An Epidemiological Study of Acute Pancreatitis in Rural Population

Abstract

Introduction: Acute pancreatitis is a common surgical emergency. Alcohol abuse and biliary tract diseases are etiological in the majority of the cases. The diagnosis is made by clinical examination which is supported by laboratory investigations and imaging studies. Most of the acute pancreatitis are of mild to moderate severity and have good prognosis. The aim of our study is to evaluate the pattern of acute pancreatitis in the rural population and compare the role of serum amylase/lipase as diagnostic tool along with imaging studies and clinical examination.Materials and Methods: This was a prospective study conducted in the surgical wards of Adichunchanagiri Hospital and Research Centre (AH and RC). A total of 79 patients of acute pancreatitis, all from the rural areas surrounding the institute, admitted to AH and RC during the period from January 2014 to June 2016 were studied.Results: The majority of patients fell in the age groups of 30-40 years (29 patients/36.7%) and 40-50 years (18 patients/22.8%). The sex distribution of patients in our study comprised 71 males and 8 females. The total number of patients with amylase level above normal value was 45 (56.8%) while that for the lipase was 41 (51.9%). The number of patients with above 3-fold elevation was 24 (30.3%) in the amylase group and 30 (38.0%) in the lipase group. Serum bilirubin was found to be within normal limits in 87.4% of cases (69 cases), whereas it was raised in 12.6% (10 cases). The etiological cause for acute pancreatitis was found to be alcohol induced in 68 patients. In 8 cases (all females), no specific cause was found and it was considered to be of idiopathic origin. Among 79 patients, 3 patients were found to have the cause of acute pancreatitis as biliary calculi. Complications: Pancreatic ascites was noted in 8 cases (10%). Pseudocyst was noted in 5 cases (6%). Mortality: 1 case diagnosed with acute severe necrotizing pancreatitis. Conclusion: The conclusion from this study was that in acute pancreatitis one should not only rely on enzyme level elevations for diagnosing acute pancreatitis. Patients with only a small increase in amylase and/or lipase levels or even with normal levels can also have or develop acute pancreatitis. Therefore, the clinician who makes the initial diagnosis of acute pancreatitis must evaluate the disease independently of the enzyme level elevations. High degree of suspicion is required; ultrasonography, computed tomography, and enzyme levels study are collectively complimentary to the clinical suspicion. Incidence of acute pancreatitis in rural population is increasing nowadays, probably due to alcohol abuse. Alcoholism ranks first as the etiological factor. KEY WORDS:Pancreatitis, alcoholic, amylases, lipase, bilirubin