Dr Teo Jin Yao, Associate Consultant from the Department of Hepato-pancreato-biliary and Transplant Surgery at Singapore General Hospital explains the symptoms and causes of acute pancreatitis.
When does acute pancreatitis occur?
Acute pancreatitis occurs when there is a sudden onset of inflammation of the pancreas. It is important to detect it early since it carries a risk of serious complications and even death in severe cases.
The pancreas has two main functions:
- Secretion of digestive enzymes and
- Production of insulin and glucagon (hormones involved in blood glucose control).
Digestive enzymes are normally released in a controlled fashion from the pancreas into the small intestine, where the enzymes are then activated to help digestion.
Pancreatic damage occurs when activated digestive enzymes are released from the pancreas in an uncontrolled fashion and begin attacking it.
Most attacks of acute pancreatitis are mild and will resolve after a few days. Some attacks are severe, and will require intensive care. It is of vital importance to recognise acute pancreatitis, and to assess whether the case is mild or severe. For severe pancreatitis, medical or surgical intervention may be needed.
There is no local data on the incidence of acute pancreatitis in Singapore. In other countries, the incidence has been estimated at between 20 to 30 cases per 100,000 population. Assuming a similar incidence in Singapore, this would translate to 1,000 to 1,500 cases of acute pancreatitis per year.
Signs and symptoms of acute pancreatitis
The hallmark feature of acute pancreatitis is severe upper abdominal pain. The pain is sudden, increases in intensity, and often radiates to the back. Nausea and vomiting, with low grade fever, are also associated with acute pancreatitis.
Causes of acute pancreatitis
In the majority of cases, acute pancreatitis is caused by gallstones or alcohol consumption. Less common causes may be related to medication, a lipid disorder, viral infections, trauma to the abdomen, or auto-immune conditions. For a minority of patients, the cause of acute pancreatitis remain unknown even after extensive investigations.
In Singapore, gallstones are the most common cause of acute pancreatitis. The pancreatic duct and bile duct are joined together as they enter the small intestine, so gallstones can block the common channel, causing obstruction of the pancreatic duct and acute pancreatitis. For some patients, acute pancreatitis may be the first sign of gallstone disease.