Pancreatitis, Acute And Chronic: Difference, Causes, Symptoms, Treatment

Pancreatitis, Acute And Chronic: Difference, Causes, Symptoms, Treatment


What Is Pancreatitis?



What Is Acute And Chronic Pancreatitis?


What Is Chronic Pancreatitis?


Chronic pancreatitis has many causes but 70 to 80 percent of cases are due to chronic alcohol abuse. It may develop after only one acute attack, especially if the ducts of the pancreas become damaged. Damage to the pancreas from drinking alcohol may cause no symptoms for many years, and then the patient suddenly has an attack of pancreatitis. It is more common in men than women and often develops between 30 and 40 years of age. In other cases, pancreatitis may be inherited. Inherited forms appear to be due to abnormalities of the pancreas enzymes that cause the enzymes to autodigest the pancreas.

In the early stages, the doctor cannot always tell whether the patient has acute or chronic disease. The symptoms may be the same. Patients with chronic pancreatitis tend to have three kinds of problems: pain, malabsorption of food leading to weight loss, or diabetes.

Some patients do not have any pain but most do. Pain may be constant in the back and abdomen, and for some patients, the pain attacks are disabling. In some cases, the abdominal pain goes away as the condition advances. Doctors think this happens because pancreatic enzymes are no longer being made by the pancreas.

Patients with this disease often lose weight, even when their appetite and eating habits are normal. This occurs because the body does not secrete enough pancreatic enzymes to break down food, so nutrients are not absorbed normally. Poor digestion leads to loss of fat, protein, and sugar into the stool. Diabetes may also develop at this stage if the insulin-producing cells of the pancreas (islet cells) have been damaged.

What Is Acute Pancreatitis?


An estimated 50,000 to 80,000 cases of acute pancreatitis occur in the United States each year. This disease occurs when the pancreas suddenly becomes inflamed and then gets better. Some patients have more than one attack but recover fully after each one. Most cases of acute pancreatitis are caused either by alcohol abuse or by gallstones. Other causes may be use of prescribed drugs, trauma or surgery to the abdomen, or abnormalities of the pancreas or intestine. In rare cases, the disease may result from infections, such as mumps. In about 15 percent of cases, the cause is unknown.

Causes of Acute And Chronic Pancreatitis


Causes of Acute Pancreatitis


In about 80 percent of the cases, acute pancreatitis is caused by gallstones and alcohol ingestion (see list below). Other causes are usually due to medications and, very rarely, infections, trauma or surgery of the abdomen. In about 10 percent of the cases, the cause is unknown (idiopathic).

  • Gallstones (45 percent)
  • Alcohol (35 percent)
  • Idiopathic (10 percent)
  • Other, including medications, trauma or surgery (10 percent)
Medications that can cause acute pancreatitis include:

  • Azathioprine
  • Thiazide
  • Valproic acid
  • Dideoxyinosine
  • Sulfasalazine
  • Trimethoprim-sulfamethoxazole
  • Pentamidine
  • Tetracycline

Trauma


Types of trauma that can cause acute pancreatitis in rare cases include:

  • Postoperative trauma (due to surgery)
  • Hyperlipidemia (or excessive amounts of fat and fatty substances in the blood)
  • Hypercalcemia (or an abnormally large amount of calcium in the blood)
  • Ductal obstruction
  • Infectious Agents
Infectious Agents can include:

  • Mumps
  • Coxsackie B virus
  • Cytomegalovirus (CMV)
  • Candida
  • HIV
  • Salmonella
  • Shigella
  • E. coli
  • Legionella
  • Leptospirosis

Chronic Pancreatitis Histology


In more than 90 percent of the cases, chronic pancreatitis is caused by prolonged alcohol ingestion resulting in pancreatic damage and scarring (see below list). In a small percentage of the cases, the cause is unknown and, very rarely, patients can have chronic pancreatitis that tends to run in families (hereditary pancreatitis).

Alcohol accounts for 70 percent of cases, while 20 percent are considered idiopathic, or of unknown origin.

Other causes, which account for 10 percent of cases, include:

  • Tropical pancreatitis
  • Hereditary pancreatitis
  • Hyperparathyroidism
  • Cystic Fibrosis
  • Pancreas Divisum

Symptoms of Acute And Chronic Pancreatitis


Most patient with acute pancreatitis have upper abdominal pain that travels through the back. Patients may describe this as a “piercing sensation” aggravated by eating. The abdomen may be swollen and very tender.

Symptoms of chronic pancreatitis include:

  • Pain
  • Malabsorption of food leading to weight loss or diarrhea
  • Diabetes
  • Nausea
  • Vomiting
  • Fever
  • Increased heart rate
The pain of chronic pancreatitis is usually constant in nature and radiates to the back. In some patients, this pain may be disabling. The weight loss is usually due to the patient’s inability to secrete pancreatic enzymes to break down foods so nutrients are not absorbed normally. Finally, diabetes may develop if the insulin-producing cells in the pancreas are damaged.

Treatment for Acute And Chronic Pancreatitis


How Is Chronic Pancreatitis Treated?


The doctor treats chronic pancreatitis by relieving pain and managing the nutritional and metabolic problems. The patient can reduce the amount of fat and protein lost in stools by cutting back on dietary fat and taking pills containing pancreatic enzymes. This will result in better nutrition and weight gain. Sometimes insulin or other drugs must be given to control the patient's blood sugar.

In some cases, surgery is needed to relieve pain by draining an enlarged pancreatic duct. Sometimes, part or most of the pancreas is removed in an attempt to relieve chronic pain.

Patients must stop drinking, adhere to their prescribed diets, and take the proper medications in order to have fewer and milder attacks.

What Is the Treatment for Acute Pancreatitis?


The treatment a patient receives depends on how bad the attack is. Unless complications occur, acute pancreatitis usually gets better on its own, so treatment is supportive in most cases. Usually the patient goes into the hospital. The doctor prescribes fluids by vein to restore blood volume. The kidneys and lungs may be treated to prevent failure of those organs. Other problems, such as cysts in the pancreas, may need treatment too.

Sometimes a patient cannot control vomiting and needs to have a tube through the nose to the stomach to remove fluid and air. In mild cases, the patient may not have food for 3 or 4 days but is given fluids and pain relievers by vein. An acute attack usually lasts only a few days, unless the ducts are blocked by gallstones. In severe cases, the patient may be fed through the veins for 3 to 6 weeks while the pancreas slowly heals.

Antibiotics may be given if signs of infection arise. Surgery may be needed if complications such as infection, cysts, or bleeding occur. Attacks caused by gallstones may require removal of the gallbladder or surgery of the bile duct. Surgery is sometimes needed for the doctor to be able to exclude other abdominal problems that can simulate pancreatitis or to treat acute pancreatitis. When there is severe injury with death of tissue, an operation may be done to remove the dead tissue.

After all signs of acute pancreatitis are gone, the doctor will determine the cause and try to prevent future attacks. In some patients the cause of the attack is clear, but in others further tests need to be done.