in children, but are associated with high healthcare costs due to substantial disease burden.[45] Globally, the estimated average total cost of treatment for children with these conditions is approximately $40,500/person/year.[45]

Other animals

Fatty foods may cause canine pancreatitis in dogs.[46]

See also

References

  1. ^ a b c d e f g h i j k l m n o p q r s t u v w x y z aa ab ac ad ae "Pancreatitis". niddk.nih.gov. August 16, 2012. Archived from the original on 7 March 2015. Retrieved 1 March 2015.
  2. ^ "Patient Care & Health Information > Diseases & Conditions: Pancreatitis". Mayo Clinic. 4 June 2022.
  3. ^
    S2CID 25600369
    .
  4. ^
    PMID 23622135
    .
  5. ^
    PMID 17466744
    .
  6. ^
    PMID 27733282
    .
  7. ^
    PMID 27733281
    .
  8. ^
    PMID 25530442
    .
  9. ^
    PMID 25510320
    .
  10. S2CID 2459785
    .
  11. ^ Pancreatic abscess at eMedicine
  12. ^ NIDDK (July 2008). "Pancreatitis". National Digestive Diseases Information Clearinghouse. U.S. National Institute of Diabetes and Digestive and Kidney Diseases. 08–1596. Archived from the original on 2007-01-07. Retrieved 2007-01-05.
  13. ^ "Pancreatitis". A.D.A.M., Inc. Archived from the original on 2012-12-30. Retrieved 2013-01-05.
  14. S2CID 6580794
    .
  15. PMID 19506173
    .
  16. ^ "Pancreatitis Explained". Better Health Channel. State Government of Victoria. 2011. Archived from the original on 2010-05-13.
  17. PMID 1752477
    .
  18. S2CID 49311482
    .
  19. PMID 18209761
    .
  20. PMID 25829880
    .
  21. S2CID 39945446. Archived
    from the original on 2011-02-08.
  22. PMID 28725301
    .
  23. PMID 8899796
    .
  24. ^ Economou M, Zissis M (2000). "Infectious cases of acute pancreatitis" (PDF). Annals of Gastroenterology. 13 (2): 98–101. Archived from the original (PDF) on 2017-08-09. Retrieved 22 November 2017.
  25. PMID 19208917. Archived
    from the original on 2012-06-10.
  26. PMID 9224338
    .
  27. ^ Whitcomb D (2006). "Genetic Testing for Pancreatitis". Archived from the original on 2017-10-16.
  28. ^ "Causes of pancreatitis (mnemonic)". Radiopaedia.org. Retrieved 26 June 2021.
  29. ^ a b "Clinical manifestations and diagnosis of acute pancreatitis". www.uptodate.com. Archived from the original on 2015-12-08. Retrieved 2015-12-08.
  30. ^ a b Hospitalist Handbook (4th ed.). Department of Medicine University of California, San Francisco. 2012. pp. 224–25.
  31. ^ Greenberger NJ, Wu B, Conwell D, Banks P (eds.). "Chronic Pancreatitis". Gastroenterology, Hepatology, & Endoscopy. Current Medical Diagnosis and Treatment. p. 301.
  32. ISBN 978-0071444415
    .
  33. PMID 24512896
    .
  34. PMID 3197985
    .
  35. S2CID 2025443
    .
  36. S2CID 195787962
    .
  37. ^ Balentine JR, Stöppler MC. "Symptoms and Signs of Acute and Chronic Pancreatitis Differences". E Medicine Health.
  38. PMID 23762266
    .
  39. S2CID 207210094
    .
  40. PMID 10905786. Archived
    from the original on 2012-10-08.
  41. S2CID 46327341
    .
  42. S2CID 41655611
    .
  43. ISBN 978-0071802161
    .
  44. PMID 24661411
    .
  45. ^
    PMID 26704866
    .
  46. ^ Calderone J (July 30, 2016). "8 Toxic Foods for Dogs". Consumer Reports. Archived from the original on February 11, 2017.

External links

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