Pancreatitis

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Questions Received:

  1. What is acute pancreatitis and what causes this?

  2. What are the symtoms of pancreatitis, and how long does it usually last? Does the procedure, endoscopic retrograde cholangiopancreatography give you acute pancreatitis? My blood count for this test for the pancreas was over 37 thousand. Please tell me anything you can, I have to have the procedure again in a week.

  3. Can pancreatitis affect the health of a child? My cousin was just diagnosed with pancreatitis, everyone keeps asking themselves why did the Gynecologist not know that she was ill? They did an emergency c-section and the baby is fine, but she is in critical/stable condition. Could this have been caused by the pregnancy?

  4. Are there any drugs that could be the cause of pancreatitis, if so what are they?

Responses:

What is acute pancreatitis and what causes this?

12th April 1999

The pancreas has two important roles - one is to produce digestive enzymes that are passed into the digestive tract through a duct, and the other is to release hormones into the blood to control sugar levels. So the pancreas is both an exocrine and an endocrine gland. The pancreatic enzymes can become a danger to the pancreas itself if they become activated within the pancreatic tissues, and this is what happens in pancreatitis. The enzymes begin to digest the cells of the pancreas. Pancreatitis is an inflammatory process that produces different degrees of oedema, haemorrhage, and the destruction of pancreatic cells. It can be very serious. Acute pancreatitis means that the inflammation has suddenly appeared, whereas chronic pancreatitis means a more gradual process over a longer period of time. Pancreatitis is more common in adults than in children.

There are several possible causes:

Disease of the biliary tract, for example: gall stones blocking the duct where it opens into the duodenum

 

Diagram of Pancreas & Liver

< Diagram showing the pancreas, liver, duodenum, and stomach. The gall bladder and bile ducts are shown in green, the portal vein and tributaries in blue, and the abdominal aorta and branches in red.

 

 

 

 

 

 

 

 

 

What are the symtoms of pancreatitis, and how long does it usually last? Does the procedure, endoscopic retrograde cholangiopancreatography give you acute pancreatitis? My blood count for this test for the pancreas was over 37 thousand. Please tell me anything you can, I have to have the procedure again in a week.

20th April 1999

The main symptom of pancreatitis is severe abdominal pain that is sudden in onset and continuous. It is usually felt in the midline just below the ribs, but may be biased to one side or the other depending on which part of the pancreas is most affected. The pain often radiates to the back, and the affected person may obtain some relief by sitting forward and holding the knees. However, analgesia is generally required. Nausea and vomiting often accompany the pain. The pain is usually severe for the first day and then decreases over following days as the inflammation subsides. Clinical examination may reveal a degree of shock, increased heart rate, increased white blood cell count and fever. The serum levels of amylase and other pancreatic enzymes may rise to five times their normal values during the first 24 to 72 hours - presumably the blood count you mention was for one of these enzymes.

The procedure you mention, endoscopic retrograde cholangiopancreatography (ERCP), is known to trigger acute pancreatitis in some patients (eg: Solana de Lope et al, 1998; Maldonado et al, 1999). One possible reason is that during the procedure a small quantity of bile might enter the pancreatic duct and irritate it. Under normal physiological conditions this does not occur, because even though the biliary system of the liver and the pancreatic duct share a final common pathway into the duodenum, the secretion pressure of the pancreas is generally somewhat higher than the biliary pressure in the common bile duct, and thus the pancreas is protected from bile reflux. During the ERCP procedure, however, reflux might be induced. As a minimally invasive and cost-effective procedure, ERCP has established itself as a valuable tool for the detection and treatment of a variety of biliary tract disorders (Schmalz and Geenen, 1999; Sahai et al, 1999). Thus any associated risks have to be weighed up in relation to potential benefits. It is also of course possible that pancreatitis that occurs after an ERCP might be caused by the clinical problem that warranted the use of the procedure in the first place, for example gallstones, and not necessarily by the use of the procedure itself. Alternatives to ERCP are being developed, including non-invasive magnetic resonance cholangiopancreatography, but so far the results and usefulness have been less satisfactory than ERCP (Shimizu et al, 1999).

References

Can pancreatitis affect the health of a child? My cousin was just diagnosed with pancreatitis, everyone keeps asking themselves why did the Gynecologist not know that she was ill? They did an emergency c-section and the baby is fine, but she is in critical/stable condition. Could this have been caused by the pregnancy?

13th May 1999

Although we are not in a position to comment directly on your cousin's situation - the health care team looking after her are able to do that - the following general comments may be of some help.

Pancreatitis during pregnancy can seriously affect the health of both the fetus and the mother (Chang et al, 1998; Ramin et al, 1995). If clinical signs of distress are detected in the baby that would prompt delivery by Cesarean section.

Diagnosing pancreatitis is not straightforward since similar symptoms can be generated by other disease processes as well, and it is necessary to distinguish between these before appropriate treatment can begin. Ultrasound examination of the abdomen and identification of elevated levels of amylase and lipase (enzymes produced by the pancreas) in the mother's blood are usually sufficient to confirm the diagnosis of pancreatitis.

Most cases of pancreatitis during pregnancy are caused by a bile stone passing down through the bile duct from the gall bladder and obstructing the opening into the duodenum shared with the pancreatic duct. It is unlikely that pregnancy causes pancreatitis - gall stones are usually present in the gall bladder before pregnancy begins - although pregnancy may conceivably influence the timing of the onset of pancreatitis and its subsequent course (Block, and Kelly, T.R. 1989). If the attack of pancreatitis during pregnancy is mild, recovery begins soon after delivery (Chen et al, 1995). If an operation is required to relieve the obstruction, keyhole surgery (endoscopic sphincterotomy) is effective and generally prevents recurrence of pancreatitis (Barthel, Chowdhury, and Miedema, 1998).

References

Are there any drugs that could be the cause of pancreatitis, if so what are they?

28th January 2004, edited 15th January 2007

About 2% of all cases of pancreatitis are thought to be drug-induced to some degree (Wilmink and Frick, 1996; Kvande and Madsen, 2001). When ethanol abuse, smoking, and biliary disease are ruled out as aetiologies for pancreatitis, the possibility of drug-induced disease should be investigated (Underwood and Frye, 1993). More than 260 drugs have been implicated so far as possible causes or co-factors in pancreatitis (Battillocchi et al, 2002). The mechanisms suggested for drug-induced pancreatitis include pancreatic duct constriction; immunosuppression; cytotoxic, osmotic, pressure, or metabolic effects; arteriolar thrombosis; direct cellular toxicity; and hepatic involvement. However, much of the evidence so far comes from limited case studies, and clear evidence of an association requires rechallenge tests (in which the suspected drug is given again briefly after recovery from the first occurrence of pancreatitis), consistent case reports, evidence from animal experiments, and data on the incidence of acute pancreatitis during drug trials (Wilmink and Frick, 1996).

The following lists classify drugs and other agents according to published opinions about their degree of possible involvement in pancreatitis. Some agents appear in more than one list, indicating that there are different opinions about the level of association.

Agents reported to have a definite association with pancreatitis:

Agents reported to have a probable association with pancreatitis:

Agents reported to have a questionable association with pancreatitis:

(This was edited on 15th January 2007 to remove acetaminophen because it is the same as paracetamol, which is mentioned above and would therefore be a contradiction in terms)

References

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