Pancreatitis refers to inflammation of the pancreas, the organ responsible for producing digestive enzymes and the hormone insulin, required for blood sugar control. The pancreas is found in the upper portion of the abdomen, behind the stomach.
Pancreatitis can cause severe abdominal pain and compromise the body’s ability to absorb nutrients from food. Other symptoms include vomiting, a general feeling of malaise, fever and a swollen abdomen.
There are two forms of pancreatitis, the acute and the chronic form. Alcohol consumption is thought to be the underlying cause of acute pancreatitis in around a third of cases, while gallstones account for another third. About half of those who experience one episode of acute pancreatitis due to alcohol consumption go on to develop further episodes in the future. Ongoing alcohol consumption is a risk factor for relapse, with the risk increasing, the more alcohol is consumed. Prolonged excess alcohol consumption causes ongoing damage to the pancreas and chronic pancreatitis eventually develops.
In chronic pancreatitis, the organ is persistently inflamed, which leads to permanent pancreatic damage and scarring. This can reduce the amount of digestive enzymes and insulin being produced, which can cause malnutrition and diabetes, respectively. In cases of necrotizing pancreatitis, where the pancreatic tissue starts to die, cyst-like pockets (pseudocysts) may form, which are prone to infection, rupture and bleeding. In severe cases, toxins and enzymes leak from the pancreas into other areas of the abdomen, which can lead to vascular damage and internal bleeding.
Prognosis in acute pancreatitis
Acute pancreatitis usually improves independently or when dietary changes are made. Patient outcomes are often very positive and people usually make a full recovery. Alcohol intake should be eliminated, even in cases where alcohol was not the cause of the condition. Smoking should be stopped because it acts as a stressor to the body’s defence mechanisms against inflammation. In cases where gallstones are identified as the cause, the gallbladder is surgically removed to prevent any further episodes.
Ranson’s prognostic signs can be used to predict a patient’s prognosis. Of these, signs that can be identified at the time of hospital admission include the following:
- Age over 55 years
- A plasma glucose level higher than 200 mg/dL
- A serum lactate dehydrogenase (LDH) level higher than 350 IU/L
- An aspartate aminotransferase level higher than 250 UL
- A white blood cell count higher than 16,000/μL
Six more signs can be established within two days of hospital admission and include:
- A decrease in hematocrit of more than 10%
- An increase in blood urea nitrogen of more than 5 mg/dL
- A serum calcium level less than 8 mg/dL
- A partial pressure of oxygen in arterial blood of less than 60 mmHg
- A base deficit of less than 4 mEq/L
- An estimated fluid sequestration of more than 6 L
Mortality due to acute pancreatitis is increased with the increasing number of signs. The mortality rate is less than 5% among those with less than three signs, while it ranges from 15% to 20% among those with three signs or more.
Prognosis in chronic pancreatitis
In the chronic form, episodes of pancreatitis tends to become more severe over time and the overall 10-year and 20-year survival rates are estimated to be about 70% and 45%, respectively.
For some people, a diagnosis of chronic pancreatitis can mean a lifetime of pain and gastrointestinal symptoms. Around half of such individuals suffer from pain severe enough to require surgical intervention, which may be used to drain pseudocysts, remove gallstones, place stents in a blocked duct or remove some or all of the pancreas.
Patients with chronic pancreatitis are advised to follow a low-fat diet, refrain from smoking and drinking alcohol and avoid any abdominal trauma. Pancreatic enzyme supplements may be prescribed (along with a proton pump inhibitor to prevent their breakdown by acid) and insulin administered.
Patients with chronic pancreatitis are at an increased risk of developing pancreatic cancer and should be fully evaluated if symptoms worsen, particularly if duct stricture develops. Examples of tests that may be carried out include analysis of stricture biopsy and assessment of serum markers CA 19-9 and carcinoembryonic antigen.