| Pancreatitis is an inflammation of the pancreas. There are two types, acute and chronic. Acute pancreatitis is an inflammation of the pancreas that usually resolves without permanent damage to the organ. In this condition, the enzymes produced by the pancreas actually "digest" the gland.
Acute pancreatitis is caused by alcohol consumption in approximately 80% of cases. The remaining 20% cases are caused by drugs, infection, surgical complications, blunt and penetrating trauma, hereditary predisposition, obstruction of the pancreatic duct due to pancreatic cancer or gallstone formation, structural abnormalities, or excessive calcium or fats in the blood. One risk factor for pancreatitis is high levels of triglycerides in the blood (hypertriglyceridemia).
Chronic pancreatitis indicates that damage persists even after the causative agent (usually alcohol) is removed. Recurrent attacks can lead to progressive deterioration of the pancreatic structure and function.Incidence and Prevalence: Approximately 58,500 cases of acute pancreatitis and 24,900 cases of chronic pancreatitis are reported annually in the US; the incidence of pancreatitis is 4 of 100,000 for Native Americans, 5.7 of 100,000 for whites, and 20.7 of 100,000 for blacks (Khoury). |
Source: Medical Disability Advisor
| History: Pain is the most common symptom of acute pancreatitis. This pain can be very severe and usually involves the epigastric region on the right upper quadrant of the abdomen and can radiate to the back. Nausea and vomiting are frequent in acute pancreatitis, as is fever. The pain of chronic pancreatitis is less severe and is usually more a dull ache. It is typically sporadic in nature. Physical exam: Individuals with acute pancreatitis often have low-grade fevers, tachycardia, tachypnea, and hypotension. Most also have abdominal tenderness, and bowel sounds are often decreased or absent. In severe cases, leaking of blood from the pancreas will cause bluish discoloration of the flanks (Grey Turner sign) or of the periumbilical area (Cullen sign). The physical exam is less useful in chronic pancreatitis because the intensity of the symptoms varies widely and often the individual sees the doctor between episodes. Tests: Blood tests for infection and pancreatic function are complete blood count, blood glucose, BUN, creatinine and electrolytes, serum amylase and lipase, and serum bilirubin. CT helps in the visualization of the pancreas. X-rays and ultrasound may also be useful. |
Source: Medical Disability Advisor
| Treatment for acute and mild pancreatitis is aimed only at nutritional support and maintaining blood chemical balance using intravenous (IV) fluids with careful monitoring until the inflammation subsides. No food is taken by mouth during the episode and IV nutrition is provided until inflammation subsides, at which point the IV is discontinued and the individual resumes regular eating. If the acute pancreatitis is severe, treatment takes place in an intensive care unit of the hospital. In addition, a nasogastric suction tube (to counteract vomiting) and oxygen ventilation are used.
Treatment of chronic pancreatitis is directed at the control of pain and replacement of pancreatic enzymes that aid in the absorption of nutrients. Control of pain begins with the avoidance of alcohol. Analgesics, enzyme therapy, and, sometimes, endoscopic therapy are then given to relieve obstructions.
Surgical treatment is indicated in individuals who fail to improve with medical treatment, in those with excessive bleeding from the pancreas (hemorrhagic pancreatitis), and in those with infection of the pancreas. For those with infection of the pancreas, draining of abscesses and removal of necrotic tissue are performed. In cases of hemorrhagic pancreatitis, surgical procedures to cauterize or ligate blood vessels are performed. Procedures that resect part of the pancreas and adjacent ducts are often performed. In very severe cases, total removal of the pancreas (total pancreatectomy) with islet autotransplantation may be utilized. |
Source: Medical Disability Advisor
| In mild pancreatitis where the inflammation is confined to the organ itself, the prognosis is excellent. The condition usually leaves no permanent damage and mortality is low. If severe hemorrhage or damage to other organs occurs, mortality can be 10% to 50% (Khoury). Acute pancreatitis is graded according to a system called the Ranson score. This is based on the individual's age and on a variety of lab tests. A Ranson score of 0 to 2 has a minimal mortality rate; a Ranson score of 3 to 5 has a 10% to 20% mortality rate, while a Ranson score of 5 or higher has a 50% mortality rate (Khoury).
In chronic pancreatitis, recurrent attacks tend to become progressively more severe, especially if the individual is not compliant with recommendations to avoid alcohol and modify diet.
Surgical intervention is usually successful with low mortality rates. However, as a result of surgery, individuals will require pancreatic enzyme supplementation and many become insulin-dependent diabetics. Individuals who underwent resection for chronic pancreatitis have significantly lower scores on a quality of life questionnaire in physical and psychological domains than healthy controls. |
Source: Medical Disability Advisor
| Acute pancreatitis may be complicated by infections from pancreatic fluid collections in the abdominal cavity (ascites), death of pancreatic tissue (necrosis), and cysts forming channels (fistulas) to other body organs. Other possible complications are splenic vein blood clots (thrombosis) and an excessive loss of fats in the feces (steatorrhea). In intractable cases, circulating toxins may cause systemic failure due to septic shock.
Other complications include weight loss, abdominal pain, fatigue, foul stools, and diabetes. |
Source: Medical Disability Advisor
| Individuals may need to transfer to modified duty or switch to part-time work. Heavy lifting restrictions may be necessary for a minimum of 6 weeks. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Does individual have severe abdominal pain and tenderness? Low-grade fever, elevated pulse rate, low blood pressure, or shallow respiration?
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Does individual report nausea, vomiting, and weight loss?
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Is the abdominal pain dull rather than sharp?
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Has individual received adequate blood testing to establish the diagnosis?
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Were conditions with similar symptoms ruled out?
Regarding treatment:
- If treated for acute and mild pancreatitis, is individual following treatment until inflammation subsides? If acute pancreatitis was severe, was hospitalization required? Were nasogastric suction tube and oxygen ventilation used?
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If treated for chronic pancreatitis, is individual avoiding alcohol? Was endoscopy needed? Analgesics or enzyme therapy?
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Was surgery necessary? What procedure was performed? Duct drainage? Pancreatic head resection? Total pancreatectomy?
Regarding prognosis:
- Did individual become an insulin-dependent diabetic?
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Does individual have any comorbid conditions that may impact recovery?
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Did complications occur that could impact recovery and lengthen disability?
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Source: Medical Disability Advisor
| Khoury, Gattas, and Samer Deeba. "Pancreatitis." eMedicine. Ed. Jerome F.X. Naradzay. 17 Jun. 2004. Medscape. 28 Dec. 2004 <http://emedicine.com/emerg/topic354.htm>. |
Source: Medical Disability Advisor
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