Type 2 diabetes may increase your risk for acute pancreatitis.
Your pancreas is a comma-shaped organ located between the rear wall of your stomach and your spine. It is actually a gland with both exocrine and endocrine functions. As an exocrine gland, it secretes digestive enzymes through a duct that enters your small intestine just below your stomach. It fulfills its endocrine function by manufacturing and releasing glucose-regulating hormones directly into your bloodstream. Your pancreas's anatomical location and physiologic functions account for the characteristic signs, symptoms and metabolic abnormalities associated with acute pancreatitis.
Acute pancreatitis is characterized by reversible inflammation of your pancreas. Pancreatic inflammation can be initiated by a number of factors, including medications, infections, pancreatic tumors and autoimmune diseases, such as lupus. However, the majority of cases are caused by gallstones lodging in the pancreatic duct or by alcohol abuse. According to a 2009 review in the вЂњWorld Journal of Gastroenterology,вЂќ a specific cause of acute pancreatitis can be identified in about 80 percent of patients.
The cardinal symptom of acute pancreatitis is upper abdominal pain that begins suddenly. In most patients, the pain is severe and constant, and is described as deep and boring in character. It often penetrates to the mid back, but may also radiate into the chest, lower back or lower abdomen. Your pain may increase if you lie on your back, but it is often relieved by sitting, leaning forward with your chest on your knees or assuming a fetal position. About 75 to 90 percent of patients with acute pancreatitis also develop nausea and vomiting.
Examination and Imaging
Since many conditions can cause symptoms similar to those of acute pancreatitis, your doctor will search for signs that confirm your diagnosis. An abdominal examination may reveal bloating, exquisite tenderness or rigidity - stiffness due to muscular contractions in your abdominal wall. Some patients with acute pancreatitis have a fever or abnormally low blood pressure. Your physician will probably order an ultrasound, CT or MRI of your abdomen. These tests may detect a gallstone lodged in your pancreatic duct, or they may reveal pancreatic swelling or fluid pockets around your pancreas. This information will help establish your diagnosis and guide your treatment.
Several laboratory tests are useful for diagnosing acute pancreatitis. When your pancreas is inflamed, it releases digestive enzymes into your bloodstream. Thus, serum amylase and lipase levels are typically elevated in patients with acute pancreatitis. Similarly, if a gallstone is lodged in your pancreatic duct, certain liver enzymes may be higher than normal. If pancreatic inflammation is severe, your blood glucose level, white blood cell count and triglyceride level may rise sharply, while your calcium level may fall. Your doctor might order other blood tests to gauge the severity of your pancreatic inflammation.
Acute pancreatitis is relatively mild in about 80 percent of cases, and most patients recover fully. Approximately 20 percent of acute pancreatitis cases become severe, and 2 to 6 percent of patients die from this disease. This relatively high mortality rate is concerning in light of an observed increase in the incidence of acute pancreatitis over the past 40 years. While the cause of this trend has not been identified, a study published in the December 2010 issue of вЂњDiabetes CareвЂќ cited the obesity epidemic as one possible contributor. As obesity increases, so does the incidence of type 2 diabetes and gallstone disease. Gallstones are a well-known risk factor for acute pancreatitis, and some of the medications used to treat type 2 diabetes may also heighten risk. Your doctor can determine if you are at increased risk for acute pancreatitis and make suggestions to lower that risk, if necessary.