Acute Pancreatitis Treatment in Mumbai, India

Acute Pancreatitis is the inflammation of the pancreas, an essential organ of the digestive system. The pancreas produces enzymes that help digest food and also makes hormones that maintain your blood glucose levels. Pancreatitis usually results from years of alcohol abuse or gallstones, which are stones that develop in the gallbladder. The gallbladder is located close to the pancreas anatomically. If left untreated, acute pancreatitis may result in complications.

Associated Anatomy

Pancreas

Acute Pancreatitis Symptoms

• Abdominal pain below the ribs is the main symptom. It usually speeds up quickly and may last for several days. The pain may become sudden and intense, radiating to the back and spine. The pain may be aggravated by eating.
• Nausea and vomiting
• High fever and infection-like symptoms
• Swollen abdomen, which is tender to touch
• Dehydration
• Low blood pressure
• Rapid heartbeats and pulse rate

Acute Pancreatitis Causes

Pancreatitis usually occurs when the body's digestive enzymes are activated without being released from the pancreas, thus irritating the pancreatic cells. This results in inflammation. The most common causative factors for this include:

• Gallstones - The gallbladder and the pancreas share a common duct that allows them to pass on their enzymes into the digestive system, specifically the intestinal area. When gallstones form, they obstruct this duct; hence the active enzymes of the pancreas come in contact with the pancreatic cells themselves and cause injury.
• Chronic Alcoholism - Alcohol abuse makes the pancreatic cells much more sensitive to damage by other factors.
• High Triglyceride Levels in The Blood (Hypertriglyceridemia) - This reports causing at least 1-4% of all cases of acute pancreatitis.

Other uncommon factors include:

• Certain medications
• High calcium levels in the blood (hypercalcemia), which may be caused by an overactive parathyroid gland (hyperparathyroidism)
• Pancreatic cancer
• Abdominal surgery
• Cystic fibrosis
• Infections of the Pancreas
• Trauma leading to injury of the abdomen
• Obesity, etc.

Repeated cases of acute pancreatitis eventually develop into chronic pancreatitis. This may cause the accumulation of scar tissue in the pancreas and hamper its function.

Sometimes, a cause for pancreatitis is not detected. This condition is known as idiopathic pancreatitis.

Acute Pancreatitis Stages

Acute pancreatitis is divided into different stages based on its severity.

• Mild Acute Pancreatitis: There is no visible organ failure in this stage, and systemic or local complications are absent. There is a meager mortality rate among patients.
• Moderately Severe Acute Pancreatitis: There may be the presence of temporary and treatable organ failure or certain local complications.
• Severe Acute Pancreatitis: This stage shows persistent organ failure, escalating into multi-organ failure. There may be the presence of systemic complications, and necrosis may develop.

Acute Pancreatitis Additional Type

Repeated occurrences of acute pancreatitis may escalate into chronic pancreatitis. This is characterized by impaired pancreatic function. Therefore, the patient may observe an inability to digest food which may have affected blood sugar levels as the pancreas fails to properly produce blood sugar-lowering hormones.

Acute Pancreatitis Treatment

Acute pancreatitis treatment depends on its severity. The treatment usually involves creating an environment where the pancreas can heal itself for acute pancreatitis. This includes:

• Painkillers: The primary symptom, abdominal pain, is treated using painkillers.
• IV Nutrition: Since eating solid foods may aggravate the pancreas, you may be fed through a feeding tube or using IV nutrition.
• Antibiotics: If the doctor suspects an infection, they may prescribe antibiotics.

Hospitalization may be required to prevent complications. Suppose the inflammation does not subside using these acute pancreatitis treatments. In that case, the doctor may recommend laparoscopic surgeries like Endoscopic retrograde cholangiopancreatography (ERCP), where a small tube is inserted to break down the gallstones.

If any scar tissue or diseased tissue is developed, further invasive surgery may be needed.

Acute Pancreatitis Risk Factors

• Excessive alcohol consumption: While alcohol abuse does not directly cause acute pancreatitis, it makes your body cells much more sensitive to damage due to other factors
• Cigarette smoking: Chain smokers are three times more likely to develop chronic pancreatitis than nonsmokers. Cutting cigarette smoking can reduce this by more than half.
• Obesity: Obesity causes your body to increase digestive enzymes, thus increasing the risk of the pancreatic cells coming in contact with them directly.
• Diabetes: Diabetes increases the risk of fluctuating blood sugars and is a considerable risk factor for pancreatitis.
• Genetic factors: A family history of pancreatitis may make a person more prone to developing acute pancreatitis later in life.

Acute Pancreatitis Complication

Acute pancreatitis may lead to complications such as kidney failure, organ failure, pancreatic cancer, malnutrition, diabetes, pseudocysts, or other blockages of the pancreatic ducts. There may also be elevated inflammatory cytokines present in the body, which may cause systemic complications.

Test Required for Acute Pancreatitis

Acute Pancreatitis is best diagnosed by the Serum Lipase test, part of the Pancreas Function Test (PFT). If the lipase levels are detected at 3x or more than the normal range, acute pancreatitis primarily appears. The levels increase within 4-8 hours of acute pancreatitis and remain high for 8-14 days.

Acute Pancreatitis Prevention

Primary Prevention

Primary prevention for acute pancreatitis includes preventing its causes and risk factors. These include:

• Avoiding the use of aspirin in children
• Avoiding alcohol abuse,
• Opting for genetic counseling for cystic fibrosis,
• Immunization against mumps,
• Proper safety precautions to prevent abdominal trauma
• Avoid Endoscopic retrograde cholangiopancreatography (ERCP) surgery in patients who don’t need it

Secondary Prevention

If acute pancreatitis is not treated correctly, it may persist and result in chronic pancreatitis. After the first bout of pancreatitis, doctors recommend:

• Cholecystectomy - removal of the gall bladder to prevent gallstones
• Alcohol abstinence - To prevent alcohol-induced damage to the pancreas
• Suspending triggering medications - Doctors recommend replacing medicines that aggravate pancreatitis
• Weight control - to avoid overproduction of digestive enzymes

Acute Pancreatitis Diagnosis

Acute Pancreatitis needs to be differentiated from gallstones, pancreatic cysts or pancreatic pseudocysts, and chronic pancreatitis. The typical distinguishing tests are:

• Serum lipase test
• Imaging tests like Ultrasound
• CT/MRI scans
• Leukocytosis detection
• Epidemiology

In India, the most common cause of Acute Pancreatitis is gallstones blocking the pancreatic duct. In India, the occurrence is 7.9 cases per 100,000 people, and men are at higher risk than women for acute pancreatitis.

Acute Pancreatitis Prognosis

Expected Prognosis

• Mild acute pancreatitis typically has a low mortality rate, and most patients recover easily within 5-10 days.
• Severe pancreatitis is also treatable if acknowledged at the right time and not allowed to progress.

Natural Progression

• If allowed to progress without treatment, acute pancreatitis usually escalates into severe acute pancreatitis or chronic pancreatitis.
• This may result in severe malnutrition as the pancreas’ function may be impaired and lead to diarrhea and weight loss.
• Further escalation can be in complete organ failure of the pancreas.

Pathophysiology

The pathophysiology of acute pancreatitis is characterized by an absence of intracellular and extracellular compartmentalization and blockage of pancreatic transport due to gallstones. There is also increased activation of pancreatic enzymes. Cell membranes may have functional alterations, and cell destruction may occur.

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