Pancreatitis

Pancreatitis, or inflammation of the pancreas, occurs when the pancreatic enzymes that digest food are activated inside the pancreas.

Learning Objective

List the factors involved in pancreatitis

Key Points

Pancreatitis occurs when the pancreatic enzymes that digest food are activated in the pancreas instead of the small intestine, causing the pancreas to digest, or break down its own tissue. Pancreatitis can be either acute or chronic.
The most common symptoms of pancreatitis are severe, upper-abdominal burning pain radiating to the back, nausea, and vomiting that worsens with eating.
Gallstones are the single most common cause of acute pancreatitis, while alcohol is the single most common cause of chronic pancreatitis.
The treatment of pancreatitis is supportive and depends on severity of the illness. Mild pancreatitis treatment typically involves restriction of foods to avoid production of digestive enzymes, and administration of opiate-based painkillers. The prognosis for mild pancreatitis is good.
Severe pancreatitis is a serious medical emergency, and patients are typically admitted to an intensive care unit with some level of hypovolemic shock. This form has high mortality rates, especially where the pancreatic enzymes have begun to kill off parts of the pancreas, causing tissue necrosis.

Terms

necrosis
The localized death of cells or tissues through injury, disease, or the interruption of blood supply.
hypovolemic shock
A life-threatening medical condition that occurs due to inadequate oxygen levels in the body for aerobic cellular respiration due to decreased blood volume.
jaundice
A yellowish pigmentation of the skin, the whites of the eyes (sclera), and other mucous membranes caused by increased levels of bilirubin in the blood that build up in extracellular fluid, usually due to liver disease.

Full Text

Pancreatitis is inflammation of the pancreas. The pancreas plays an important role in the regulation of blood glucose levels through the production of hormones, as well as in digestion, through the production of enzymes that break down food in the small intestine. Pancreatitis occurs when the pancreatic enzymes that digest food are activated in the pancreas instead of the small intestine, causing the pancreas to digest, or break down, its own tissue . Pancreatitis can be acute, beginning suddenly and lasting a few days, or chronic, occurring over many years.

The Pancreatic Duct

The pancreas connects to the small intestine via the pancreatic duct. A blockage in this duct can cause pancreatitis.

Symptoms and Causes

The most common symptoms of pancreatitis are severe upper-abdominal burning pain radiating to the back, nausea, and vomiting that worsens with eating. Unexplained weight loss may occur from decreased amounts of pancreatic enzymes hindering digestion.

Eighty percent of pancreatitis cases are caused by alcohol and gallstones. Gallstones are the single most common cause of acute pancreatitis, while alcohol is the single most common cause of chronic pancreatitis. Pancreatitis can be caused by certain medications, as well as trauma, mumps, autoimmune disease, genetic predisposition, scorpion stings, high blood calcium, high blood triglycerides, hypothermia, certain viruses, bacteria and fungi, and less commonly, pancreatic cancer.

Treatment

The treatment of pancreatitis is supportive and depends on the severity of the illness. Mild pancreatitis treatment typically involves restriction of foods to avoid production of digestive enzymes, and administration of opiate-based painkillers. Severe pancreatitis is a serious medical emergency, and patients are typically admitted to an intensive care unit with some level of hypovolemic shock. Treatment is still supportive, with the aim of eliminating the underlying cause of the pancreatitis.

Complications and Prognosis

Early complications of pancreatitis include shock, infection, systemic inflammatory response syndrome, low blood calcium, high blood glucose, and dehydration. Blood loss, dehydration, and fluid leaking into the abdominal cavity can lead to kidney failure. Respiratory complications are often severe. Fluid in the lungs is usually present, and shallow breathing from pain can lead to lung collapse. Pancreatic enzymes may enter the blood stream and attack the lungs, causing inflammation.

Late complications include recurrent pancreatitis and the development of pancreatic pseudocyst, which are 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.

Prognosis is generally good for mild pancreatitis. Severe pancreatitis has high mortality rates, especially where the pancreatic enzymes have begun to kill off parts of the pancreas, causing tissue necrosis.

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