Q&A on Acute Pancreatitis Causing Abdominal Pain| Causes,Tests,Treatment,Recovery
My Abdominal Pain is Excruciating, Am I Suffering with Pancreatitis?
Palpation and percussion of epigastric xiphoid process causes excruciating abdominal pain in patients suffering with acute pancreatitis. This test is known as Kamenchik's sign. You may also feel severe pain with examination of back below 12th rib near vertebral column. The sign is known as Mayo-Robson's sign.
What is Acute Pancreatitis?
Pancreatitis is either acute or chronic. If you get a severe abdominal pain first time because of inflammation of pancreas, you are suffering with acute pancreatitis. Acute pancreatitis is an inflammation of pancreas.
What is Chronic Pancreatitis?
Chronic pancreatitis is a disease causing frequent and repeated episode of pancreatitis.
Watch 3D Video of Chronic Pancreatitis, Its Causes and Symptoms:
What are the Common Causes of Acute Pancreatitis?
Inflammation of pancreas is often after alcoholism, gallstones, following ERCP1, abdominal trauma, penetrating gastric or duodenal ulcers, malignancy, viral infections, a duodeno-pancreatic neural reflex2 and medications.
Which Viral Infection Causes Acute Pancreatitis?
Which Medications May Cause Acute Pancreatitis?
Diuretics such as thiazides and furosemide, tetracycline, sulfonamides, estrogens, azathioprine and mercaptopurine are known to cause acute pancreatitis.
What is the Most Common Cause of Acute Pancreatitis?
Alcoholism is the most common cause of pancreatitis and pancreaticobiliary malformation3.
What are the Other Symptoms of Acute Pancreatitis?
There are other symptoms that may be associated with pain like nausea, vomiting, diarrhea, fever and chills.
Is There any Classic Sign of Acute Pancreatitis, Which Could Diagnose Pancreatitis During Clinical Examination?
You may have discoloration over the flank because of retroperitoneal hemorrhage. The specific sign is known as Grey-Turner sign. Occasionally you may see a hemorrhagic discoloration around umbilicus known as Cullen's sign.
Why is There a Hemorrhage During Acute Pancreatitis?
Inflammation of pancreas causes activation of pancreatic enzyme. Pancreatic enzyme lipase causes necrosis of fat and blood vessels. Blood vessel necrosis results in hemorrhage4. Pancreas is not enclosed by a capsule like most of the abdominal organs. Lack of capsule causes blood to drain into surrounding retroperitoneal tissue, muscles and subcutaneous tissue.
Which is the Reliable Diagnostic Test For Acute Pancreatitis?
Reliable diagnostic test is elevation of lipase and amylase in blood serum. Amylase level is often increased in other abdominal illnesses. Pancreatitis is diagnosed when lipase level is 2.5 to 3 times higher than amylase level. Serum lipase is normal when amylase is increased in other abdominal diseases causing abdominal pain.
Is There a Test Which Can Help Differentiate Between Mild Acute Pancreatitis and Severe Pancreatitis?
CAT scan study can differentiate mild acute pancreatitis from severe pancreatitis. Triple phase abdominal CT study is special study and considered as gold standard to evaluate acute pancreatitis.
Why is It Important to Diagnose Acute Pancreatitis Earlier?
Acute pancreatitis can phase into chronic pancreatitis if not treated earlier. Chronic pancreatitis is terrible disease causing several episodes of chronic intractable pain.
What is the Treatment For Acute Pancreatitis?
Acute pancreatitis is necrotic or non-necrotic in nature. Non-necrotic acute mild pancreatitis is treated with fasting and aggressive I.V. fluid5. Acute severe pancreatitis is treated with admission in ICU, I.V. fluid, nutritions6 and may be even surgery.
Pain management of Acute Pancreatitis involves treatment using morphine rather than meperidine. Morphine was contraindicated in the past because of spasm of sphincter of odi induced by morphine. Recent study indicates morphine is better analgesic than meperidine and recommended for treatment of acute pancreatitis. Most of the patients suffering from acute pancreatitis are treated with antibiotics. Most of the patients are also treated with Endoscopic Retrograde CholangioPancreatography (ERCP).
What is ERCP (Endoscopic Retrograde CholangioPancreatography)?
ERCP1 (Endoscopic Retrograde Cholangio Pancreatography) is endoscopic surgery. If patient suffering from acute pancreatitis is not showing any improvement within 24 to 48 hours after initial treatment ERCP is recommended. ERCP is performed within 48 to 72 hours after diagnosis of pancreatitis.
What Are The Indications For ERCP (Endoscopic Retrograde CholangioPancreatography) in Patients Suffering From Acute Pancreatitis?
ERCP is indicated if investigations indicate presence of stones in common bile duct and intrahepatic or extrahepatic duct is dilated.
What are the Chances of Complete Recovery from Acute Pancreatitis?
Most of the mild pancreatitis patients recover completely. Recovery depends on severity of pancreatic inflammation. Severe pancreatitis causes severe necrosis and pancreatic damage. Twenty percent of acute pancreatitis is severe and mortality rate is 20% in this group.
What are the Complications of Acute Pancreatitis?
Complications are rare in patients suffering with acute pancreatitis. Complications observed are as follows:
Pancreatic abscess, pseudocyst, duodenal obstruction, ARDS (acute respiratory distress syndrome), DIC (disseminated intravascular coagulation) and metabolic abnormalities.
What are the Metabolic Abnormalities In Patients Suffering From Acute Pancreatitis?
Metabolic abnormalities are low calcium in blood (hypocalcaemia), hyperglycemia (high blood sugar) and insulin dependent diabetes mellitus caused by beta cell damage. Beta cell secretes insulin and damage to beta cells result in low insulin secretion resulting in diabetes.