|Normal pancreas: at left: picture of a computerised
tomography (CAT Scan) with normal healthy organs; at right: diagrammic
What is acute pancreatitis?
Acute pancreatitis is an acute, i.e. suddenly
occurring, inflammation of the pancreas. It results in damage to the
cells of the pancreas, which limits its function for a temporary period.
Depending on the severity of the damage, acute pancreatitis can also
lead to the death of pancreatic cells, which results in various harmful
substances being secreted into the body, which in turn can cause the
patient to become critically ill. As the illness progresses, other organs
may be attacked and their function affected. We differentiate two forms
of acute pancreatitis:
1. Acute oedematous pancreatitis
2. Acute necrosing pancreatitis
At the outset of pancreatitis it is usually impossible
to diagnose which of the two forms is present or developing in the patient.
Thus all patients with acute pancreatitis must receive intensive care
at an early stage.
Acute oedematous pancreatitis
This is the gentler form, and around 85% of patients
with acute pancreatitis suffer from this version of the disease. It
causes temporary damage to the pancreas, but does not normally affect
any of the surrounding organs. In most cases, the patient recovers completely
from the inflammation and there is no long-term damage to the pancreas.
|At left: picture of a computerised tomography
(CAT Scan) of a distinct homogenic enlargement of the pancreas with a
oedematous pancreatitiss; at right: diagrammic presentation
Acute necrosing pancreatitis
Around 15% of patients with acute pancreatitis suffer from this most
serious inflammation of the pancreas. Sudden widespread destruction
of pancreatic tissue occurs. Furthermore, failure of other organs such
as lungs and liver can often seriously endanger the patient's life.
As a consequence of the disease, the function of the pancreas is in
most cases permanently reduced, leading to digestion disorders and/or
diabetes. Loss of function is proportionate to the amount of destruction
of pancreatic tissue. Defunct tissue can also lead to problems in the
abdomen, such as pseudo-cysts, abscesses and obstruction of fluids in
the ducts of the gall, as well as in the stomach or intestines. These
complications have to be individually assessed and treated according
to their severity, they often necessitate surgery.
|At left: picture of a computerised tomography (CAT
Scan) of a necrosing zone; at right: diagrammic presentation
are the causes of acute pancreatitis?
There is a long list of possible causes of acute pancreatitis. However,
in Central and Western Europe, gallstones and excessive alcohol consumption
are responsible for 90% of cases. Metabolised alcoholic substances can
damage pancreatic tissue directly. If a gallstone passes from the gall
bladder to the common bile duct, it can block the pancreatic duct (which
joins the common bile duct shortly before the duodenum), and this can
lead to acute pancreatitis. In addition to these common causes, there
is a whole host of much rarer causes, such as infections, various forms
of medication, and congenital defects in the pancreatic ducts. Finally,
there is also a small number of cases, where to date no cause for pancreatitis
has been found.
are the symptoms of acute pancreatitis?
- Sudden onset
- Severe, dull pain in the upper abdomen (often radiating around to
the patientīs back, like a belt)
- Nausea, vomiting, bloated feeling
- High temperature
of acute pancreatitis
Treatment of acute pancreatitis is largely determined by the patient's
symptoms and varies according to the form of the disease (mild or severe).
In general, patients with acute pancreatitis need to be monitored and
treated in hospital. The patient will be prevented from eating or taking
fluids for a number of days to allow the pancreas to recuperate. Pain
relief and fluids via intravenous drip will be administered. The circulatory
system, lungs and kidneys will be monitored carefully. Nutrition can be
phased in if treatment is successful. Intensive care must be administered
if the severe form of acute pancreatitis is found. Restoring and monitoring
organ function is imperative.
cases require surgery?
One out of three patients with acute pancreatitis requires surgery.
Surgical intervention is indicated if the patient's condition deteriorates
and an infection or haemorrhage is found in defunct pancreatic tissue.
The patient's abdomen in opened with a lengthwise incision, and infected
and defunct parts of the pancreas are removed to prevent further infections.
Finally, tubes are inserted through which the area around the pancreas
is drained to prevent further infections. In severe cases of acute pancreatitis,
the patient may be required to stay in hospital for several weeks.
Apart from treating the actual acute condition, physicians
will also investigate the origin of the disease. Gallstones, if found
to be the cause, will be removed with ERCP immediately. The flow of
pancreatic enzymes and bile into the duodenum is thus restored and the
immediate cause for the damage is removed. After the patient has recovered
from acute pancreatitis caused by gallstones, the gall bladder will
be removed. In most cases, this is done with keyhole surgery (laparoscopic
When dealing with acute pancreatitis, doctors will
routinely investigate the patient's alcohol consumption. Where alcohol
is the cause, excessive consumption may not always be to blame. Some
people with increased sensitivity may develop acute pancreatitis after
consuming moderate amounts of alcohol. Conversely, some excessive drinkers
never develop acute pancreatitis. Whatever the case, it is imperative
that acute pancreatitis sufferers limit their alcohol intake in the
aftermath of the disease.
effects of acute pancreatitis
The following problems can arise apart from the functional damage to
the pancreas (disgestive disorders due to the lack of digestive enzymes
in the remaining part of the pancreas, or development of diabetes mellitus
due to the lack of sufficient quantities of insulin):
1. Formation of pseudocysts
Due to tissue damage of the pancreas including the destruction of entire duct sections, a loss of continuity in the pancreatic duct system can result. Leaking pancreatic fluids or blood collect in or around the pancreas. This collection of pancreatic fluids, blood, and dead tissue, which is found in or on the pancreas, is called a pseudocyst. They often disappear without any therapy; however, there are pseudocysts which get bigger and bigger resulting in complaints such as nausea, vomiting, pain, and weight loss. It can also happen that the passage of food in the stomach or intestines is hindered or the flow of bile is obstructed. Finally, there is the danger of them rupturing and emptying into the abdominal cavity. Pseudocysts causing symptoms, generally require surgery in which a section of the small intestine is opened and stitched onto such a pseudocyst, enabling the cyst contents to drain directly into the intestine. Often, an endoscopic drainage can be performed as well.
2. Pancreatic Abscesses
Sometimes, in the aftermath of an acute inflammation, an accumulation
of pus can occur in the pancreas area, causing instances of recurring
high temperature. Normally, the physician can puncture the abscess under
a local anaesthetic (closely monitored by ultrasound or CAT). Pus can
then be removed via catheter. If this is impossible, surgery will be
required. The patient will also need antibiotic treatment.
of my pancreas has been removed - what next?
Patients who have had part or the all of their
pancreas removed will experience a reduction of the pancreas function,
depending on how much of the organ has been removed. This will cause
the following deficiencies:
- Not enough pancreatic enzymes (digestive disorders)
- Insufficent insulin production (high blood-sugar levels)
These deficiencies can be addressed by taking appropriate medication.
Pancreatic Enzyme Substitution
At present, drugs which substitiute pancreatic
enzymes are available. They must be taken with all meals and snacks.
Correct doses vary from patient to patient and are determined by nature
of food taken and by symptoms present in the patient. Bloated feelings
and diarrhoea with excess fatty substances can be addressed and handled
with these drugs. More capsules need to be taken with main meals than
with snacks. Enzymes must be in direct contact with food in order to
be effective and 6-12 capsules per day are needed. The doses may vary
significantly and are governed by the nature of the drug (amount of
enzymes contained in one capsule) and the remaining function of the
Substitiute enzymes are readily asborbed into the
body and patients do not suffer side-effects. In very rare cases, the
drug can cause an allergic reaction.
If a pancreatic disorder or surgery has caused high blood sugar levels,
patients will require some form of blood sugar level correction. Initially,
and if levels are not severely elevated, this can be achieved by nutritional
means and with medication capable of influencing blood glucose levels.
However, insulin treatment may be necessary if the amount on insulin
producing cells in the pancres has been reduced significantly. Treatment
can be tailor-made to the requirements of the individual patient, as
a variety of insulin types are now available. Thus, the patient's nutritional
preferences can be respected. The goal of any such treatment is the
well-being of the patient and efficient managing of blood sugar levels.
Thus, doctors can avoid severe damage over the short and longer term.
Close supervision by a GP or specialist is required in the initial phase
of the treatment.
spleen has been removed - what next?
Sometimes the spleen is removed during pancreatic
Life is possible without spleen. The spleen supports the immune system.
If removed, a person is more susceptible to bacterial infections, some
of which can cause life-threatening diseases. To protect patients against
this threat, inoculations must be administered. Pneumococcal infections
and vaccinations against this particular disease must be mentioned here.
According to current research, patients need to receive these inoculations
again after about 3 to 5 years.
Patients need to visit their doctor when suffering from infections and
fever, and inform medical staff that they do not have a spleen. The
physician will decide whether a treatment with antibiotics is warranted.
Removal of the spleen can lead to a build-up
of blood platelets (thrombocytes). It is important to keep an eye on
this. Blood thickening and possibly thrombosis can result if the number
of platelets is elevated to risk-level. Should this occur, your doctor
will prescribe medication to reduce the risk of thrombosis.