Acute pancreatitis is a gastro-intestinal induced condition occurs due to sudden inflammation of pancreas. It shows mild discomfort pain to life-threatening symptoms.

Digestive gland organ pancreas located between vertebra L1 and L2 on the posterior abdominal wall, situated transversely between duodenum and spleen.

Pancreas head positioned near inferior vena cava, right renal vein, and duodenum loop while their tail reaches splenic hilum at top.

The primary function of the pancreas is divided into two forms as: exocrine and endocrine secretions.

Pancreatic juice from acinar cells flows into duodenum through accessory ducts, while glucagon and insulin enter in blood.

In mild pancreatitis cases, mostly it resolves within a few days with appropriate medical treatment.

In severe pancreatitis cases, it needs prolonged hospital stay.

Gallstones in bile ducts cause acute pancreatitis when bile flows back into pancreas. Excessive alcohol causes premature enzyme activation and inflammation in body.

Global occurrence of acute pancreatitis varies widely 13 to 45 cases per 100000 person every year based on location and lifestyle.

It has incidence of 30 to 40 cases per 100000 every year in US and Europe, while it is lower in Asia but rising in urbanized areas.

It affects males due to high alcohol consumption, while females are more affected due to biliary tract disease.

Black individuals have 3 times higher hospitalization rates as compared to white skin individuals.

Pancreas in upper abdomen produces insulin and digestive enzymes for carbohydrate, fat, and protein metabolism.

80% of pancreas weight serves exocrine function, while 20% serves endocrine function. Pancreas is 0.1% of body weight but produces 13 times more protein than liver and reticuloendothelial system.

Pancreas produces 15 digestive enzymes in rough endoplasmic reticulum, modified in Golgi apparatus and stored as proenzymes.

Acute pancreatitis results from imbalance in cellular homeostasis caused due to injury to acinar cells and impaired zymogen granule secretion.

The causes of acute pancreatitis are:

Gallstones

Chronic alcohol use

High triglycerides

Infections

Trauma or surgery

Biliary pancreatitis has higher mortality than alcoholic pancreatitis, but both rates are declining due to improved supportive care. 

Acute pancreatitis has 1-2% mortality rate, but severe cases have higher unknown mortality ratio. 

The updated CT Severity Index combines Balthazar and pancreatic necrosis scores to predict mortality and identify necrosis on imaging for high mortality risk. 

Identify severe medical cases in form of mild or severe. Mild cases show pancreas with edema, inflammation, minimal dysfunction.

Collect details including pain, gallstones, family and medical history to understand clinical history of patient.

Abdominal Examination 

Liver Examination 

Pulmonary Examination 

Acute symptoms are:

Severe Abdominal Pain, Nausea and Vomiting, Fever, Tachycardia, Hypotension, Signs of Dehydration, Abdominal Distention, and Respiratory Distress

Patients with severe acute pancreatitis need intensive care due to potential complications.

Medical treatment provides supportive care, reduce inflammation, prevent infection, and address complications.

Patient’s inpatient care duration for severe pancreatitis complications and response to treatment varies from days to months.

Acute pancreatitis patients need immediate IV hydration due to fluid loss to retroperitoneum and intra-abdominal areas. Early aggressive fluid resuscitation within 24 hours is crucial.

Parenteral nutrition is necessary when oral intake is insufficient and specific attention to fat emulsions is essential to prevent essential fatty acid deficiency.

Further research is needed to determine the specific cytokines that should be targeted to improve outcomes of acute pancreatitis.

Gastroenterology

Proper nutrition has great importance in pancreatitis patients, particularly those who are undergoing the treatment. 

Start physical activity and exercise to improve the strength, endurance and overall wellness of the patients. 

Excessive alcohol consumption should be avoided in patients with history of alcohol-induced pancreatitis. 

Patients with a history of gallstones should avoid high-fat foods and consume healthy rich diet. 

Proper awareness about acute pancreatitis should be provided and its related causes with management strategies. 

Appointments with a gastroenterologist and preventing recurrence of disorder is an ongoing life-long effort. 

Gastroenterology

Acetaminophen: 

It blocks the pain impulse generation to inhibit prostaglandin synthesis in CNS. 

Tramadol: 

It modulates the descending pain pathways by binding with parent and M1 metabolite to μ-opioid receptors. 

Gastroenterology

Ampicillin: 

It interferes with cell wall synthesis to penicillin-binding proteins inhibition of cell wall synthesis. 

Ceftriaxone: 

It inhibits bacterial cell wall synthesis by binding with one or more penicillin-binding proteins. 

Gastroenterology

Interventional procedures include gallstone pancreatitis, pancreatic duct disruption, pseudocysts, and cholecystectomy. 

Gastroenterology

Initial treatment phase, evaluation of history, physical examination and endoscopy test are to confirm diagnosis. 

Pharmacologic therapy is effective in the treatment phase as it includes the use of analgesics and antibiotic agent. 

In supportive care and management phase, patients should receive required attention such as lifestyle modification and surgical intervention. 

The regular follow-up visits with the gastroenterologist are scheduled to check the improvement of patients along with treatment response.