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Acute pancreatitis is a medical condition in which patients develop inflammation in their pancreas, resulting in severe pain in the abdomen, tenderness in the stomach, indigestion, etc. The annual mortality due to acute pancreatitis is recorded to be 1.16 per 10,000 population . And, India is the top country in terms of acute pancreatic cases (618,862.3) .
Although the major reasons for acute pancreatitis are alcohol abuse and gallstone formation, risk factors like genetic mutation and pancreatic abnormalities can make you vulnerable to this disease. Delay in treatment may lead to further complications like damage to blood vessels, internal bleeding, necrosis in the pancreas, etc.
Here’s a quick glance at the symptoms and complications to look out for and the treatment you could undergo.
|Symptoms||Severe abdominal pain, indigestion, vomiting, sickness, fever, yellowing of the skin and sclera, tendered tummy, increased heartbeats, rapid breathing, etc.|
|Complications||Pancreatic pseudocyst, acute peripancreatic fluid, necrotic collections, walled-off necrosis, haemorrhagic pancreatitis, thrombosis, pseudoaneurysm, abdominal compartment syndrome, cardiac disease, lung disease, etc.|
|Causes||Gallstones, alcohol consumption, hypertriglyceridemia, trauma in the pancreas, genetic mutation, infections, certain drugs, hypercalcemia, vascular diseases, pancreatic abnormalities, malignancies, autoimmune pancreatitis, idiopathic pancreatitis|
|Onset||There is no particular time frame after which you can develop the symptoms of this acute pancreatitis|
|Diagnosis||Physical examination, laboratory-based diagnosis of amylase and lipase, CT scan, MRI scan, ultrasound scan|
|Prevention||Taking a balanced diet, avoiding foods high in fatty acid, controlling body weight, cutting down alcohol consumption|
|Medication||Intravenous or IV fluid, antibiotics, painkillers, nutritional supplements|
The major symptom of acute pancreatitis is a sudden arousal of extreme pain in the middle of your stomach or abdomen. The pain worsens with time and can gradually spread toward your back.
Following are the associated symptoms that you can witness due to acute pancreatitis :
Drinking or eating may worsen your pain. The severity can be more pronounced if you eat food items with high-fat content. However, you may get temporary relief from your stomach pain if you lean forward or lie prostrate. On the other hand, if you lie on your back, keeping your face upward, you may feel a severe aching in your stomach.
There may be several reasons for acute pancreatitis, but if your gallstone leads to the development of this medical condition, you will feel the severity of this condition particularly after taking a heavy meal. In the case of alcoholic acute pancreatitis, the pain starts after 6-12 hours of excessive drinking.
The causes of acute pancreatitis are easily identifiable in around 75% – 85% of the total cases. Following are some major reasons that lead to the development of this type of inflammation in the pancreas :
Gallstone formation is the most frequent cause of acute pancreas and almost 28% – 38% of the cases are due to this reason . The development of gallstone and its subsequent migration obstruct the ducts, including the duodenum. As a result of this obstruction, there is pressure on the ducts, which thereby leads to the secretion of digestive enzymes from the pancreas in an unregulated manner.
Alcohol consumption is the second most prominent cause of acute pancreatitis. Nevertheless, there is no scientific reason demonstrating how this alcohol abuse causes swelling or inflammation in patients’ pancreas. Studies have found a mutation in genes that inhibit trypsin secreted from the pancreas that can possibly indicate towards a connection.
Hydrolysis of overly secreted triglycerides can result in highly concentrated fatty acids. It can cause injury in the acinar cells and vascular inner cellular linings of the pancreas. This pancreatic damage can lead to the formation of perpetual acidic surroundings in the pancreas, which can subsequently cause the symptoms of acute pancreatitis.
A blunt trauma to your gut may eventually cause acute pancreatitis. The prevalence of this disease in association with abdominal trauma is around 0.2% to 12%. If there is any suspicion about or chances of abdominal trauma, you need to undergo the required diagnostic procedures and ensure proper treatment so that you do not develop this medical condition.
Genetic mutations, especially in fibrosis genes or phenotypic genotypes, also increase the risk of acute pancreatitis. Besides this, you can be more vulnerable in case you have a family history of patients with this disease. Autosomal dominance of the hereditary factor of acute pancreatitis can be the result of a mutation in the trypsinogen gene.
Studies have also found that infections caused due to parasites, fungi, viruses, bacteria, or other pathogens can subsequently result in acute pancreatitis. Among these, viral infection is the leading cause of this medical condition.
Although drug-induced acute pancreatitis is unusual, there are many instances of such cases. Use of medications like sulfonamides, didanosine, diuretics, tetracycline, pentamidine, oestrogen, azathioprine, and steroids can lead to the development of this illness. You may witness acute pancreatitis due to prolonged consumption of these medicines as they can cause immunological reactions, toxic effects, ischemia, etc.
Hypercalcemia or a high concentration of calcium within your body may result in toxicity and subsequent cell damage. It may cause damage in your pancreas and thereby result in the development of acute pancreatitis.
Ischemia or chronic restriction of blood flow in your pancreas can also lead to acute pancreatitis. The ischemia can occur due to several reasons, including shock, atheromatous embolization, and rheumatological disease.
There are also some other rare causes of acute pancreatitis as mentioned below:
There are three types of acute pancreatitis categorised according to their severity :
Besides this, there is also another classification of acute pancreatitis according to its inflammation. These are as stated below:
Acute pancreatitis causes severe abdominal pain and other associated symptoms like vomiting and fever. All these may leave no choice for patients but to initiate the treatment process or hospitalise even before diagnosis. So, patients generally need to undergo the diagnosis while they are in the hospital itself . If it is otherwise, for example, if they are not under the supervision of an expert prior to the diagnosis, they should immediately contact a certified expert.
Early detection and treatment can help individuals avoid serious complications of acute pancreatitis including internal bleeding within gastrointestinal tracts, necrosis of pancreatic tissues, etc. This way, the inflammation can heal quickly.
Usually, patients undergo a medical diagnosis process for acute pancreatitis during their in-patient care at hospitals. Doctors suggest different types of diagnostic processes according to symptoms and complications assessed after physical examination.
Following are some of the tests that you need to undergo for the diagnosis of acute pancreatitis :
Patients with this medical condition suffer intensely due to excruciating abdominal pain along with palpation and tenderness. When doctors see such symptoms, they refer to laboratory-based diagnostic techniques to know whether the patient has developed acute pancreatitis.
A biochemical test can also help in finding whether the cause of a painful stomach and other symptoms are the results of acute pancreatitis. In this process, serologists check inflamed tissues to get the trace of pancreatic enzymes like Amylase and Lipase within them. If these organic chemicals are present at much higher than their normal levels, they can infer that the concerned individual has developed acute pancreatitis.
Doctors may also suggest the following three types of imaging diagnosis processes for acute pancreatitis :
These images help doctors to understand whether you have any inflammation in the pancreas.
A major prognosis of acute pancreatitis is a reduction in the efficiency of the exocrine and endocrine glands in the pancreas. Almost 20% – 30% of patients suffer from this issue. Your body fails to secrete sufficient digestive enzymes due to the damage to pancreatic parenchyma or acinar cells in pancreatic ducts .
Further, you can also witness a recurrence of acute pancreatitis. A study has observed the recurrence of acute pancreatitis in almost 21% of patients . The risk of this recurrence depends on several factors, including the cause and severity of your first onset, the degree of structural damage to the organs, etc.
Following are the different treatment processes and medications for acute pancreatitis treatment :
After you get your complication under control, you should ideally follow the below-mentioned follow-up techniques so that your medical conditions do not aggravate:
You should avoid alcohol after recovering from acute pancreatitis, especially if it is the cause of this medical condition. If you are addicted to it, you need to get the assistance of a specialist doctor while undergoing the de-addiction process. You can take counselling, join a self-help group, or use medicines like acamprosate to streamline your de-addiction process.
If a gallstone is the reason behind your acute pancreatitis, your doctor will perform an endoscopy to remove it. In this process, a surgeon inserts a long and thin tube inside your abdominal cavity to pluck and remove the stone. In this regard, you also need to know that after this endoscopy you should ideally avoid spicy and fatty foods as they may become difficult for you to digest.
Alcohol consumption and gallstone are two major reasons for developing acute pancreatitis. Therefore, you need to take measures so that these do not become the potential cause of this medical condition.
Here are the ways you can follow for prevention of acute pancreatitis :
Maintaining a balanced diet is the most effective measure that you can take to reduce your chances of forming gallstones. You need to ensure that your regular diet consists of a significant proportion of vegetables and fruits. Besides, it must include foods made from whole grains, including oats, brown rice, wholemeal bread, etc. This will also significantly reduce your body’s cholesterol levels, which has a distinct correlation with the development of gallstones.
You also need to reduce your intake of foods that have a high proportion of fatty acids to reduce the risk of forming a gallstone. For example, studies have found that meat, one of the major sources of saturated fatty acid, can increase the risk of developing gallstones .
You may run the risk of developing a gallstone in case you are overweight. With regular exercise and maintenance of a balanced diet according to a nutritionist, you can maintain proper and healthy body weight.
Alcohol is one of the major reasons behind developing acute pancreatitis. You should ideally minimise alcohol intake for the prevention of this medical condition. Nevertheless, if you have already suffered from acute pancreatitis once due to your alcohol abuse, you should completely refrain from drinking.
There are different categories of complications of acute pancreatitis, as mentioned below :
Following are some major local complications of acute pancreatitis:
In the pancreatic pseudocyst, you can develop inflammation on your pancreatic walls with almost no sign of necrosis. There is also an accumulation of fluid within the organ. This cyst may erupt within 4 weeks of the initial onset of interstitial oedematous pancreatitis.
In this complication, there is an accumulation of homogeneous fluids without any clear sign of inflammation on the walls of the pancreas. Further, the chances of getting necrosis are also negligible. Like pancreatic pseudocyst, it also occurs within 4 weeks of developing interstitial oedematous pancreatitis.
This complication is related to necrotizing pancreatitis. Along with a collection of fluid, doctors can find clear signs of necrosis or death of healthy tissues through a CT scan. You can start experiencing damage in your pancreatic and peripancreatic tissues.
Walled-off necrosis refers to a medical condition in which doctors can diagnose necroses with clear inflammatory walls. You may develop this medical condition after 4 weeks of the onset of necrotising pancreatitis.
It is a rare complication of pancreatitis. The pancreatitis haemorrhage occurs due to ruptured pseudoaneurysms resulting from necrosis and consequent bleeding. This complication can also lead to the mortality of patients. Early detection and surgical embolization can reduce this risk of mortality.
Following are some peripancreatic complications that patients have to deal with:
Patients with acute pancreatitis become vulnerable to other health conditions like cardiac, hepatic, nephrogenic and lung disease.
The average expenses of treating acute pancreatitis can range between Rs.2,000 and Rs.55,000, depending on the required medical facilities. Various factors like charges of doctors or clinics, hospitalisation costs, treatment methods, etc., can influence the overall expenditure of treatment.
Acute pancreatitis is an inflammation that develops suddenly in the pancreas, causing intense pain in your abdomen. It is necessary that you start the treatment process in a specialised hospital as soon as possible to prevent complications.
In the treatment procedure, you may need to take fluids, oxygen support, nutritional supplement, and medicines like antibiotics and painkillers. Furthermore, in case a gallstone is the cause of acute pancreatitis, you need to undergo a surgical process to remove that from your gallbladder as soon as the medical issues come under control.
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Following are the different viral and bacterial infections that can lead to the development of acute pancreatitis: Infection caused due to viruses like Cytomegalovirus, Coxsackie virus, Echovirus, Hepatitis A/B/C virus, HIV, Epstein-Barr virus, Rubella virus, Varicella virus, and Mumps virus Infections caused due to bacteria like Legionella, Campylobacter jejuni, Mycobacterium tuberculosis, Mycobacterium avium, Leptospirosis, and Mycoplasma
Yes, if you develop a severe infection caused by parasites like Cryptosporidium, Ascaris lumbricoides, Microsporidia and Clonorchis sinensis, you can be vulnerable to acute pancreatitis.
Following are the certified medical experts you may need to get in touch with while undergoing the treatment process for acute pancreatitis, depending on the severity of your medical condition: General surgeon Endocrinologist Gastroenterologist Pulmonologist Radiologist Intensivist
Some symptoms that can lead doctors to recommend more specific diagnostic tests processes for acute pancreatitis are: Renal colic Peptic ulcer disease Cholangitis Bowel perforation Bowel obstruction Cholecystitis Acute hepatitis Mesenteric ischemia Basilar pneumonia Diabetic ketoacidosis Aortic dissection Myocardial infarction
Chronic pancreatitis is an inflammatory disease, progressive in nature, which can cause permanent damage to the endocrine and exocrine parenchyma of the pancreas. As a result, patients can witness intense pain in the abdomen. It also leads to complications like malabsorption and diabetes mellitus.
The global rate of transition from the onset of acute pancreatitis to its recurrence is 20%. Whereas the transition rate from recurrent to chronic acute pancreatitis is 35%.
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