ACUTE PANCREATITIS

ACUTE PANCREATITIS

Definition of Acute Pancreatitis

Acute pancreatitis is a sudden inflammation of the pancreas, which can be mild or severe.

Incidence and Etiology

• Incidence: Acute pancreatitis is a relatively rare condition, with an estimated incidence of 5-10 cases per 100,000 people per year.
• Etiology: The exact cause of acute pancreatitis is often unclear, but common factors include:
  • Gallstones: 30-40% of cases
  • Alcohol abuse: 20-30% of cases
  • Hypertriglyceridemia: 5-10% of cases
  • Idiopathic (unknown cause): 20-30% of cases
  • Other causes: trauma, medications, infections, etc.

Risk Factors

• Family history of pancreatitis
• High body mass index (BMI)
• Smoking
• Abdominal trauma
• Certain medications, such as estrogens and certain antibiotics

Pathophysiology

• Enzymatic Autodigestion: The pancreas produces digestive enzymes, which can become activated within the pancreas itself, leading to autodigestion of the pancreatic tissue.
• Inflammation: The autodigestion of pancreatic tissue leads to the release of pro-inflammatory cytokines, which cause inflammation and damage to the pancreas and surrounding tissues.

Clinical Features

• Abdominal Pain: Severe, persistent pain in the upper abdomen, often radiating to the back
• Nausea and Vomiting: Common symptoms, especially after eating
• Systemic Symptoms: Fever, tachycardia, hypotension, and laboratory evidence of organ dysfunction

Laboratory Investigations

• Serum Amylase: Elevated in 90% of cases, but not specific for pancreatitis
• Serum Lipase: More specific for pancreatitis than amylase, with a sensitivity of over 90%
• Inflammatory Markers: Elevated in response to inflammation, including CRP, ESR, and WBC count

Role of Imaging

• USG (Ultrasound): Useful for detecting gallstones, but not sensitive for pancreatic inflammation
• CT (Computed Tomography): The gold standard for diagnosing acute pancreatitis, especially in severe cases
• MRI (Magnetic Resonance Imaging): Not commonly used for acute pancreatitis, but useful for detecting complications and evaluating the extent of pancreatic damage

Complications

• Necrosis: Death of pancreatic tissue, which can lead to abscess formation and fistulae
• Pseudocyst: A collection of pancreatic juice that forms a cyst-like structure, often requiring drainage
• Organ Failure: Pancreatitis can lead to multi-organ failure, including respiratory, cardiovascular, and renal failure

Indications for ERCP and Surgical Management

• ERCP (Endoscopic Retrograde Cholangiopancreatography): Indicated for:
  • Suspected gallstone pancreatitis
  • Pancreatic duct obstruction
  • Chronic pancreatitis
• Surgical Management: Indicated for:
  • Severe necrotizing pancreatitis
  • Infected pseudocysts or abscesses
  • Pancreatic duct disruption

Homoeopathic Therapeutics for Acute Pancreatitis

• Lachesis: For acute inflammation and pain
• Arsenicum album: For nausea, vomiting, and abdominal pain
• Nux vomica: For digestive issues and nausea
• Phosphorus: For pancreatic inflammation and digestive issues
• Carbo vegetalis: For nausea, vomiting, and abdominal pain