Pancreatitis

Pancreatitis

Pancreatitis is an inflammation of the pancreas, a gland located behind the stomach.  The pancreas secretes digestive enzymes through a duct into the small intestine.  These enzymes aid in the digestion of fats, carbohydrates and proteins.  The pancreas also secretes two hormones: insulin and glucagon, which aid in the absorption of sugar.

Inflammation occurs when the digestive enzymes produced are triggered to attack the pancreas.  In severe cases, bleeding, tissue damage, infection and cysts occur as a result of this inflammation.  Enzymes and toxins present in the pancreas can then spread through the bloodstream causing further damage to other organs such as the heart, liver, lungs and kidneys.

There are two types of pancreatitis: acute and chronic.  Acute pancreatitis is characterized by sudden attacks, which can be very intense and life-threatening, resulting in several complications.  Once treated, a complete recovery is common.  Chronic pancreatitis occurs when damage to the pancreas continues.  Symptoms are similar to the acute version but much more severe.  Pancreatic dysfunction may occur resulting in poor digestion and weight loss.

Pancreatitis typically occurs in individuals between 30 and 40 years of age.  This condition seems to be more common in men than women, and many scientists believe that it may be inherited.  Acute pancreatitis is most commonly caused by alcohol abuse.  If patients that have recovered from one acute attack continue to abuse alcohol, chronic pancreatitis may arise.  90% of chronic pancreatitis cases are caused by alcoholism.  Other causes of acute pancreatitis are gallstones, prescribed drugs, trauma to the area, surgery to the abdomen or infection.  In 15% of cases, the cause of acute pancreatitis is unknown.

Symptoms

In cases of acute pancreatitis, one of the first symptoms is intense and possibly constant pain in the upper abdomen.  This pain can then lead to the back and other areas, or be further aggravated when eating.  The abdomen may feel swollen and tender.  Other symptoms include:

In 20% of cases, the acute attacks are severe.  In such cases the symptoms may include:

Many of the symptoms associated with chronic pancreatitis may be similar to those of the acute version.  In chronic cases the pain may be more severe.  The pain may be constant and even disabling, and may go away as the condition advances.  Also, pancreatic dysfunction, is common among chronic patients and will result in a lack of pancreatic enzymes leading to poor digestion and weight loss.  If the insulin producing cells in the pancreas are also affected, diabetes may occur.

Diagnosis

Diagnosis of acute pancreatitis may be done with a combination of blood tests.  These tests will determine if there is an elevated amount of amylase (digestive enzyme) or elevated levels of sugars and fats--all of these are potential signs of pancreatitis.  Changes in levels of calcium, magnesium, sodium, potassium and bicarbonate in the blood may also help in diagnosis.  After recovery, the levels of all these substances should return to normal.

With chronic pancreatitis, the blood tests will be performed in combination with urine and stool tests in order to determine the severity of the condition.  Pancreatic function tests may be performed in order to determine if the pancreas is capable of producing digestive enzymes.  The physician may also decide to view the pancreas using techniques such as ultrasonic imaging or endoscopic retrograde cholangiopancreatography (ERCP).  Surgery may also be used in order to rule out other conditions that mirror pancreatitis.

Treatment

The treatment of acute pancreatitis depends on the severity of the attack.  In many cases, if no complications arise, there is a full recovery without any treatment.  If treatment is necessary, the patient will be hospitalized and the complications will be treated immediately.  Intravenous fluids will be given to restore blood volume.  The kidneys, lungs and heart will be monitored in order to prevent failure.  If uncontrollable vomiting persists, a tube will be inserted through the nose and into the mouth in order to remove fluid and air.  If the attack is severe, food can be fed intravenously for as long as six weeks while the pancreas heals.  And, antibiotics will be administered to treat infection.  Surgery may be necessary for a number of reasons:

Gallstones are a potential complication of pancreatitis.  Physicians will use ultrasound viewing techniques to detect them and surgery will be performed to remove them.  Depending on the severity of the disease, gallstones will either be removed immediately, as with mild cases, or within a month or if the attack is severe and the pancreas needs time to heal.  Computerized Axial Topography (CAT) Scan can be used to determine the extent of the condition.  This information is important for determining when the gallstones should be removed.  After removal of gallstones, the inflammation should disappear and the patient should make a full recovery.  Individuals who have recovered from acute pancreatitis should avoid alcohol and large meals.

The treatment of chronic pancreatitis is mainly used to manage pain, aid in metabolism and bolster the absorption of food.  Pills containing pancreatic enzymes may be administered in order to aid in digestion, which can lead to weight gain and proper nutrition.  Insulin or other medications may be given to control blood sugar.  Surgery may be used to repair pancreatic ducts or remove part or all of the pancreas in order to relieve chronic pain.  Patients suffering from chronic pancreatitis should, by no means, drink alcohol.  Also, in order to relieve pain and have fewer attacks, individuals suffering from chronic pancreatitis should follow their prescribed diet and take their proper medication(s).