What Causes Necrotizing Pancreatitis & How is it Treated? | Symptoms and Diagnosis of Necrotizing Pancreatitis

What is Necrotizing Pancreatitis?

Necrotizing Pancreatitis is a condition that arises when the pancreatic tissue gets necrosed as a result of inflammation. In cases of Necrotizing Pancreatitis, at times the bacteria spreads to the necrosed tissue causing infection. Anatomically speaking, pancreas is located behind the stomach. The function of the pancreas is to produce enzymes that aid in digestion. Normally, these enzymes are passed through duct in the small intestine. However, if the pancreas get inflamed these enzymes start leaking into the pancreas and start to destroy the pancreatic tissues. This inflammation is termed as pancreatitis.[2]

If the inflammation is extremely severe, the supply of oxygen is cut off at some parts of the pancreas causing necrosis of the tissues of the pancreas. This is what is termed as Necrotizing Pancreatitis.[2]

According to experts, Acute Pancreatitis is an extremely common presentation and stands at the 12th position when it comes to people coming to the emergency room with gastrointestinal symptoms in the United States. These numbers have increased by more than 10% since 2006 and additionally there is approximately 0.5% mortality rate.[1]

This condition can range from mild to severe in intensity. If pancreatitis is severe then it can cause a variety of complications, including tissue necrosis. For Acute Pancreatitis to be severe the patient should have multiple organ failure for more than 48 hours with an extremely high mortality rate of 25%. For a patient to be diagnosed with Necrotizing Pancreatitis more than 30% of the gland should be affected by necrosis.[1]

What Causes Necrotizing Pancreatitis?

As stated, Necrotizing Pancreatitis is a complication of severe acute pancreatitis. Generally, it occurs when acute pancreatitis remains untreated or the treatment is rendered ineffective. Alcohol abuse is the primary cause of pancreatitis. Gallstones are yet another cause for pancreatitis.[2]

Pancreatitis is classified into two types, namely acute pancreatitis and chronic pancreatitis. Acute pancreatitis occurs when the symptoms develop out of the blue. Research suggests that around 20% of the cases of pancreatitis are acute in nature and majority of the complications are due to this form of pancreatitis.[2]

Chronic pancreatitis on the other hand occurs when the symptoms of pancreatitis wax and wane and flare up from time to time. There have been rare instances when chronic pancreatitis has led to Necrotizing Pancreatitis.[2]

In the United States more than half of the cases of acute pancreatitis leading to Necrotizing Pancreatitis are caused by gallstones and 25% are due to alcohol abuse. Some of the other causes of Pancreatitis include pancreatic injury, pancreatic tumor, hypercalcemia, hypertriglyceridemia, or due to certain medications causing pancreatic damage. Certain medical conditions like cystic fibrosis and some autoimmune conditions may lead to Necrotizing Pancreatitis.[2]

What are the Symptoms of Necrotizing Pancreatitis?

Abdominal pain is the primary symptom of necrotizing pancreatitis. The pain may be felt near the stomach, around the back, or the front of the abdomen. The intensity of the pain can be extremely severe that may last for a few days. At times, there is also swelling of the abdomen, fever, nausea, vomiting and dehydration. Some people also have hypotension and tachycardia.[2]

If Necrotizing Pancreatitis is not treated then the bacterial infection may cause sepsis which can be potentially life threatening. There have been cases where Necrotizing Pancreatitis results in pancreatic abscess.[2]

How Is Necrotizing Pancreatitis Diagnosed?

The diagnosis of Necrotizing Pancreatitis begins with a detailed physical examination exploring the area where the patient complains of pain. If pancreatitis is suspected then further tests will be ordered in the form of pancreatic enzyme levels, and levels of sodium, potassium, and glucose. The triglyceride levels will also be checked.[2]

Additionally, abdominal ultrasound, CT and MRI scan of the abdomen. All these tests and laboratory analysis will clearly show that some part of the pancreas has necrosed and the diagnosis of Necrotizing Pancreatitis is confirmed.[2]

How is Necrotizing Pancreatitis Treated?

Necrotizing Pancreatitis is treated in two stages. First the pancreatitis is treated and then the part of the pancreas that is necrosed is treated separately. For treating pancreatitis, the physician uses medications in the form of pain killers along with IV fluids, plenty of rest, antiemetics, and NG tube feeding in some extreme cases. NG tube feeding allows the pancreas to heal as the food directly goes into the stomach through the tube.[2]

For treating the necrosed pancreatic tissue, this is usually done surgically by removing the necrotic tissue. If there is presence of infection, then a course of antibiotics will also be prescribed. Removal of the necrotic pancreatic tissue is done by inserting a catheter into the abdomen. The tissue is then removed by way of this catheter. If this procedure is not successful then an open surgery may have to be performed.[2]

Studies suggest that three weeks after the onset of the condition is the best time to perform surgery for Necrotizing Pancreatitis. However, this can be done sooner depending on the severity of the disease. Additionally, the patient has to be monitored to ensure that sepsis does not develop due to Necrotizing Pancreatitis. In case sepsis is found then it will have to be treated emergently. For this, the physician will give IV fluids, antibiotics and artificial breathing for people who have trouble with shortness of breath.[2]

Sepsis however can be prevented if Necrotizing Pancreatitis is diagnosed and treated early. Coming to the prognosis, diagnosing and treating the condition early is the key for a good outcome.[2]

If proper treatment is not given in a timely fashion then complications like sepsis may occur which can pose a threat to the life of the patient. Necrotizing Pancreatitis is a treatable condition and with proper and timely treatment there is a high likelihood of complete recovery and returning back to normal function. It is also essential for people diagnosed with this condition to make certain lifestyle changes so as to prevent future recurrences and prevent further damage to the pancreas due to Necrotizing Pancreatitis.[2]

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