Types Of Pancreatitis

Introduction

What is pancreatitis?

The pancreas is an organ with endocrine and exocrine functions that have an impact on the entire body. 

• Endocrine functions include the synthesis of hormones such as insulin or glucagon to regulate blood sugar levels.¹
• Exocrine functions involve creating enzymes that aid in digestion in the intestines¹

Pancreatitis is the inflammation of the pancreas, and this occurs when the pancreas is damaged by enzymes, causing the organ to malfunction and become inflamed, either acutely or chronically. Pancreatitis can proceed from acute to recurrent acute to chronic in some individuals, and the symptoms and duration of this condition might differ from person to person.² The incidence of pancreatitis has varied over time due to population movement, demographic variance, and lifestyle changes.³ Although some causes are more related to  acute pancreatitis and others to  chronic pancreatitis, the most common causes of pancreatitis are:

• Gallstones
• Strong alcohol use
• Genetic diseases
• Medication
• Infections due to viruses or parasites
• Abdomen injury
• Pancreatic cancer

Importance of understanding types of pancreatitis

Sometimes it is difficult to distinguish the various forms of pancreatitis, as they have very similar symptoms. It is essential to understand the type of pancreatitis in order to stop the growth of these diseases, treat the symptoms, and lower both morbidities and mortality. Untreated pancreatitis can lead to irreversible damage.⁴ 

Acute pancreatitis

Definition and causes

Acute pancreatitis is a condition that can develop rapidly and persist for less than six months. The majority of patients with acute pancreatitis recover with treatment, while some may require a prolonged hospital stay. According to recent research, it affects up to 30 to 40 cases per 100,000 adults per year and 10 to 15 cases per 100,000 children worldwide.⁵ Gallstones are the most common cause of acute pancreatitis, which induces inflammation of the pancreas as the stones pass through and become lodged in a bile or pancreatic duct.

Symptoms and diagnosis

Symptoms

The primary symptom of acute pancreatitis is typically epigastric or diffuse abdominal pain that sometimes spreads to the back and may  last for several days, which may also be accompanied by other symptoms like ⁵

• Nausea
• Vomiting
• Abdominal distension and muscle tensing
• Fever
• Breathing problems
• Agitation
• Altered consciousness
• Low oxygen saturation
• Rapid and shallow breathing
• Tachycardia
• Hypotension
• Lack of intestine movements
• Oliguria

Diagnosis 

The severity of acute pancreatitis can be categorised based on the local or peripancreatic problems as well as additional systemic effects, such as temporary or permanent organ failure as:⁴ 

• Mild: When there is no indication of organ dysfunction and no other complications
• Moderate: When there is an indication of temporary organ dysfunction coupled with local or systemic complications leading to temporary organ failure
• Severe: When there is an indication of persistent organ failure 

Consequently, when, alongside the clinical history, a patient meets 2 of the following 3 criteria, they are diagnosed with this type of pancreatitis:⁴

• Abdominal discomfort that is consistent with acute pancreatitis
• Blood tests show up to three times the normal levels of lipase or amylase (digestive enzymes)
• Other abnormalities that are compatible with cross-sectional abdominal imaging, such as computed tomography (CT) or magnetic resonance cholangiopancreatography (MRCP)
• Urine trypsinogen-2, white blood cell count, haematocrit, and blood urea nitrogen, generally known as BUN, are additional analyses that can be influenced by acute pancreatitis and can be helpful in the diagnosis 

Treatment options

Acute pancreatitis normally resolves in a few days with rest, and treatment involves keeping the person hydrated, taking pain medication, taking antibiotics when there is an infection and having a low-fat diet. Those who are unable to swallow meals may need to stay in the hospital so that they can get intravenous fluids and nutrition.

When acute pancreatitis manifests in more severe forms, surgery may be necessary to remove the gallbladder, drain fluid from the abdomen when there is an abscess or an infected pseudocyst (doctors may also remove damaged pancreatic tissue under these circumstances), and perform endoscopic cholangiopancreatography to address obstructions or narrowing of the bile and pancreatic ducts.⁴

Chronic pancreatitis

Definition and causes

The term "chronic pancreatitis" refers to a long-lasting pancreatic inflammation that does not go away and worsens over time. This may cause persistent structural damage that can develop into fibrosis (thickening or scarring of the tissue) and ductal strictures. When this occurs, pancreatic activities are impaired, which lowers the production of digestive enzymes and can result in insulin shortage, which can also culminate in diabetes.⁴

This type of pancreatitis is frequently brought on by excessive alcohol consumption, genetic problems, or less frequently by blockages in the pancreatic ducts, high blood fat levels, or high blood calcium levels. Idiopathic pancreatitis occurs when doctors cannot establish a cause for chronic pancreatitis.

Symptoms and diagnosis

Symptoms

Similar to acute pancreatitis, chronic pancreatitis' primary symptom is abdominal pain. Fatty stools, weight loss, glucose intolerance (which in extreme cases might result in diabetes type 1), weariness, and abdominal distension are additional symptoms that may be present.⁴

Diagnosis

The same tests used to diagnose acute pancreatitis can also be used to diagnose chronic pancreatitis. However, the duration of inflammation and the clinical history, on the other hand, can assist in differentiating one from the other. Moreover, the search for fat in the faeces is one test that may assist in the diagnosis indirectly.⁴

Treatment options

The treatment for chronic pancreatitis is the same as for acute pancreatitis, and it also improves the function of the pancreas, including:⁴

• Replacing lost digestive enzymes and substituting vitamins A, B, D, E, and K
• Monitoring blood sugar levels and, in more serious cases, doctors may prescribe metformin for diabetes 

Hereditary pancreatitis

Definition and causes

The diagnosis of hereditary pancreatitis is made when there are many bursts of pancreatitis that start during childhood and last at least a few days. Those who have the genetic form of pancreatitis typically experience chronic pancreatitis and are more likely to develop type I diabetes mellitus. The patients' carers should seek medical attention as soon as symptoms start to occur.

The great majority of cases are caused by changes in the PRSS1 gene, which is inherited in an autosomal dominant form. Yet, other genes can also contribute to this type of pancreatitis.

Symptoms and diagnosis

Symptoms

Hereditary pancreatitis can present with recurring bouts of pancreatic inflammation, elevated leucocyte levels, and jaundice, as well as symptoms of chronic pancreatitis, including abdominal pain or the onset of type I diabetes. Visceral vein thromboses or pancreatic calcifications may also manifest.

Diagnosis

Clinical history, physical examination to check for pain, swelling, or the presence of fluid in the body, blood tests that may be done to rule out acute or chronic pancreatitis, as well as imaging tests are used to make the diagnosis.

Treatment options

Hereditary pancreatitis has no specific treatment. As a result, the treatment options available are to ease symptoms and improve pancreatic function, as in chronic pancreatitis.⁶

Risk factors for developing pancreatitis

Certain groups of people are more likely to get pancreatitis than others, such as those assigned male at birth (AMAB), people with a family history, people of  African-American heritage, and those with a personal or family history of gallstones.¹ The risk factors can be categorized according to below: ¹

Lifestyle factors

• Poor health
• Improper diet
• Alcohol abuse
• Smoking
• Chronic stress 

Medical conditions

• High blood lipids
• Autoimmune disorders
• Pancreas cancer

Genetics

Genetic mutations, such as in certain genes, are risk factors for developing pancreatitis.⁷

Prevention of pancreatitis

Pancreatitis cannot be prevented altogether; however, by making certain lifestyle changes or by seeking medical help, we can reduce the worst possible outcome. 

Lifestyle changes

Avoiding alcohol and smoking, eating a low-fat diet, and maintaining a healthy weight are a few lifestyle modifications we should adopt to reduce our risk of pancreatitis.

Medical interventions

If someone is abusing drinking or smoking, interventions and medical attention may be required. Also, if at any time you experience any of the symptoms of pancreatitis, seek medical help.

Genetic counselling

Genetic counselling for hereditary pancreatitis should only be performed in selected patients by direct DNA sequencing and comprises not only the client's medical history but also the pedigree of three generations, including a history of pancreatitis, the age at when they were diagnosed, and, if possible, the results of tests confirming pancreatitis. They can also learn about diabetes, infertility in AMABs, exocrine insufficiency, chronic sinusitis or nasal polyps, cystic fibrosis in the family, and histories of alcohol and smoking abuse.⁷

Summary

Pancreatitis is an inflammation of the pancreas that can be distinguished into acute, chronic, and hereditary. It can have various causes and, when severe, can lead to irreversible damage. Some of the risk factors are the consumption of alcohol and tobacco and a high-fat diet. There is no real way to prevent pancreatitis with the exception of trying to live a healthy life. If someone is abusing, drinking or smoking or if you or someone you know experience any of the symptoms of pancreatitis, seek medical help.