Acute Pancreatitis: Causes, Symptoms, Diagnosis, Risks, Treatments, and Condition During Pregnancy

It is a disease that occurs mainly due to poor eating habits.

Causes of acute pancreatitis

The most common cause of acute pancreatitis is gallbladder stones. The gallstones pass through the common bile duct to enter the small intestine.

At the entrance to the small intestine, the main pancreatic duct joins or is immediately next to the common bile duct.

Stones that get stuck in the common bile duct are thought to affect the main pancreatic duct, causing an obstruction of the normal flow of pancreatic fluid and leading to pancreatic injury.

Another way that a stone can cause pancreatitis is by causing a backflow of bile into the pancreatic duct, resulting in pancreatic injury.

While the actual mechanism for how gallstones cause pancreatitis is not entirely true, the association of gallstones and pancreatitis is clear. There are several other causes of acute pancreatitis including:

  • High levels of triglycerides in the blood (possibly familial chylomicronemia syndrome).
  • Medicines taken.
  • High levels of triglycerides in the blood.
  • High levels of calcium in the blood.
  • Heavy alcohol consumption.

Each year, there are more than 300,000 hospital admissions for the treatment of acute pancreatitis, and the estimated cost of these admissions is more than $ 2 billion.

Between 16.5% and 25% of patients who develop acute pancreatitis experience a recurrent episode in the first few years.

Prevention is a primary goal of treatment, with efforts focused on identifying the underlying cause and triggers to avoid future episodes.

Symptoms

Acute pancreatitis usually begins with sudden or gradual pain in the upper abdomen that sometimes spreads to the back. The pain may be mild at first and get worse after eating.

The pain is often severe, constant, and generally lasts for several days in the absence of treatment. A person with acute pancreatitis usually looks and feels very ill and needs immediate medical attention.

Most cases require hospitalization for 3 to 5 days for close monitoring, pain control, and intravenous hydration. Other symptoms can include:

  • Swollen and tender abdomen.
  • Nausea and vomiting
  • Fever.
  • Rapid pulse.

Diagnosis of acute pancreatitis

Acute pancreatitis is confirmed by the history, physical examination, and usually a blood test (amylase or lipase) for the digestive enzymes of the pancreas. Blood amylase or lipase levels are typically elevated 3 times the normal level during acute pancreatitis.

In some cases, when blood tests are not elevated and the diagnosis is still in question, abdominal images, such as a computed tomography (CT) scan, may be done.

Tests After confirming the diagnosis,

Certain imaging tests may be done during or after the hospital stay to help identify the cause. Such tests include:

Transabdominal ultrasound: This is commonly done during hospitalization to specifically evaluate the gallbladder for stones because gallstones are the most common cause of acute pancreatitis.

Ultrasound uses sound waves that bounce off the pancreas, gallbladder, liver, and other organs, and their echoes generate electrical impulses that create an image, called an ultrasound, on a video monitor .

If the gallstones are causing inflammation, sound waves also bounce off them, showing their location .

Endoscopic ultrasound: This test is not commonly required during acute pancreatitis. Compared to transabdominal ultrasound, it is relatively more invasive, as a doctor passes a thin flexible tube into the stomach.

A camera and ultrasound probe are attached to the end of the tube, allowing the doctor to see images of the gallbladder, pancreas, and liver.

The images are more sensitive than transabdominal ultrasound in detecting small stones in the gallbladder and bile ducts that may have been missed. You can also visualize the pancreas for abnormalities.

Magnetic Resonance Cholangiopancreatography (MRCP) : MRCP uses magnetic resonance imaging (MRI), a non-invasive procedure that produces cross-sectional images of parts of the body. After being lightly sedated, the patient lies down in a cylindrical tube.

The technician injects the dye into the patient’s veins, helping to show the pancreas, gallbladder, and bile and pancreatic ducts . This is another sensitive test to evaluate the gallbladder, bile ducts, and pancreas for causes of acute pancreatitis.

Computed tomography (CT) scan: A computed tomography scan is a non-invasive radiograph (x-ray) that produces three-dimensional images of parts of the body. The patient lies on a table that slides into a donut-shaped machine .

Typically it is not performed initially for an episode of acute pancreatitis, it can be performed when the diagnosis is uncertain or if there are several days in hospital, this to assess the extent of pancreatic damage when a patient does not recover as quickly as expected.

Risks

Risk stratification for acute pancreatitis

In most cases, acute pancreatitis resolves with therapy, but about 15% of patients develop severe illness. Severe acute pancreatitis can lead to life-threatening failure of multiple organs and infection.

Therefore, it is extremely important to seek medical attention if you experience signs or symptoms of acute pancreatitis. There are several clinical risk assessment systems available to help clinicians predict who is most likely to develop severe acute pancreatitis.

These scores are based on various clinical data collected on admission and during the first 48 hours of hospitalization. Commonly used scoring systems include:

  • Bedside severity index in acute pancreatitis.
  • Ranson’s criteria.
  • The APACHE II score.
  • Treatment of acute pancreatitis.
  • Fluids

Treatments

Early and appropriate fluid resuscitation – especially within the first 24 hours of onset. Pancreatitis is associated with a lot of swelling and inflammation.

Giving fluids intravenously prevents dehydration and ensures that the rest of the body’s organs get adequate blood flow to support the healing process.

Nutritional support: Initially, no nutrition is provided to rest the pancreas and intestines for the first 24 to 48 hours.

After 48 hours, a plan to provide nutrition should be implemented because acute pancreatitis is a highly active state of inflammation and injury that requires many calories to support the healing process.

In most cases, patients can begin to eat on their own within 48 hours. If this is not possible, a feeding tube that is passed through the nose into the intestines can be used to provide nutrition.

This method is safer than giving nutrition through an IV. There is no benefit to using probiotics for acute pancreatitis.

Pain control: IV medications, usually strong narcotic pain medications, are effective in controlling pain associated with acute pancreatitis.

Nausea is a common symptom and can be caused by inflammation of the pancreas and slowing of the intestines. Effective intravenous medications are available for nausea. The pain and nausea will decrease as the inflammation resolves.

Treatment of underlying problems

In addition to providing care and support, underlying causes must be assessed promptly.

If acute pancreatitis is believed to be due to gallstones, medications, high triglycerides, or high levels of calcium within the patient’s body (or other external causes), targeted therapy may be implemented.

Endoscopic retrograde cholangiopancreatography (ERCP): This is a procedure in which a doctor passes a thin, flexible tube with a camera attached to the end through the patient’s mouth and into the first part of the small intestine, where the bile duct and the pancreatic duct.

With this device, a small catheter can be passed into the bile duct to remove gallstones that may have become stuck and that are the cause of pancreatitis. In certain situations, a special catheter may also be passed into the pancreatic duct to help the pancreas heal.

The following procedures that can be performed are:

  • Sphincteroctomy : Using a small wire on the endoscope, a doctor finds the muscle that surrounds the pancreatic duct or bile duct and makes a small cut to enlarge the opening of the duct. When there is a pseudocyst, the duct is drained.
  • Cornerstone Removal: The endoscope is used to remove stones from the pancreatic or bile duct with a small basket. Gallstone removal is sometimes done in conjunction with a sphincterotomy.
  • Stent placement: Using the endoscope, a doctor places a small piece of plastic or metal that looks like a straw into a narrowed pancreatic or bile duct to keep it open.
  • Balloon dilation : Some endoscopes have a small balloon that a doctor uses to dilate or stretch a narrow pancreatic or bile duct. A temporary stent may be placed for a few months to keep the duct open.

It is well documented that one of the main side effects of ERCP is pancreatitis; however, there are several clearly defined situations when urgent ERCP is indicated for acute pancreatitis.

Antioxidant therapies

Basic and clinical evidence suggests that the development of both acute pancreatitis (AP) and chronic pancreatitis (CP) may be associated with oxidative stress.

The results show that free radical activity and oxidative stress rates are higher in the blood and duodenal juice of patients with pancreatitis.

Based on these findings, the idea of ​​using antioxidant regimens in the treatment of PA and PC as an adjunct and in combination with their traditional therapy is reasonable. In practice, however, the overall effectiveness of antioxidants is not known, the best mix of agents, and the dosage is unclear.

The therapy is currently believed to consist of a trial with a blend of antioxidants containing vitamin C, vitamin E, selenium, and methionine.

Complementary pancreatitis therapies

Alternative therapies are those that can be used in conjunction with medical treatment to help the patient feel better. No one should start an alternative therapy without talking to their doctor.

  • Yoga – Research has found that chronic pancreatitis patients who practice yoga 3 times a week can reduce pain, need for pain relievers, and improve quality of life.
  • Massage Therapy: Massage therapy involves touching and using different techniques of stroking or kneading the muscles of the body. It can involve part of the body or be a full body massage. The massage can be done through clothing or on exposed skin.

It can be done on specialized chairs or on a table. Massage therapy should only be performed by a licensed massage therapist. Massage is used for muscle and bone discomfort; improved circulation; reduction of swelling; relaxation; and pain control.

It can be used as a complement to other treatments and as a stress reducer. Studies have shown that massage can improve the relaxation response and overall sense of well-being.

Therapeutic Touch: Therapeutic Touch is an energy exchange process, in which the practitioner uses the hands as a focus to aid the healing process . It is based on the idea that humans are a form of energy.

When we are healthy, energy flows freely and is balanced. The disease is believed to reflect an imbalance or disturbance of energy flow. Therapeutic tactile treatment can vary from 5 to 30 minutes, depending on the needs of the individual patient.

The exact methods vary among practitioners, but generally keep the hands 2 to 4 inches away from the patient’s fully clothed body, moving them from head to toe, and over the front and back.

Research has shown that therapeutic touch promotes relaxation and a sense of comfort and well-being. Research has also shown that therapeutic touch is effective in decreasing anxiety and altering the perception of pain.

Physical exercise: Physical  exercise improves the general functioning of the body and the quality of life. Exercise can decrease stress, pain, nausea, fatigue, and depression. Regular exercise affects hormonal balance, as well as most of the body’s systems.

Regular participation in physical activity increases your heart rate and maintains an increased heart rate over a period of time.

Depending on your physical condition and after the advice of your doctor, you can start walking for 5 to 10 minutes twice a day, with the goal of increasing the activity to 45 minutes at least 3 times a week. It is important that your exercise time is uninterrupted. This is the time for you.

If you cannot walk, there are other ways to exercise (eg, stretching exercises, isometrics).

Meditation: meditation or relaxation fosters a state of freedom from anxiety, tension, and anguish.

A state of relaxation can be achieved using different methods such as diaphragmatic breathing, progressive muscle relaxation, repetitive affirmation, prayer, yoga, or guided / visual imagery.

When practiced regularly, meditation can improve sleep, concentration, and the ability to cope with stress. It can help with the treatment of pain, nausea, and anxiety.

You can find free tapes and brochures on meditation in libraries and inexpensive materials in stores. You can also choose to attend breakout groups. Once you have learned the technique, meditation can be practiced at no cost.

Laughter : Science is looking more closely at the effects of “happy” laughter, that is, laughter caused by happiness, not laughter that is the result of emotions such as shame and anxiety.

While it’s easy to see how laughter can improve mood, many researchers are finding evidence that lighthearted laughter can, in fact, boost the immune system. More research is needed to elucidate the positive aspects of laughter.

Acupuncture: The term acupuncture describes a set of procedures that involve the stimulation of anatomical points on the body through a variety of techniques . American acupuncture practices incorporate medical traditions from China, Japan, Korea, and other countries.

The most scientifically studied acupuncture technique consists of penetrating the skin with fine, solid metal needles that are manipulated with the hands or by electrical stimulation.

Acute pancreatitis and pregnancy

Acute pancreatitis is defined as sudden inflammation of the pancreas manifested clinically by abdominal pain, nausea, and dehydration that is usually self-limited but can occasionally progress to serious illness and even death.

There are many causes of acute pancreatitis, the two most common being alcohol use and gallbladder / bile duct disease. In this review, we will discuss the specific case of acute pancreatitis in pregnancy.

While acute pancreatitis is responsible for nearly 1 in 200 hospital admissions in the United States annually, the rate of acute pancreatitis in pregnancy is fortunately rare.

Acute pancreatitis is estimated to occur in approximately 1 in 10,000 pregnancies, however this rate varies by region and type of hospital. Most cases of acute pancreatitis in pregnancy are caused by gallstone disease.

It is believed that with the weight and hormonal changes induced by pregnancy, gallstones are more likely to form and travel through the common bile duct to obstruct the flow of the pancreatic duct.

Another proposed mechanism for acute pancreatitis in pregnancy is high levels of fat in the blood called triglycerides. Again, the hormonal changes of pregnancy can predispose certain women to developing this condition.

When triglyceride levels become too high, oxygen cannot properly travel to the pancreas through the bloodstream and pancreatitis can occur.

Of course, all the other reasons for developing acute pancreatitis (alcohol use, reaction to certain medications, and trauma to the pancreatic duct) can also lead to acute pancreatitis in pregnancy.

Treatment of acute pancreatitis in pregnancy

Treatment of acute pancreatitis in pregnancy is similar to that of nonpregnant patients with a few exceptions. The digestive tract should be rested by not eating, pain control and aggressive fluids given through an IV are essential.

Generally, if the cause is gallstone pancreatitis, gallbladder removal is deferred until after pregnancy. Often times, a stent can be placed in the bile duct to time the situation until a surgical resection is needed.

However, if it is not possible to wait until the end of the pregnancy, surgical resection can usually be done safely.

If triglycerides are the cause of acute pancreatitis, certain medications and dietary modifications can be used to help prevent recurrent attacks.

However, if the attack occurs late, in the third trimester, delivery is generally recommended, as this will cause an immediate decrease in the triglyceride level. Other causes of acute pancreatitis, such as traumatic ductal injury, must be carefully evaluated on an individual basis.

Outcomes of acute pancreatitis in pregnancy

Fortunately, the maternal mortality rate is less than 1% for acute pancreatitis in pregnancy. The preterm birth rate, however, is about 20%. Also in patients with non-biliary pancreatitis, the preterm delivery rate appears to be somewhat higher.

It is very important, therefore, that pregnant patients report to the emergency room as soon as possible for evaluation in case they develop any symptoms of abnormal abdominal pain.

Conclusions

Although it is a rare event, acute pancreatitis occurs during pregnancy. Fortunately, if treated early, preterm labor can generally be avoided and the incidence of recurrent attacks minimized.