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Pancreatitis

July 6th, 2009

Pancreatitis simply means inflammation of the pancreas. Located in the upper part of the abdomen, behind the stomach, the pancreas plays an important role in digestion.

Inflammation of the pancreas has various causes. Once the gland becomes inflamed, the condition can progress to swelling of the gland and surrounding blood vessels, bleeding, infection, and damage to the gland. There, digestive juices become trapped and start “digesting” the pancreas itself. If this damage persists, the gland may not be able to carry out normal functions.

Pancreatitis may be acute (new, short-term) or chronic (ongoing, long-term). Either type can be very severe, even life threatening. Either type can have serious complications.

Acute pancreatitis usually begins soon after the damage to the pancreas begins. Attacks are typically very mild, but about 20% of them are very severe.

Chronic pancreatitis begins as acute pancreatitis. If the pancreas becomes scarred during the attack of acute pancreatitis, it cannot return to its normal state. The damage to the gland continues, worsening over time.

About 80,000 cases of acute pancreatitis occur in the United States each year. Pancreatitis can occur in people of all ages, although it is very rare in children. Pancreatitis occurs in men and women, although chronic pancreatitis is more common in men than in women.

Alcohol abuse and gallstones are the two main causes of pancreatitis, accounting for 80%-90% of all cases.

Pain is a major symptom in acute pancreatitis, and it is usually quite intense and steady, located in the upper abdomen, and radiating to the patient’s back. Nausea and vomiting and abdominal swelling are also common symptoms. A patient will often have a slight fever, with an increased heart rate and low blood pressure.

Patients with acute pancreatitis are at risk of complications related to shock, a very serious syndrome that occurs when the blood pressure is too low to get adequate circulation to critical organs. Without adequate blood pressure, organs are deprived of oxygen, nutrients, and waste removal and may not function well. Kidney, respiratory, and heart failure are serious possible outcomes of shock.

Even if shock does not occur, circulating pancreatic enzymes and related toxins can cause damage to the heart, lungs, kidneys, lining of the gastrointestinal tract, liver, eyes, bones, and skin. As the pancreatic enzymes affect blood vessels, the risk of blood clots increases. When blood flow is blocked by clotting, the supply of oxygen is further decreased to various organs and additional damage done.

Other serious complications of acute pancreatitis include pancreatic necrosis, abcess, and pseudocyst formation. Pancreatic necrosis occurs when a significant portion of the pancreas is permanently damaged during an acute attack. Pancreatic necrosis has an increased risk of death and an increased chance of pancreatic infection. A pancreatic abscess is a local collection of pus that may develop several weeks after the illness subsides. Another late complication of pancreatitis, occurring several weeks after the illness begins, is called a pancreatic pseudocyst, which occurs when dead pancreatic tissue, blood, white blood cells, enzymes, and fluid leaked from the circulatory system accumulate. Pseudocysts cause recurrent abdominal pain and also press on other nearby structures in the gastrointestinal tract, causing disruption of function. Pseudocysts are life threatening when they become infected (abscess) and rupture. Simple rupture of a pseudocyst causes death 14% of the time, but rupture complicated by bleeding causes death 60% of the time.

In very severe cases of pancreatitis, called necrotizing pancreatitis, the pancreatic tissue begins to die, and bleeding increases. Due to the bleeding into the abdomen, two distinctive signs may be noted in patients with necrotizing pancreatitis. Turner’s sign is a reddish-purple or greenish-brown color to the area between the ribs and the hip (flank). Cullen’s sign is a bluish color around the navel.

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