What happens in acute pancreatitis, exactly?

What is it?

Acute pancreatitis is a sudden inflammation of the pancreas. Typical symptoms include a severe pain in the upper stomach, nausea, vomiting, and a loss of appetite.

In the US there are about 18 cases of acute pancreatitis per 100 000 people a year, and it accounts for about 220 000 hospitalizations.

What causes it?

Alcohol is a very common cause of acute pancreatitis: in the US it accounts for around 65% of cases. Other common causes include gall stones, metabolic disorders, and physical damage to the stomach.

What happens during it?

The pancreas produces digestive enzymes that help break down things like proteins and fats in order for them to be digested. Normally, the protein-breaking enzyme called trypsinogen only becomes active when it’s released to the small intestine. This helps to protect the body since our body is largely made out of proteins too – if the active form of trypsinogen would come into contact with our tissues, it would start to break them down.

In acute pancreatitis, the trypsinogen comes into contact with certain enzymes and starts converting to the active form.  This can lead to a variety of responses including inflammation, fluid accumulation, injury to blood vessels, and cell death.

Molecules called caspases have a very important protective role during acute pancreatitis. They prevent the destroying of the cells by trypsinogen through stopping it from converting to the active form, for example. Things like alcohol consumption and physical damage can significantly reduce the amount of caspases in the pancreas, which leads to a high risk of serious cellular damage.

How can it be treated?

The treatment of acute pancreatitis aims to give the bowel rest. This is achieved through giving the patient nothing to eat and drink, and making sure they are hydrated through giving them intravenous fluids. The stomach pain can be controlled with medications like opioids.

If the trypsinogen enzymes don’t start killing cells, the prognosis of acute pancreatitis is quite good. If they do, the condition has a mortality rate of 10-30%.

 

 

 

Sources: en.wikipedia.org/wiki/Acute_pancreatitis, https://en.wikipedia.org/wiki/Caspase, https://en.wikipedia.org/wiki/Necrosis, http://www.aafp.org/afp/2007/0515/p1513.html

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