Pancreatitis means inflammation of the pancreas. There are two types:
Between 13-45 in 100,000 people have acute pancreatitis each year in the UK. Acute pancreatitis has become more common in recent years. One of the reasons for this is that there has been an increase in the incidence of obesity. Also, increases in the availability and use of laboratory tests have made the condition easier to diagnose. People with acute pancreatitis tend to experience the following symptoms:
Acute pancreatitis can cause you to be very poorly and can even be life-threatening. You will need to be admitted to hospital if your doctor suspects that you have acute pancreatitis. There are lots of causes of tummy (abdominal) pain and being sick (vomiting) so tests are done to rule out other problems and to confirm the diagnosis. Blood tests can check the blood level of amylase and/or lipase (these are digestive enzymes made by the pancreas). Although not 100% reliable, a high blood level of these enzymes strongly suggests that pancreatitis is the cause of your symptoms. An ultrasound scan may be done to look for a gallstone if this is the suspected underlying cause. Other types of scans such as CT scans may be needed if an ultrasound scan does not give a clear answer. If you have severe tummy pain that you haven't had before, you should always have it checked by a doctor quickly. If you also have vomiting and fever, or feel generally unwell, contact your GP immediately or, if in the UK, call 111 out of surgery opening hours. The pancreas is in the upper abdomen (tummy) and lies behind the stomach and guts (intestines). It makes a fluid that contains chemicals (enzymes) which are needed to digest food. The enzymes are made in the pancreatic cells and are passed into tiny tubes (ducts). These ducts join together like branches of a tree to form the main pancreatic duct. This drains the enzyme-rich fluid into the part of the gut just after the stomach (called the duodenum). The enzymes are in an inactive form in the pancreas (otherwise they would digest the pancreas). They are 'activated' in the duodenum to digest food. Groups of special cells called 'islets of Langerhans' are scattered throughout the pancreas. These cells make the hormones insulin and glucagon. The hormones are passed (secreted) directly into the bloodstream to control the blood sugar level. The bile duct carries bile from the liver and gallbladder. This joins the pancreatic duct just before it opens into the duodenum. Bile also passes into the duodenum and helps to digest food. Gallstones or alcohol cause more than 8 in 10 cases of acute pancreatitis. Other causes of acute pancreatitis are rare. Gallstones are the most common cause in the UK. A gallstone can pass through the bile duct and out into part of the gut just after the stomach (the duodenum). This usually does not cause a problem. However, in some people a gallstone becomes stuck in the bile duct or where the bile duct and pancreatic duct open into the duodenum. This can affect the chemicals (enzymes) in the pancreatic duct (or even block them completely) and trigger a pancreatitis. AlcoholAbout a third of cases of acute pancreatitis are associated with alcohol, although the relationship is not clear. Few individuals who abuse alcohol go on to develop alcoholic pancreatitis. However, it seems that whilst alcohol itself does not damage the cells of the pancreas, it makes them more sensitive to damage from other causes such as smoking, high fat content in the blood or infections. Many patients with chronic alcoholic pancreatitis have a history of recurrent acute pancreatitis triggered by alcohol abuse. High blood fat levelsThis is known as hypertriglyceridaemia. It is reported to cause 1-4% of all cases of acute pancreatitis and up to 56% of pancreatitis cases during pregnancy. Uncommon causesThese include the following:
AutoimmuneThis is where your own immune system attacks the pancreas. This can be associated with other autoimmune diseases - for example, Sjögren's syndrome and primary biliary cirrhosis. UnknownThis is where no cause is found in about 1 in 10 cases. However, a number of these cases are probably due to tiny gallstones or 'gallstone sludge' which passes through the bile duct but is too small to be seen on scans or other tests. The digestive chemicals (enzymes) that are made in the pancreas become activated and start to 'digest' parts of the pancreas. They are normally only activated after they reach the part of the gut just after the stomach (the duodenum). This leads to a range of chemical reactions that cause inflammation in the pancreas. How the above causes actually trigger this sequence of events is not clear.
Dr Sarah Jarvis, January 2020 People with diabetes who inject insulin The National Institute for Health and Care Excellence (NICE) has updated its guidance on pancreatitis. The only significant change has been for people with diabetes who use insulin. The guidance notes that injecting insulin can lead to the build-up of a protein called amyloid under the skin. This can interfere with the absorption of insulin and affect blood glucose control. For this reason, it is important to rotate the sites you use to inject your insulin. The treatment depends on how bad your attack of acute pancreatitis is. There is no specific treatment that will take the inflammation away. However, in most cases the pancreatitis settles over a few days, although symptoms can get worse before they get better.
Less commonly, complications develop and the situation can become very serious. Other treatments that may then be needed include the following:
As mentioned, acute pancreatitis is classified as mild if no complications develop (about 4 in 5 cases). In this case the outlook is very good and full recovery is usual. Severe acute pancreatitis (about 1 in 5 cases) means that one or more complications develop. Despite intensive care treatment, the mortality rate of people with severe acute pancreatitis is around a quarter.. An attack of acute pancreatitis may be a one-off event. However, if there is an underlying cause, then it may happen again (recur) unless the cause is corrected. One of the following may be relevant to prevent a recurrence, depending on the cause:
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