Why Choose Cedars-Sinai Marina del Rey Hospital for Acute Pancreatitis Treatment?
An ongoing acute pancreatitis episode requires urgent medical attention and appropriate treatment. The well-trained doctors and specialists at Cedars-Sinai Marina del Rey Hospital offer multiple treatment approaches for acute pancreatitis, including careful monitoring, hospitalization, and when necessary, gallstone removal surgery. In the latter case, postoperative care is also provided to ensure a safe and speedy recovery.
Acute pancreatitis is a severe condition defined by acute inflammation in the pancreas, which occurs suddenly and can last for a few days. Acute pancreatitis can be cured in about a week, sometimes without treatment, but in extremely severe cases it can be fatal.
The pancreas is a long flattened gland located in the upper left abdomen between the stomach and the spine. Part of the pancreas is surrounded by the duodenum (the first part of the small intestine). The pancreas is both an exocrine gland and an endocrine gland, meaning that it excretes enzymes that help support digestion and it controls blood sugar levels in the body.
Acute pancreatitis patients are admitted to the hospital and strictly monitored.
In most cases, patients are able to leave the hospital after 5-10 days. In extremely severe cases, patients are admitted to special care units for specific treatment of complications.
The initial treatment usually includes:
- Fluid intravenous supply: Fluids are administered directly into the vein to avoid dehydration. Without proper fluids, a patient suffering from an acute pancreatitis episode could experience hypovolemic shock (a drop in blood volume).
- Fasting: Patients are often told to fast for at least a few days after acute pancreatitis is diagnosed, as solid food can put too much stress on the pancreas. In some mild cases, a normal diet is not restricted. Once the pancreas starts to recover, the patient may drink clear liquids and eat bland foods. If solid foods are forbidden for longer, a nasogastric or feeding tube might be inserted.
- Pain medication: Acute pancreatitis can be extremely painful, so strong painkillers (such as morphine) are often required. These medications can cause side effects ranging from dizziness to drowsiness to slowed heartbeat.
- Oxygen supply: Oxygen is usually supplied to ensure normal levels in the organs.
After an acute pancreatitis episode, steps should be taken to help promote recovery, including avoiding alcohol, not smoking, eating a low-fat diet filled with fruits and vegetables, whole grains, and healthy proteins, and increasing fluid consumption.
Also after an acute episode, the underlying cause is treated:
- Removal of gallstones: Gallstone removal can take place during the initial hospital stay, or in the weeks to follow. In some cases, laparoscopic or open surgery is required. In other cases, an endoscopic retrograde cholangiopancreatography (ERCP) technique is used. In an ERCP procedure, a thin flexible tube with a camera is passed through the mouth to the stomach. Under X-ray guidance, surgical instruments are used to remove the gallstones.
- Alcohol consumption: Daily uncontrolled alcohol consumption can cause acute pancreatitis. In such cases, alcohol should be completely excluded from the patient's diet. Additional addiction treatment may also be required, including counseling or acamprosate medication. Continued consumption of alcohol in such cases may result in additional complications.
In severe cases, additional complications may include:
- Pancreatic pseudocysts: Pancreatic pseudocysts are fluid-filled sacs that develop on the surface of the pancreas four weeks after an acute pancreatitis condition. They appear in one out of 20 pancreatitis patients. Symptoms of pancreatic pseudocysts include indigestion, pain, and bloating. Large pseudocysts can also burst, causing bleeding or infection. Drainage procedures are often used to treat pancreatic pseudocysts. In some cases, patients will present no symptoms and pseudocysts will eliminate themselves.
- Infected pancreatic necrosis: Pancreatic necrosis occurs in cases where a high level of inflammation causes the blood supply to be cut off from the pancreatic tissue. Necrotic or dead tissue is prone to infection, which can then spread into the blood and body. Antibiotics and surgery are most often used to treat pancreatic necrosis. If left untreated, necrosis can be fatal.
- Systemic inflammatory response syndrome (SIRS): SIRS can occur when inflammation of the pancreas involves multiple organs, causing one or more organs to fail. The treatment goal is to offer support for the affected organs and their respective body functions. The risk of death increases as more organs are affected.
- Chronic pancreatitis: Chronic pancreatitis can occur over many years and multiple acute episodes, but it can also develop after one severe episode. Damaged pancreatic tissues can result in digestive issues and diabetes.
Classification of acute pancreatitis is based on severity (i.e. local and systemic complications):
No complications are present in mild pancreatitis. Infectious complications and persistent organ failure are present in severe and critical pancreatitis cases.
Symptoms of acute pancreatitis are:
- Sudden, severe dull pain in the upper abdomen, which worsens over time and sometimes radiates to the back. Abdominal pain can be worsened by eating (especially fatty foods) and drinking.
- Abdominal tenderness and swelling
- Nausea, vomiting
- Accelerated pulse
- Diarrhea, indigestion
To diagnose acute pancreatitis, a doctor will perform a physical examination and question the patient about the symptoms and health history. Tests used to diagnose pancreatitis include:
- Blood counts
- Blood levels of pancreatic enzymes: Some patients with acute pancreatitis display high levels of lipase and amylase.
- Liver tests
- Stool tests
- Ultrasound: An ultrasound uses sound waves, which are bounced off the organs to create an image. These images could indicate an obstruction of the pancreatic duct or bile duct.
- Computer tomography scan: A combination of X-rays and computer technology are used to create a three-dimensional representation of the organs. Computer tomography scans can indicate the extent of inflammation in the pancreas, and show if any gallstones are present.
- Magnetic resonance imaging (MRI): A combination of radio waves, magnetic fields, and an injectable contrast medium are used to render an image of the organs. MRIs allow us to observe the gallbladder, pancreas, and related ducts.
- Endoscopic retrograde cholangiopancreatography (ERCP): An endoscope is passed through the mouth to the stomach, where a special contrast solution is injected, via the endoscope, into the patient's bile and pancreatic ducts. This X-ray-visible contrast allows us to observe the ductal network.
Risk Factors for Acute Pancreatitis
Risk factors associated with acute pancreatitis include:
Studies show that certain combinations of risk factors play an especially important role in the occurrence of acute pancreatitis.
Causes of Acute Pancreatitis
Acute pancreatitis is caused by the unexplained activation of digestive enzymes in the pancreas, which results in pancreatic cell irritation.
The exact cause that leads to the auto-digestion of the pancreas is not known, but it may be related to a blockage in the biliary ducts or pancreatic duct.
Gallstones are a common background condition that can cause acute pancreatitis. These episodes tend to occur after a large meal when gallstones move from the gallbladder and block access from the pancreas to the digestive tract.
Massive alcohol consumption is another frequent cause of acute pancreatitis. It is believed that alcohol interferes with normal enzyme activity, causing the digestion of the pancreas itself. Alcohol-related acute pancreatitis usually develops six to 10 hours after massive alcohol ingestion.
Other less common conditions that could cause acute pancreatitis are:
- Unintended trauma of the pancreas (e.g. during regular examination procedure, or during gallstones removal surgery)
- Medication side effect (often related to antibiotics or chemotherapy)
- Bacterial or viral infections (mumps, measles)
Alternative treatment cannot cure acute pancreatitis, but some alternative therapies, like yoga, meditation, breathing exercises, or acupuncture performed by a specialist, can help with pain management during an acute episode.
Some Chinese herbs may be effective, but there is no strong clinical evidence to support it.
Sufferers of acute pancreatitis should not attempt self-treatment.
A healthy lifestyle can help prevent acute pancreatitis.
Because gallstones are the main cause, doctors encourage consuming a lot of fruits and vegetables (at least five servings per day), whole grains, and healthy fats.
High cholesterol foods like pork, sausages, fast food, butter, and cakes should be avoided.
Increased weight is a predisposing factor of pancreatitis. Daily exercise and a healthy balanced diet are both suggested.
Alcohol should be consumed in moderation.