Pancreatitis

The inflammation of the pancreas is called pancreatitis.

The pancreas is a long, flat gland tucked behind your stomach between the upper part of your small intestine (duodenum) and your spleen.

The pancreas plays important roles in digestion and metabolism. It produces digestive enzymes and hormones.

The digestive enzymes help digest fats, proteins, and carbohydrates in food.

The hormones released by pancreas include insulin and glucagons.

These hormones help the body use the glucose it takes from food for energy.

Digestive enzymes do not become active until they reach the small intestine where they begin digesting food. If these enzymes become active inside the pancreas, they start "digesting" the pancreas itself.

There are two forms of pancreatitis. These are different in causes and symptoms and require different treatment:

  • Acute pancreatitis
  • Chronic pancreatitis

    The main causes of pancreatitis are alcohol and gallstones.

    The ethanol in alcohol normally leads to intracellular accumulation of digestive enzymes and their premature activation and release. It also increases the permeability of ductules, which allow enzymes to reach the parenchyma, resulting in pancreatic damage.

    On the other hand, gallstones that lodge in the lower portion of the bile duct can block the pancreatic duct, causing digestive juices to back into the pancreas, where they destroy healthy tissue.

    Acute Pancreatitis

    This is a rapid onset inflammation of the pancreas. Depending on its severity, it can have severe complications and high mortality despite treatment.

    Mild cases settle with conservative measures or endoscopy. However, severe cases require mostly more than one intervention of surgery to contain the disease.

    Minor causes of the acute form are:

  • Medications such as NSAIDs
  • Peptic ulcer disease
  • Abdominal or cardiopulmonary bypass surgery
  • Trauma to the abdomen or back
  • Inherited abnormalities of the pancreas
  • Inherited disorders of metabolism
  • Intestinal parasites such as ascaris (These can block the pancreatic outflow)
  • Scorpion and snakebites
  • Viral infections, such as mumps, hepatitis virus and rubella

    Symptoms

    The acute form of pancreatitis usually begins with pain in the upper abdomen. The pain may last for a few days. It may be severe and may become constant in the abdomen. The pain may also reach to the back and other areas.

    The pain may be sudden and intense or begin as a mild pain that gets worse when food is eaten. Patients with the acute illness look and feel very sick.

    Common symptoms include:

  • Severe abdominal pain that radiates through to the back.
  • Nausea
  • Vomiting
  • Loss of appetite.
  • Fever
  • Shock
  • Instability
  • Swollen and tender abdomen
  • Nausea
  • Rapid pulse

    The most relentless cases can cause dehydration and even low blood pressure. Vital organs such as the heart, lungs, and kidneys may fail.

    If bleeding occurs in the pancreas, shock and death may follow.

    Diagnosis

    A computerized axial tomography scan (CT scan) can be used detect both forms of the illness. A person's medical history, physical examination or a blood test can also be used to diagnose acute pancreatitis.

    An abdominal ultrasound may be done to look for gallstones and a CAT scan to look for inflammation or destruction of the pancreas. CAT scans are useful in locating pseudocysts.

    For the duration of acute attacks, the blood contains three times more amylase and lipase than usual. Amylase and lipase are digestive enzymes formed in the pancreas.

    There may also be changes in the levels of glucose, calcium, magnesium, sodium, potassium, and bicarbonate in the blood. These levels usually return to normal after the pancreas improves.

    Treatment

    Treatment is designed to support vital bodily functions and prevent complications. The level of treatment depends on the severity of the attack.

    If there are no kidney or lung complications, the acute form of the disease usually improves on its own. A hospital stay is normally expected so that fluids can be replaced intravenously.

    Pancreatic pseudocysts may be drained or surgically removed If they occur and are considered large enough to interfere with the pancreas's healing.

    An acute attack usually lasts only a few days unless the pancreatic duct or bile duct is blocked by gallstones.

    A person may require intravenous feeding for 3 to 6 weeks while the pancreas heals in severe cases in a process called total parenteral nutrition.

    Patients are advised not to drink alcohol and not to eat large meals during the healing process.

    After all signs of acute pancreatitis are gone, the doctor will try to decide what caused it in order to prevent future attacks.

    Likely Complications

    Likely complications from acute pancreatitis include breathing problems and hypoxia, which means that cells and tissues are not receiving enough oxygen.

    Hypoxia is treated by the patient being given oxygen through a facemask. Some people still experience lung failure and require a ventilator despite receiving oxygen.

    Sometimes, the patient cannot stop vomiting and needs to have a tube placed in the stomach to remove fluid and air.

    Patients who cannot eat may receive fluids and pain relievers intravenously.

    Antibiotics are normally prescribed if an infection develops. Surgery may be needed for extensive infections.

    Surgery may also be needed to find the source of bleeding, to rule out problems that resemble pancreatitis, or to remove severely damaged pancreatic tissue.

    Acute pancreatitis can sometimes cause kidney failure. If the kidneys fail, one needs dialysis to help the kidneys remove wastes from the blood.

    Chronic Pancreatitis

    If damage to the pancreas continues, chronic pancreatitis usually develops. It occurs when digestive enzymes attack and destroy the pancreas and nearby tissues, causing scarring and pain.

    It is usually caused by many years of alcohol abuse. It may also be triggered by only one acute attack, especially if the pancreatic ducts are damaged.

    The damaged ducts cause the pancreas to become inflamed, tissue to be destroyed, and scar tissue to develop.

    Harm from alcohol abuse may not appear for many years. However, a person may have a sudden attack from the years of abuse.

    Up to 70 percent of chronic pancreatitis in adult patients is due to alcoholism. Alcoholism causes are more common in men than in women and often develops between the ages of 30 and 40.

    In some instances, pancreatitis can be because of hereditary factors. This form of pancreatitis begins in childhood. It may not however be diagnosed for several years.

    Patients with hereditary pancreatitis usually get the symptoms that come and go. Such occurrences last from 2 - 14 days.

    Hereditary pancreatitis will easily be determined if two or more family members suffer from pancreatitis in more than one generation.

    Causes

    Besides alcoholism and hereditary, other causes of the chronic form of the disease are;
  • Blocked or narrowed pancreatic duct because of trauma or pseudocysts have formed
  • Heredity
  • Idiopathic (undetermined causes)
  • Congenital conditions such as pancreas divisum
  • Cystic fibrosis
  • High levels of calcium in the blood (hypercalcemia)
  • High levels of blood fats (hyperlipidemia or hypertriglyceridemia)
  • Some drugs
  • Certain autoimmune conditions

    Symptoms

    Most people with the chronic illness have:
  • Abdominal pain (some people have no pain at all).
  • Nausea
  • Vomiting
  • Weight loss

    The pain may get worse when eating or drinking and spread to the back. In some cases, abdominal pain goes away as the condition advances. This is perhaps because the pancreas is no longer making digestive enzymes.

    Weight loss normally occurs even when the patientÂ’s appetite and eating habits are normal. This is because the body does not secrete enough pancreatic enzymes to break down food. Nutrients are therefore not absorbed normally.

    Poor digestion leads to excretion of fat, protein, and sugar. If the insulin-producing cells of the pancreas (islet cells) have been damaged, diabetes may also develop at this stage.

    Diagnosis

    The problem of chronic form of the disease is difficult to diagnose without modern technology and equipment.

    However, with ultrasonic imaging, endoscopic retrograde cholangiopancreatography (ERCP), and CAT scans, a doctor can see problems indicating chronic pancreatitis.

    Such problems include calcification of the pancreas, in which tissue hardens from deposits of insoluble calcium salts.

    In more advanced stages of the disease, when diabetes and malabsorption occur, a doctor can use a number of blood, urine, and stool tests to help diagnose chronic pancreatitis and to monitor its progression.

    Pancreatic function tests help a doctor decide whether the pancreas is still making enough digestive enzymes.

    Treatment

    Treatment normally takes the same pattern as it does for acute form of the disease. Pain reduction is normally the first step in the treatment of chronic pancreatitis. Secondly, a diet that is high in carbohydrates and low in fat is planned.

    The doctor may prescribe pancreatic enzymes to take with meals if the pancreas does not secrete enough of its own. The enzymes should be taken with every meal to help the body digest food and regain some weight. Taking enzyme supplements is a vital part of treatment.

    Sometimes insulin and other drugs are needed to control blood glucose.

    Surgery can often ease pain and help manage complications. The surgery involves draining an enlarged pancreatic duct or removing part of the pancreas.

    Individuals with this illness must stop drinking alcohol, stick to their prescribed diet, and take the proper medications.

    Pancreatitis in Children

    Trauma to the pancreas and hereditary are the two known causes of childhood pancreatitis.

    Children with cystic fibrosis, a progressive, disabling, and incurable lung disease, may also have the disease.

    Chronic pancreatitis is nevertheless rare in children and in where it occurs the cause may be undetermined.

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