Intensive Care Management of Acute Pancreatitis and New Predictors of Mortality

Abstract

Acute pancreatitis refers to inflammation of the pancreas, causing sudden and severe abdominal pain. The pancreas is an organ that lies in the back of the mid-abdomen. It produces digestive juices and certain hormones, including insulin. Pancreatitis usually develops as a result of gallstones or moderate to heavy alcohol consumption over a period of years. Most attacks of acute pancreatitis do not lead to complications, and most people recover uneventfully with medical care. However, a small proportion of people have a more serious illness that requires intensive medical care. In all cases, it is essential to determine the underlying cause of acute pancreatitis and, if possible, to treat these condition to prevent a recurrence. Pathogenesis: The digestive enzymes (chemicals) that are made in the pancreas become activated and start to 'digest' parts of the pancreas (They are normally only activated after they reach the duodenum.) This leads to a range of chemical reactions that cause inflammation in the pancreas. How the above causes actually trigger this sequence of events is not clear. In most cases (about 4 in 5), the inflammation is mild and settles within a week or so. Symptoms may be bad for a few days but then settle and the pancreas fully recovers. In some cases (about 1 in 5) the inflammation quickly becomes severe. Parts of the pancreas and surrounding tissues may die (necrosis). Pancreatic enzymes and chemicals may get into the bloodstream and cause inflammation and damage to other organs in the body. This can lead to shock, respiratory failure, kidney failure and other complications. This is a very serious situation which can be fatal. Pancreatitis diagnosis: Diagnosing acute pancreatitis can be difficult because the signs and symptoms of pancreatitis are similar to other medical conditions. The diagnosis is usually based upon a medical history, physical examination, and the results of diagnostic tests. No single blood test proves the diagnosis of acute pancreatitis, but certain tests corroborate it. Blood levels of two enzymes produced by the pancreas, amylase and lipase; usually increase on the first day of the illness but return to normal in 3 to 7 days. If the person has had other flare-ups (bouts or attacks) of pancreatitis, however, the levels of these enzymes may not increase, because so much of the pancreas may have been destroyed that few cells are left to release the enzymes. The white blood cell count is usually increased. Imaging tests provide information about the structure of the pancreas, the ducts that drain the pancreas and gallbladder, and the tissues surrounding the pancreas. Imaging tests may include an x-ray of the abdomen, chest, CT scan or MRI of the abdomen a CT scan is particularly useful in detecting inflammation of the pancreas and is used in people with severe acute pancreatitis and in people with complications, such as extremely low blood pressure.