Pancreatitis

When the pancreas becomes inflamed, then this is called pancreatitis. This is not an easy condition to deal with and it can become very dangerous. The pancreas is the long and flat gland in our body that is located in the upper abdomen, behind the stomach. The pancreas is responsible for producing enzymes that help our digestion. Moreover, they are of a great help in regulating the way the body processes the glucose.

Pancreatitis can appear in two different ways. Acute pancreatitis appears suddenly and it can last for a couple of days. On the other hand, chronic pancreatitis can occur over many years. Treatment has been found for mild pancreatitis, while the severe cases can become life-threatening.

 

What Are the Signs and Symptoms?

When the sudden inflammation of pancreas occurs, it is called acute pancreatitis and it can last for a short time. The first symptoms range from mild discomfort to a severe pain and illness. Fortunately, with the right treatment, the patient can recover completely. When acute pancreatitis appears it can result in bleeding into the gland, cyst formation or infection. What is more, this condition can harm other vital organs.

Acute pancreatitis signs and symptoms can be the following:

  • Upper abdominal pain
  • Abdominal pain that radiates to your back
  • Abdominal pain that feels worse after eating
  • Fever
  • Rapid pulse
  • Nausea
  • Vomiting
  • Tenderness when touching the abdomen

On the other hand, the long-lasting inflammation of the pancreas is called chronic pancreatitis. Usually, chronic pancreatitis appears after a short and intense episode of acute pancreatitis. In this case, one major cause that can lead to chronicity is the heavy use of alcohol.

Chronic pancreatitis has the following signs and symptoms:

  • Upper abdominal pain
  • Losing weight without trying
  • Oily, smelly stools (steatorrhea)

Causes That Lead to Pancreatitis

When the digestive enzymes are still in the pancreas and they are activated causing the irritation of the cells in your pancreas and cause its inflammation, then pancreatitis appears. When the pancreas is functioning poorly, it can cause digestion problems and diabetes. 80% of pancreatitis cases are caused by heavy use of alcohol or gallstones. Acute pancreatitis is caused by gallstones while the chronic condition appears as a consequence of alcohol use.

The conditions that can lead to pancreatitis appearance:

  • Alcoholism
  • Gallstones
  • Abdominal surgery
  • Certain medications
  • Cigarette smoking
  • Cystic fibrosis
  • Family history of pancreatitis
  • High calcium levels in the blood (hypercalcemia)
  • High triglyceride levels in the blood (hypertriglyceridemia)
  • Infection
  • Injury to the abdomen
  • Pancreatic cancer

What is more, once pancreatitis is installed, it can cause various complications. Some of the most frequent are the following:

  • Pseudocyst that appears when acute pancreatitis can cause fluid and debris to collect in cystlike pockets in your pancreas. A large pseudocyst that ruptures can cause complications such as internal bleeding and infection.
  • Infection. Acute pancreatitis episodes, your pancreas is vulnerable to bacteria and infection. These infections require intensive treatment and many times a surgery is necessary to remove the infected tissue.
  • Kidney failure. When the kidney failure is persistent and severe, it can be treated with dialysis.
  • Breathing problems. Acute pancreatitis can cause chemical changes in your body that affect your lung function. Therefore, the level of oxygen in your blood might fall to dangerously low levels.
  • Diabetes which appears because of the damage of insulin-producing cells in your pancreas.
  • Malnutrition. Both acute and chronic pancreatitis can cause your pancreas to produce fewer of the enzymes that are needed to break down and process nutrients from the food you eat. This can lead to malnutrition, diarrhea, and weight loss, even though you may be eating the same foods or the same amount of food.
  • Pancreatic cancer. Long-standing inflammation in your pancreas caused by chronic pancreatitis is a risk factor for developing pancreatic cancer.

How Is Pancreatitis Diagnosed?

When they diagnose acute pancreatitis, the doctors measure levels in the blood of two digestive enzymes. These enzymes are called amylase and lipase. When the levels of these enzymes are high, these are clear signs that the doctors are dealing with acute pancreatitis.

In addition, in order to make sure that the diagnosis is correct, the doctor may perform other tests such as:

  • Pancreatic function test to find out if the pancreas is making the right amounts of digestive enzymes
  • Glucose tolerance test that helps them measure damage to the cells in the pancreas that make insulin
  • Ultrasound, CT scan, and MRI, which make images of the pancreas so that problems may be seen
  • ERCP to look at the pancreatic and bile ducts using X-rays
  • Biopsy, in which a needle is inserted into the pancreas to remove a small tissue sample for study

In more advanced stages of the disease, doctors may ask for blood, urine, and stool tests that help them confirm the diagnosis.

Treatment for Acute and Chronic Pancreatitis

When the patient is diagnosed with acute pancreatitis, he will have to stay a few days in the hospital for intravenous (IV) fluids. The doctors will administrate also antibiotics and medication to help the patient recover and relieve the pain. During the hospitalization period, the patient is not allowed to eat and drink. This method helps the pancreas rest and recover. In case the patient vomits, the doctors may place a tube through the nose and the stomach to help the patient remove the fluid and air.

If everything goes well and other complications do not appear, then the problem will be resolved in just a couple of days. When the doctors are dealing with more severe cases, then the patient might receive nasogastric feeding. This means that the patient will receive a special liquid through a long and thin tube which is used for several weeks until the pancreas recovers.

The recommendations for the person once the pancreas is healed will be not to smoke or drink any alcohol. Moreover, the patients are not allowed to eat fatty meals. When the cause of pancreatitis is not clear, there might be needed addition tests to make sure that they will find the correct diagnosis.

Therapeutic Endoscopic Retrograde Cholangiopancreatography (ERCP) for Acute and Chronic Pancreatitis

ERCP is a specialized technique used to view the pancreas, gallbladder, and bile ducts, It is also used to treat complications of acute and chronic pancreatitis. Once the doctor suspects that the patient is dealing with narrowing of the pancreatic duct or bile ducts, he will perform ERCP.

After lightly sedating the patient and giving medication to numb the throat, the doctor inserts an endoscope. This is a long, flexible, lighted tube with a camera. The doctor inserts it through the mouth, throat, and stomach into the small intestine. The endoscope is connected to a computer and screen. The doctor guides the endoscope and injects a special dye into the pancreatic or bile ducts that help the pancreas, gallbladder, and bile ducts appear on the screen while x rays are taken.

When the doctors are performing ERCP, the following procedures can be made:

  • Sphincterotomy used to create a tiny cut to enlarge the duct opening by using a small wire on the endoscope.
  • Gallstone removal. The endoscope is used to remove pancreatic or bile duct stones with a tiny basket. Gallstone removal is sometimes performed along with a sphincterotomy.
  • Stent placement. Using the endoscope, the doctor places a tiny piece of plastic or metal that looks like a straw in a narrowed pancreatic or bile duct to keep it open.
  • Balloon dilatation. Some endoscopes have a small balloon that the doctor uses to dilate, or stretch, a narrowed pancreatic or bile duct. A temporary stent may be placed for a few months to keep the duct open.

When the patient is dealing with chronic pancreatitis, the patient will require hospitalization for pain management, IV hydration, and nutritional support. When the person is losing weight, nasogastric feedings may be necessary for several weeks.

The synthetic pancreatic enzymes are also prescribed to help the pancreas secrete enough of these enzymes.The doctor’s recommendation might be to take these enzymes during every meal. They help the patient to digest food and regain some weight. The next action will be to establish together with the patient a nutrition diet. The diet should be low in fat and include frequent and small meals. The dietitian has a very important role at this stage. Moreover, in order to cope with chronic pancreatitis, the patient will have to drink plenty of fluids and limit the intake of caffeine.

People with chronic pancreatitis are strongly advised not to smoke or consume alcoholic beverages, even if the pancreatitis is mild or in the early stages.

References:

https://www.niddk.nih.gov/health-information/digestive-diseases/pancreatitis

http://www.mayoclinic.org/diseases-conditions/pancreatitis/diagnosis-treatment/dxc-20252637

http://www.webmd.com/digestive-disorders/digestive-diseases-pancreatitis#2

https://en.wikipedia.org/wiki/Pancreatitis#Causes

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