Pancreatitis

Inflammation of the pancreas, which may be acute or chronic. The main causes of acute pancreatitis are alcohol abuse and gallstones. Less common causes are injury, viral infections, surgery on the biliary system, or certain drugs. Chronic pancreatitis is usually due to alcohol abuse. Rarer causes include hyperlipidaemias, haemochromatosis, and severe acute pancreatitis. Chronic pancreatitis leads to permanent damage. Acute pancreatitis is less damaging but there may be recurrences. Symptoms of acute pancreatitis are a sudden attack of severe upper abdominal pain, which may spread to the back, often with nausea and vomiting. Movement often makes the pain worse. The attack usually lasts about 48 hours. Chronic pancreatitis usually has the same symptoms, although the pain may last from a few hours to several days, and attacks become more frequent. If there is no pain, the principal signs may be malabsorption or diabetes mellitus. Severe acute pancreatitis may lead to hypotension, heart failure, kidney failure, respiratory failure, cysts, and ascites. Chronic pancreatitis may also lead to the development of ascites and cysts, as well as bile duct obstruction and diabetes mellitus. A diagnosis may be made by blood tests, abdominal X-rays, ultrasound scanning, CT scanning, MRI, or ERCP. Acute pancreatitis is treated with intravenous infusion of fluids and salts and opioid analgesic drugs. In some cases, the gut may be washed out with sterile fluid, or a pancreatectomy may be performed and any gallstones that are present removed. Treatment for the chronic form is with painkillers, insulin, pancreatin, and, in some cases, pancreatectomy.