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Acute Pancreatitis

Acute pancreatitis is one of the conditions that can cause a severe abdominal pain , a so-called “acute abdomen”.

It is defined as an inflammatory condition of the pancreatic tissue, which after its resolution returns the tissue to normal without scarring. However, this concept is false. Pathological studies have shown that there seems to be a discrepancy between the clinical impression that the condition has resolved and the histological appearance on tissue samples.

Even minor pancreatitis attacks can leave major scarring behind (Ref.5). Particularly with alcoholic pancreatitis there is evidence that alcohol can precipitate some of the protein compounds of the pancreatic juice in the ducts, which then blocks further flow of pancreatic juice and causes damage inside the pancreatic organ.

This leads to so much damage and subsequent scarring that such an acute attack, although clinically not yet apparent, has lead to a chronic pancreatitis pattern histologically. We know a lot about the possible causes of acute pancreatitis. More than 80% of all acute pancreatitis cases are due either to alcohol abuse or due to gall stones stuck in the common bile duct. The following table gives an overview of some of the various causes.

 Causes of acute pancreatitis

Frequency  of cause: Nature of cause of acute pancreatitis:
    80% alcoholism, biliary tract disease (gall stones)
    20% drugs (furosemide, azathioprine, valproic acid); hypertriglyceridemia;hyperparathyroidism; hypercalcemia; blunt or penetrating trauma to the abdomen; estrogen in women with hyperlipidemia; statins
Acute Pancreatitis (Alcohol Is One Of The Causes)

Acute Pancreatitis (Alcohol Is One Of The Causes)

Acute pancreatitis caused by statins

For many years the statins as a possible cause of pancreatitis have been overlooked until Dr.Sonal Singh of the Wake Forest University in Winston-Salem, N.C. reported in the December 2006 issue of Drug Safety that 1 person of 300,000 persons treated with statins per year will come down with acute pancreatitis. Read more details about the study in this blog.

References

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2. M Candelli et al. Panminerva Med 2000 Mar 42(1): 55-59.

3. LA Thomas et al. Gastroenterology 2000 Sep 119(3): 806-815.

4. R Tritapepe et al. Panminerva Med 1999 Sep 41(3): 243-246.

5. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse       Station, N.J., 1999. Chapters 20,23, 26.

6. EJ Simchuk et al. Am J Surg 2000 May 179(5):352-355.

7. G Uomo et al. Ann Ital Chir 2000 Jan/Feb 71(1): 17-21.

8. PG Lankisch et al. Int J Pancreatol 1999 Dec 26(3): 131-136.

9. HB Cook et al. J Gastroenterol Hepatol 2000 Sep 15(9): 1032-1036.

10. W Dickey et al. Am J Gastroenterol 2000 March 95(3): 712-714.

11. M Hummel et al. Diabetologia 2000 Aug 43(8): 1005-1011.

12. DG Bowen et al. Dig Dis Sci 2000 Sep 45(9):1810-1813.

13. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse  Station, N.J., 1999.Chapter 31, page 311.

14. O Punyabati et al. Indian J Gastroenterol 2000 Jul/Sep 19(3):122-125.

15. S Blomhoff et al. Dig Dis Sci 2000 Jun 45(6): 1160-1165.

16. M Camilleri et al. J Am Geriatr Soc 2000 Sep 48(9):1142-1150.

More references

17. MJ Smith et al. J R Coll Physicians Lond 2000 Sep/Oct 34(5): 448-451.

18. YA Saito et al. Am J Gastroenterol 2000 Oct 95(10): 2816-2824.

19. M Camilleri Am J Med 1999 Nov 107(5A): 27S-32S.

20. CM Prather et al. Gastroenterology 2000 Mar 118(3): 463-468.

21. MJ Farthing : Baillieres Best Pract Res Clin Gastroenterol 1999 Oct 13(3): 461-471.

22. D Heresbach et al. Eur Cytokine Netw 1999 Mar 10(1): 7-15.

23. BE Sands et al. Gastroenterology 1999 Jul 117(1):58-64.

24. B Greenwood-Van Meerveld et al.Lab invest 2000 Aug 80(8):1269-1280.

25. GR Hill et al. Blood 2000 May 1;95(9): 2754-2759.

26. RB Stein et al. Drug Saf 2000 Nov 23(5):429-448.

27. JM Wagner et al. JAMA 1996 Nov 20;276 (19): 1589-1594.

28. James Chin, M.D. Control of Communicable Diseases Manual. 17th ed., American Public Health Association, 2000.

29. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 157, page1181.

30. Textbook of Primary Care Medicine, 3rd ed., Copyright © 2001 Mosby, Inc., pages 976-983: “Chapter 107 – Acute Abdomen and Common Surgical Abdominal Problems”.

31. Marx: Rosen’s Emergency Medicine: Concepts and Clinical Practice, 5th ed., Copyright © 2002 Mosby, Inc. , p. 185:”Abdominal pain”.

32. Feldman: Sleisenger & Fordtran’s Gastrointestinal and Liver Disease, 7th ed., Copyright © 2002 Elsevier, p. 71: “Chapter 4 – Abdominal Pain, Including the Acute Abdomen”.

33. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.

Last modified: September 1, 2018

Disclaimer
This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.