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Hypertriglyceridemia - blood triglycerides higher than 500 mg/dL, or 5.6 mmol/L - can put you at high risk for such problems as
- fatty liver - yellow discoloration of the liver due to fatty degeneration of the parenchymal cells (hepatocytes), which release substances into bile canaliculi (little canals between hepatocytes) and into blood and lymph channels; and
- acute pancreatitis, an acute inflammatory process of the pancreas - an abdominal organ that secretes digestive enzymes.
Pancreatitis symptoms are similar to those of heart attack, appendicitis, ulcers, irritable bowel syndrome, hiatal hernia, gallstones, and hepatitis. So accurate diagnosis is important..
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Acute pancreatitis is associated with severe acute upper abdominal pain and elevated serum levels of pancreatic enzymes.
Most cases are associated with biliary sludge leading to gallstones and alcohol abuse (60-80 percent of cases), but the precise pathogenetic mechanisms are not understood completely.
Other causes of acute pancreatitis include:
- iatrogenic postoperative trauma - one of the major complications of endoscopic retrograde cholangiopancreatography (ERCP)
- hypercalcemia - elevated blood calcium levels maily due to hyperparathyroidism
- drugs such as thiazides, azathioprine, tetracyclines, estrogens, corticosteroids, sulphonamides, or atorvastatin (Lipitor)
- blunt trauma (injury) to the abdomen, often due to motor vehicle accident (MVA)
- infections, such as HIV, mumps, or cytomegalovirus
- cystic fibrosis
- congenital hereditary anomalies (pancreas divisum, choledochocele)
- Reye's syndrome (RS) - primarily a children's disease, although it may occur at any age, causing massive accumulations of fat in the liver and other organs, including pancreas.
The diagnosis is made via clinical exam, laboratory findings, and, if needed, imaging studies such as CT scan, the mainstay for imaging acute pancreatitis and its complications, or MRI, an excellent alternative imaging modality.
Serum triglyceride concentrations above 1000 mg/dL, or 11.3 mmol/L can precipitate attacks of acute pancreatitis and may account for 1.3-3.8 percent of cases.
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The clinical manifestations of hypertriglyceridemia associated pancreatitis are similar to those seen with other causes with the exception that, for poorly understood reasons, the serum amylase may not be elevated substantially.
Clinical assessment for severe pancreatitis is as accurate as most scoring systems.
Treatment of acute pancreatitis is aimed at correcting predisposing factors and at the pancreatic inflammation itself.
General management consists of supportive care with:
- intravenous hydration
- pain management
- antibiotics
- parenteral or enteral (jejunal) feeding, and
- necrosectomy (in severe cases).
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People with recurrent episodes of abdominal pain that is less severe than acute pancreatitis may experience the chylomicronemia syndrome.
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Dietary fats (from food) are absorbed through the gut – the intestines where they are assembled (synthesized) into special “lipid packets” called chylomicrons, a microscopic, minute fat particles formed during fat digestion and assimilation that directly enter the lymphatic system.
Intestinal triglycerides, or chylomicrons, containing approximately 85 percent triglycerides, are then delivered through the bloodstream to the liver, where they are processed (the normal half-life of chylomicrons is about 10 minutes).
(The half-life of a substance refers to the time required to eliminate or metabolize half of the total quantity of the substance from the body following its digestion.)
A history of recurrent episodes of acute pancreatitis is common in people with severe and uncontrolled triglyceride levels, often exceeding 5000 mg/dL, or 56.5 mmol/L.
Chylomicronemia syndrome is an inherited disorder, in which abnormal lipid (fat) metabolism causes chylomicrons (a type of lipids) to accumulate to massive levels in the blood.
This less severe, and often unrecognized, condition usually is caused by triglyceride levels greater than 1000 mg/dL, or 11.3 mmol/L.
However, people with this syndrome, at the onset of symptoms usually have triglyceride elevations greater than 2000 mg/dL, or 22.6 mmol/L and provide a history of recurrent episodes of:
- abdominal pain, sometimes with
- nausea
- vomiting, or
- dyspnea – shortness of breath or difficulty in breathing.
Therefore, in this condition pancreatitis is not necessarily present and pain commonly is mid epigastric, around the stomach. But it may occur in other regions, including the chest or back.
It should be noted that the presentation of hyperchylomicronemia may be confused with conditions such as:
- acute myocardial syndromes and
- biliary colic - a condition characterized by severe cramping pain in the right upper abdomen due to gallstones in the gallbladder or in the bile ducts.
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