Acute pancreatitis: Causes, symptoms, and treatments

Pancreatitis is an inflammation of the pancreas. It is painful, develops quickly, and can, in some cases, be fatal. In fact, the overall mortality rate of pancreatitis is around 5 percent, despite medical advancement.

Causes of acute pancreatitis

Alcohol misuse

Trypsin is a digestive enzyme produced in the pancreas in an inactive form; we know that alcohol misuse can cause trypsin to become active when it is still inside the pancreas, but scientists are not sure why. Researchers believe that ethanol molecules affect the pancreas cells, triggering them to activate trypsin prematurely.
                                       

Gallstones

Gallstones are small, pebble-like formations that develop in the gallbladder, often if there is too much cholesterol in the bile. Sometimes, the gallstones can get stuck as they make their way out of the bile ducts and into the intestines. This blokage will also affect the pancreas and prevent it from releasing its enzymes in the intestines. If the acute pancreatitis is linked to gallstones, then elective removal of the gallbadder is usually recommended before the patient leaves the hospital.

Infections

Examples of bacterial infections that can lead to acute pancreatitis include Salmonellosis, a type of food poisoning caused by the bacterium Salmonella, or Legionnaires' disease, an infection caused by the bacterium Legionella pneumophila found in plumbing, shower heads, and water-storage tanks. Acute pancreatitis can also be caused by certain viruses, such as hepatitis B, mumps, coxsackievirus, cytomegalovirus, and varicella-zoster virus.

Other possible causes of acute pancreatitis

• Some autoimmune conditions - such as lupus, or Sjogren's syndrome.
• Genetic mutations that predispose people to have recurrent severe episodes of pancreatitis.
• Injury to the pancreas.
• High triglyceride levels in the blood.
• High calcium levels in the blood.
• Idiopathic - more than 10 percent of all cases of acute pancreatitis are termed idiopathic, meaning there is no obvious cause.

Symptoms of acute pancreatitis

The ache may intensify further and become severe; it also spreads into the back in around half of cases. Eating may exacerbate the pain.Typically, the patient will experience a sudden onset of pain in the center of the upper abdomen, below the breastbone (sternum). Rarely, the pain is first felt in the lower abdomen. It will gradually become more intense until it is a constant ache.

If it is caused by gallstones, everything will happen and develop very fast. When it is caused by alcohol, symptoms develop more slowly, over a number of days.

Leaning forward or assuming a fetal position (curling up) may help lessen the pain slightly. Anybody who experiences constant pain should seek medical attention.

The following symptoms may also be present:

• vomiting
• nausea
• diarrhea
• loss of appetite
• rapid pulse
• pain with coughing, vigorous movements, and deep breathing
• tenderness when the abdomen is touched
• fever - a temperature of at least 100.4 °F (38 °C)
• jaundice - the skin and whites of the eyes take on a yellowish tinge
• strong painkillers often fail to relieve the pain
• blood pressure may drop or rise, but will fall when the patient stands, sometimes causing faintness

                                          

Treatments for acute pancreatitis

Treatment for acute pancreatitis will depend on whether it is mild or serious. "Mild" means the doctor believes the risk of complications is small, while "serious" means the risk is significant.

Treatment for mild acute pancreatitis

The aim of treatment here is to make sure the body is working properly, and to ease symptoms while the pancreas is repairing itself. This will include:

• Painkillers - mild acute pancreatitis can be moderately or severely painful.
• Nasogastric tubes - a tube removing excess liquids and air as a treatment for nausea and vomiting can be used.
• Bowel rest - In mild pancreatitis, the gastrointestinal tract will be given a few days of rest, which means that the patient will not take any food or drink by mouth until the pain has improved.
• Preventing dehydration - Dehydration often accompanies pancreatitis, and it can worsen the symptoms and complications. Patients are usually given aggressive hydration intravenously for the first 24-48 hours (fluids will pass through a tube that is connected to a vein).

Patients usually go home after about 5-7 days.

Treatment for severe acute pancreatitis

Severe acute pancreatitis usually results in some tissue necrosis - some of the pancreas tissue dies. Tissue necrosis carries a very high risk of sepsis - a severe bacterial infection that causes systemic dysfunction (or a whole body reaction), which can eventually lead to multi-organ damage or failure.

Severe acute pancreatitis can also cause hypovolemic shock - severe blood and fluid loss, which makes the heart unable to pump enough blood to the body. Parts of the body can become rapidly oxygen-deprived; this is a life-threatening situation.

Treatment for this kind of pancreatitis includes:

• Being placed in an ICU (intensive care unit) - they will then be injected with antibiotics to stop any infection that could develop from the dead tissue.
• Receiving intravenous fluids - this helps to maintain hydration and prevent hypovolemic shock.
• Some patients may require help breathing - in this case, they will be connected to ventilation equipment.
• Feeding tubes - will provide nutrition as appropriate. In this case, early feeding improves outcomes.
• Surgery - in some cases, the dead tissue may need to be surgically removed.

When doctors are sure the patient is out of danger for risk of organ failure, hypovolemic shock, and sepsis, the patient will be taken out of the ICU.

Treating gallstones

As soon as the patient has recovered and doctors have determined that gallstones caused the acute pancreatitis, the patient might undergo surgery or an ERCP (endoscopic retrograde cholangiopancreatography). After the gallstones are removed, the patient may be advised to follow a special diet to lower blood cholesterol, because excess cholesterol encourages the growth of gallstones. The guideline recommendation from the American Gastroenterological Association is that all patients should have their gallbladders removed if they developed pancreatitis from gallstones.

Treating alcohol misuse

If doctors determine that alcohol misuse was the underlying cause of the acute pancreatitis, the patient may be offered a treatment program for alcohol misuse.

                                         

Acute pancreatitis diagnosis

Patients with acute pancreatitis will have rigid abdominal wall muscles. When listening to the abdomen with a stethoscope, there may be very few or no intestinal sounds.The doctor will ask the patient about symptoms and examine their abdomen. If certain areas of the abdomen are sensitive when touched, this could be an indication of acute pancreatitis.

Blood tests

If blood levels of amylase and lipase are higher than normal, the patient will most likely be sent to the hospital. The pancreas produces elevated levels of both chemicals during acute pancreatitis.

However, blood tests may not be accurate if they are not obtained on the first or second day of illness. This is because lipase and amylase levels are highest within the first few hours and return to normal after a few days.

Amylase returns to normal within 3-7 days, and lipase returns to normal in 8-14 days

Read More

acute Pyelonephritis

Understanding pyelonephritis

Key points

1. Pyelonephritis is a severe kidney infection that may require hospitalization.
2. Common symptoms include high fever, bloody or cloudy urine, and pain in the torso or groin.
3. Pregnant women have a higher risk of pyelonephritis.
                           

Symptoms

Symptoms usually appear within two days of infection. Common symptoms include:

• a fever greater than 102°F (38.9°C)
• pain in the abdomen, back, side, or groin
• painful or burning urination
• cloudy urine
• pus or blood in the urine
• urgent or frequent urination
• fishy-smelling urine

Other symptoms can include:

• shaking or chills
• nausea
• vomiting
• general aching or ill feeling
• fatigue
• moist skin
• mental confusion

                                                                                

• Causes
• 
  
• The infection usually starts in the lower urinary tract as a urinary tract infection (UTI). Bacteria enter the body through the urethra and begin to multiply and spread up to the bladder. From there, the bacteria travel through the ureters to the kidneys.
• Bacteria such as E. coli often cause the infection. However, any serious infection in the bloodstream can also spread to the kidneys and cause acute pyelonephritis.

Diagnosing pyelonephritis

Urine tests

A doctor will check for fever, tenderness in the abdomen, and other common symptoms. If they suspect a kidney infection, they will order a urine test. This helps them check for bacteria, concentration, blood, and pus in the urine.

Imaging tests

The doctor may also order X-rays or an ultrasound to look for cysts, tumors, or other obstructions in the urinary tract.

In people who do not respond to treatment within 72 hours, a CT scan (with or without injectable dye) may be ordered. This test can also detect obstructions within the urinary tract.

                                 

Radioactive imaging

A dimercaptosuccinic acid (DMSA) test may be ordered if your doctor suspects scarring as a result of pyelonephritis. This is an imaging technique that tracks an injection of radioactive material. A healthcare professional injects the material through a vein in the arm. The material then travels to the kidneys. Images taken as the radioactive material passes through the kidneys will show infected or scarred areas.

Treating pyelonephritis

Antibiotics

Antibiotics are the first course of action against acute pyelonephritis. However, the type of antibiotic your doctor chooses depends on whether or not the bacteria can be identified. If not, a broad-spectrum antibiotic will be used. Although drugs can cure the infection within two to three days, the medication must be taken for the entire prescription period (usually 10 to 14 days). This is true even if you feel better.

The antibiotic options are:

• levofloxacin
• ciprofloxacin
• cotrimoxazole
• ampicillin

Hospital admission

In some cases, drug therapy is ineffective. For a severe kidney infection, your doctor may admit you to the hospital. The length of your stay depends on the severity of your condition and how well you respond to treatment. Treatment may include intravenous hydration and antibiotics for 24 to 48 hours. While you’re in the hospital, doctors will monitor your blood and urine to track the infection. You’ll likely receive 10 to 14 days’ worth of oral antibiotics to take after you’re released from the hospital.

                                        

Surgery

Recurrent kidney infections may result from an underlying medical problem. In those cases, surgery may be required to remove any obstructions or to correct any structural problems in the kidneys. Surgery may also be necessary to drain an abscess that doesn’t respond to antibiotics.

In cases of severe infection, a nephrectomy may be necessary. In this procedure, a surgeon removes part of the kidney.

Read More

diabetes pathophysiology

Pathophysiology

The fluctuation of blood sugar (red) and the sugar-lowering hormone insulin (blue) in humans during the course of a day with three meals — one of the effects of a sugar-rich vs a starch-rich meal is highlighted.

Mechanism of insulin release in normal pancreatic beta cells — insulin production is more or less constant within the beta cells. Its release is triggered by food, chiefly food containing absorbable glucose.

Insulin is the principal hormone that regulates the uptake of glucose from the blood into most cells of the body, especially liver, adipose tissue and muscle, except smooth muscle, in which insulin acts via the IGF-1. Therefore, deficiency of insulin or the insensitivity of its receptors plays a central role in all forms of diabetes mellitus.^[50]

The body obtains glucose from three main places: the intestinal absorption of food; the breakdown of glycogen, the storage form of glucose found in the liver; and gluconeogenesis, the generation of glucose from non-carbohydrate substrates in the body.^[51] Insulin plays a critical role in balancing glucose levels in the body. Insulin can inhibit the breakdown of glycogen or the process of gluconeogenesis, it can stimulate the transport of glucose into fat and muscle cells, and it can stimulate the storage of glucose in the form of glycogen.^[51]

Insulin is released into the blood by beta cells (β-cells), found in the islets of Langerhans in the pancreas, in response to rising levels of blood glucose, typically after eating. Insulin is used by about two-thirds of the body's cells to absorb glucose from the blood for use as fuel, for conversion to other needed molecules, or for storage. Lower glucose levels result in decreased insulin release from the beta cells and in the breakdown of glycogen to glucose. This process is mainly controlled by the hormone glucagon, which acts in the opposite manner to insulin.^[52]

If the amount of insulin available is insufficient, if cells respond poorly to the effects of insulin (insulin insensitivity or insulin resistance), or if the insulin itself is defective, then glucose will not be absorbed properly by the body cells that require it, and it will not be stored appropriately in the liver and muscles. The net effect is persistently high levels of blood glucose, poor protein synthesis, and other metabolic derangements, such as acidosis.^[51]

When the glucose concentration in the blood remains high over time, the kidneys will reach a threshold of reabsorption, and glucose will be excreted in the urine (glycosuria).^[53] This increases the osmotic pressure of the urine and inhibits reabsorption of water by the kidney, resulting in increased urine production (polyuria) and increased fluid loss. Lost blood volume will be replaced osmotically from water held in body cells and other body compartments, causing dehydration and increased thirst (polydipsia).

Read More