What is acute pancreatitis
Pancreatitis is a condition associated with development of acute and sudden inflammation of the pancreas. Experimental data show that during an attack of pancreatitis, pancreatic enzymes are released in the abdomen and cause inflammation by the damage from digestion of normal body structures, especially fat in the abdomen. In about 85% of patients, acute pancreatitis is a mild disease and is usually associated with a rapid recovery within a few days of onset of the illness.
Causes of acute pancreatitis
Gallstones and excessive alcohol usage are the most common causes for injury to the pancreas and account for more than 85% of all patients that develop pancreatitis. Many medications, and conditions such as hyperlipidemia (high levels of fat in the blood), and hypercalcemia (high levels of calcium in the blood) may also cause pancreatitis.
What is severe acute pancreatitis?
In about 15-20% of patients with acute pancreatitis, severe damage to the pancreas may lead to a life threatening illness that is often associated with prolong hospitalization, multiple surgical procedures, and death in some patients. Severe acute pancreatitis usually develops when parts of the pancreas become necrotic (dead) from the acute inflammation. Many of the complications seen in severe acute pancreatitis are associated with the presence of this dead pancreatic tissue in the abdomen.
Severe acute pancreatitis is a serious and life threatening disease and require intensive and aggressive management of multiple organ failure and severe infective complications that develop in these patients. Many of the complications seen in severe acute pancreatitis are associated with the presence of the dead pancreatic tissue in the abdomen.
What is pancreatic necrosis
Severe pancreatitis causes death of parts of the pancreas. The injured and dying pancreas releases digestive enzymes in the pancreas, which causes extensive death of fatty tissue in the abdomen. As a consequence patients with severe pancreatitis have dead pancreatic tissue and also widespread death of fatty tissue around the pancreas. This dead pancreas tissue is called pancreatic necrosis and the dead fatty around the pancreas is called peripancreatic necrosis.
What happens in severe acute pancreatitis?
Patients with severe pancreatitis go through well defined stages in their illness that require specific care. In the first week failure of multiple organs develop due damage from toxins that are released into the blood stream from the dead pancreas. Aggressive support in the intensive care unit of multiple organs such as heart, lungs and kidneys may be required.
Following the second week onwards, infection of the dead pancreas is an important issue. The treatment of infected necrosis is complex and the patient may benefit from treatment in a specialty center that treat a high volume of these conditions. Aggressive treatment of any infection that develops is a key element for survival in critically ill patients.
What are the complications of pancreatic necrosis
The complications that develop from the presence of necrotic (dead) pancreas in the abdomen include
- continuous fever, abdominal pain, and inability to tolerate a diet,
- development of infection in the dead pancreatic tissue can give rise to life-threatening infection in the blood,
- separation of the dead pancreas from the remaining living pancreas often leads to leakage of pancreatic juice into the abdomen. This is often associated with development of a condition called a pancreatic psuedocyst and
- damage to surrounding structures in the abdomen from the inflammation and leakage of pancreatic juice such as the colon, blood vessels, splenic vein, and the duodenum.