Pancreatitis: Causes, Symptoms, and Risks of Recurrence

Q: Pancreatitis: Causes, Symptoms, and Risks of Recurrence

Hello： 1. <br>The pancreatic inflammation index usually refers to amylase or lipase levels that rise to more than three times the normal value. <br>2. <br>Alcohol consumption is the primary cause; additionally, the presence of gallstones (some of which may be small and not visibl

Pancreatitis issues

Hello, doctor.
My father experienced severe abdominal pain about 5.6 years ago and went to the emergency room, where he was diagnosed with acute pancreatitis.
At that time, his enzyme levels were over 10,000, but he did not want to be hospitalized and went home after his symptoms improved.
In late November of this year, he had another episode of severe abdominal pain and went to the emergency room again, where he was again diagnosed with acute pancreatitis, with enzyme levels over 4,000.
He was hospitalized for five days during which he underwent abdominal ultrasound, CT scan, X-rays, etc.
Upon discharge, the doctors could not determine the cause and advised follow-up visits.
Before the second emergency visit, my father still had a habit of drinking alcohol, but not excessively—about once or twice a month.
After this hospitalization, he has not consumed alcohol until last Friday evening when he reported slight stomach pain.
He took some antacids, which provided relief.
The next day, he went to the hospital for blood tests, and this time the doctor mentioned that his pancreatic inflammation level was 90 and scheduled an MRI to check for possible issues with the pancreatic duct.
If the MRI does not reveal any issues, an endoscopy will be performed.
Aside from abdominal pain, my father does not seem to have any other symptoms, such as pain radiating to the back or experiencing nausea or dizziness.
1.
What does the term "inflammation level" refer to? Five years ago, it was over 10,000, last month it was over 4,000, and this time it is 90.
Since the doctors could not identify the cause, what could potentially be the issue?
2.
Is there a possibility of chronic pancreatitis or pancreatic cancer?

Y, 20~29 year old female. Ask Date: 2020/12/30

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello: 1.
The pancreatic inflammation index usually refers to amylase or lipase levels that rise to more than three times the normal value.
2.
Alcohol consumption is the primary cause; additionally, the presence of gallstones (some of which may be small and not visible on a CT scan), elevated triglycerides, hypercalcemia, or dysfunction of the ampulla of Vater are also possible causes.
3.
Chronic pancreatitis, pancreatic cancer, ampullary cancer, or bile duct cancer are all possibilities.
If an MRI does not reveal the cause, performing an endoscopic examination (specifically, endoscopic retrograde cholangiopancreatography, ERCP) is the appropriate recommendation.
Changhua Hospital cares about your health.
Dr.
Tsai An-shun.

Reply Date: 2020/12/30

More Info

Understanding pancreatitis, particularly acute pancreatitis, involves recognizing its causes, symptoms, and potential risks for recurrence. Your father's case illustrates a common scenario where acute pancreatitis can present multiple times, often with varying severity and unclear etiology.

1. Inflammatory Markers: The "inflammatory index" you mentioned typically refers to the levels of pancreatic enzymes in the blood, specifically amylase and lipase. In acute pancreatitis, these enzymes can rise significantly—often to levels more than three times the normal range. In your father's case, the initial level of over 10,000 was extremely high, indicating a severe episode. The subsequent levels of 4,000 and 90 suggest a decrease in severity, but they still indicate ongoing pancreatic inflammation.

2. Potential Causes: The causes of acute pancreatitis can vary widely. In your father's case, the absence of gallstones and minimal alcohol consumption (1-2 times a month) complicates the diagnosis. Other potential causes include:
- Hyperlipidemia: Elevated triglycerides can lead to pancreatitis.

- Hypercalcemia: High calcium levels can also trigger inflammation.

- Medications: Certain drugs can induce pancreatitis as a side effect.

- Genetic Factors: Some individuals have a genetic predisposition to pancreatitis.

- Idiopathic: In many cases, the exact cause remains unknown despite thorough investigation.

3. Risks of Chronic Pancreatitis and Cancer: Given your father's history of recurrent acute pancreatitis, there is a risk of developing chronic pancreatitis, which can lead to permanent damage to the pancreas and complications such as diabetes or malabsorption. Chronic pancreatitis can also increase the risk of pancreatic cancer, although this is more common in individuals with a long history of alcohol abuse or other significant risk factors. Regular monitoring and imaging, such as MRI or endoscopic retrograde cholangiopancreatography (ERCP), are essential for assessing any structural changes in the pancreas and biliary system.

4. Symptoms and Management: The primary symptom of pancreatitis is abdominal pain, which can vary in intensity and may radiate to the back. Other symptoms can include nausea, vomiting, and changes in bowel habits. In your father's case, the absence of these additional symptoms may suggest a milder form of inflammation or a different underlying issue. Management typically involves hospitalization for supportive care, including hydration, pain management, and dietary modifications. Long-term management may include lifestyle changes, such as dietary adjustments to reduce fat intake, and avoiding alcohol completely.

5. Follow-Up Care: Given the recurrent nature of your father's condition, it is crucial to maintain regular follow-up appointments with his healthcare provider. This will allow for ongoing assessment of his pancreatic function and any potential complications. If MRI does not reveal the cause, further investigations, such as ERCP, may be warranted to evaluate the pancreatic duct for any obstructions or abnormalities.

In conclusion, while acute pancreatitis can be a serious condition, understanding its causes and maintaining vigilant follow-up care can help manage symptoms and reduce the risk of recurrence. Your father's case highlights the importance of thorough investigation and monitoring, especially given his history and the potential for chronic complications.

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