Acute pancreatitis in old age

Acute pancreatitis in the aged population

Acute pancreatitis refers to inflammation of the pancreas, causing sudden and severe abdominal pain. Pancreas is a gland that produces digestive juices and certain hormones, including insulin. Pancreatitis usually develops as a result of gallstones or moderate to heavy alcohol consumption over a period of years. Acute pancreatitis (inflammation of the pancreas) is common in older people. It is responsible for 5-7% of the cases of abdominal pain in older persons.

Causes:

In old age it occurs primarily due to

  • gallstone induced biliary tract disease
  • drug induced pancreatitis
  • alcohol
  • pancreatic cancer

It occurs most often in women.

Signs and symptoms:

Acute illness is characterized by:

  • sudden, constant pain in the upper part of the abdomen
  • nausea
  • vomiting
  • In severe cases, the initial symptom may be shock or coma.

When the disease is more severe it is characterized by:

  • sepsis
  • pancreatic abscess
  • shock

Diagnosis:

Diagnosing acute pancreatitis can be difficult because the signs and symptoms of pancreatitis are similar to other medical conditions.

The diagnosis is usually based upon a medical history, physical examination, and the results of diagnostic tests.

Two of the following three are required to make a diagnosis:

(1) typical abdominal pain;

(2) threefold or more elevation of pancreatic enzyme values in the blood; and

(3) inflammation of the gland on computed tomography (CT) scan or magnetic resonance imaging (MRI) scan.

Once a diagnosis of acute pancreatitis is made, additional tests are needed to determine the underlying cause. This ensures that the correct treatment is given to prevent pancreatitis from recurring.

Imaging tests — Imaging tests provide information about the structure of the pancreas, the ducts that drain the pancreas and gallbladder, and the tissues surrounding the pancreas. Imaging tests may include an x-ray of the abdomen, chest, CT scan or MRI of the abdomen

Endoscopic retrograde cholangiopancreatography (ERCP) — ERCP is a procedure that can be used to remove stones from the bile duct if your pancreatitis is due to gallstones or other problems with the bile or pancreatic ducts. In addition, ERCP can be used to treat some causes of pancreatitis

Management:

Treatment usually requires hospitalization for at least a few days.

Mild pancreatitis 

  • monitoring
  • drugs to control pain and
  • intravenous fluids
  • You may not be allowed to eat anything during the first few days if you have nausea or vomiting

Moderate to severe pancreatitis

Moderate to severe pancreatitis requires more extensive monitoring and supportive care. This is because severe pancreatitis can lead to potentially life-threatening complications, including damage of the heart, lung, and kidneys. People with pancreatitis of this severity may be closely monitored in an intensive care unit.

During this time you may be given one or more of the following treatments:

Intravenous fluids are given to help prevent dehydration.

Most people with moderate to severe pancreatitis will not be able to eat in the early course of their illness. Instead, you may be fed through a tube placed through the nose or mouth into the small intestine.

If you cannot tolerate tube feeding or cannot get enough nutrients with tube feeding, you may be given nutrition through an intravenous line placed in the upper chest. You can resume eating gradually once your pain resolves and bowel function returns to normal.

About 30 percent of people with severe acute pancreatitis develop an infection in the damaged pancreatic tissue. Antibiotics can prevent infections and control infections that are already present.

Acute pancreatitis is sometimes complicated by extensive damage and/or infection to the pancreatic tissue. In these cases, the damaged and/or infected tissue may be removed in a procedure referred to as a necrosectomy. Necrosectomy can be done as a minimally invasive procedure.