Pancreatitis

Pancreatitis means inflammation of the pancreas, the organ situated in the upper part of the abdomen, behind the stomach. The pancreas plays an essential role in digestion. Two major types of substances: digestive juices and digestive hormones are produced from the gland called pancreas

Digestive juices contain enzymes and bicarbonate. They pass through a small tube known as the pancreatic duct to the small intestine (duodenum)

Digestive hormones, primarily insulin and glucagon, are discharged into the bloodstream. They control the blood sugar, a key resource of body’s energy.

Pancreatitis can be acute (new, short-term) or chronic (ongoing, long-term). Both type can be very severe, even life threatening. Either type can cause serious complications.

Acute pancreatitis becomes obvious shortly after the damage to the pancreas commences. Attacks are normally very mild, but about 20% of them are extremely severe. An attack lasts for a while and usually decides entirely as the pancreas returns to its normal state. Many people have only one attack, whereas other people have more than one attack, but the pancreas always returns to its normal condition.

All chronic pancreatitis initiates as an acute pancreatitis. If the pancreas becomes scarred at the time of the attack of acute pancreatitis, it cannot go back to its normal state. If the damage to the gland keeps on going, the condition worsens over time.

Pancreatitis occurs in people irrespective of ages, though it is not so familiar in children. Pancreatitis occurs in both men and women, although chronic pancreatitis is more evident in men than in women.

Symptoms

Initially in acute pancreatitis people experience a gradual or sudden pain in the upper abdomen. The pain occasionally spreads over the back. The patient may feel mild pain at the start and feel worse after eating. But the pain is often severe and may become regular and last for several days. A person with acute pancreatitis usually looks and feels very ill and needs urgent medical attention.

Other symptoms may include

A swollen and tender abdomen nausea and vomiting fever
A rapid pulse
Severe acute pancreatitis may cause dehydration and low blood pressure.
The heart, lungs, or kidneys can fail. If bleeding occurs in the pancreas, shock and even death may follow.

Chronic Pancreatitis Symptoms
Pain is less common in chronic pancreatitis. For those people who do have pain, the pain is generally regular and may be disabling; however, the pain frequently goes away as the condition deteriorates. This absence of pain is a bad indication because it perhaps implies that the pancreas has discontinued functioning.

Other symptoms of chronic pancreatitis are associated to long-term complications, such as the following:

Incapability to produce insulin (diabetes)
Inability to digest food (weight loss and nutritional deficiencies)
Bleeding (low blood count, or anemia)
Liver problems (jaundice)

Causes

Alcohol abuse and gallstones are responsible of pancreatitis, all most 80%-90% of all cases.

Pancreatitis from alcohol use usually occurs in patients who have been addicted to alcohol for at least five to seven years. Most cases of chronic pancreatitis are due to alcohol abuse.

Gallstones are the result of an upsurge of material within the gallbladder, another organ in the abdomen. A gallstone can obstruct the pancreatic duct, trapping digestive juices inside the pancreas. Pancreatitis caused by gallstones is likely to occur in women older than 50 years of age.

The remaining 10%-20% of cases of pancreatitis have a range of causes, including the following:

Medications,
Exposure to certain chemicals,
Injury (trauma), as might happen in a car accident or bad fall leading to abdominal trauma,
Hereditary disease,
Surgery and certain medical procedures,
Infections such as mumps (not common),
Abnormalities of the pancreas or intestine, or
High fat levels in the blood.

In about 15% of cases of acute pancreatitis and 40% of cases of chronic pancreatitis, the cause is never known.

Diagnosis

A person’s medical history and conducting a thorough physical examination, is needed like any other diagnosis. The doctor will advise a blood test to assist in the diagnosis. During acute pancreatitis, the blood contains at least three times the normal amount of amylase and lipase, digestive enzymes formed in the pancreas. Alterations may also arise in other body chemicals such as glucose, calcium, magnesium, sodium, potassium, and bicarbonate. After the person’s condition improves, the levels generally return to normal.

Diagnosing acute pancreatitis is often difficult because of the deep location of the pancreas. The doctor will likely order one or more of the following tests:

Abdominal ultrasound: Sound waves are sent toward the pancreas through a handheld apparatus that a technician glides over the abdomen. The sound waves bounce off the pancreas, gallbladder, liver, and other organs, and their echoes make electrical impulses that create a picture—called a sonogram—on a video monitor. If gallstones are causing inflammation, the sound waves will also bounce off them, showing their location.

Computerized tomography (CT) scan: The CT scan is a noninvasive x ray that creates three-dimensional pictures of components of the body. The person lies on a table that slides into a donut-shaped machine. The test may confirm the presence of gallstones and the level of damage to the pancreas.

Endoscopic ultrasound (EUS): After spraying a solution to anesthetize the patient’s throat, the doctor inserts an endoscope—a thin, flexible, lighted tube—down the throat, through the stomach, and into the small intestine. The doctor activates an ultrasound attachment to the scope that generates sound waves to create visual images of the pancreas and bile ducts.

Magnetic resonance cholangiopancreatography (MRCP): MRCP uses magnetic resonance imaging, a noninvasive test that produces cross-section images of parts of the body. Once the patient is lightly sedated, the patient has to lie in a cylinder-like tube for the test. The technician injects dye in order to view the pancreas, gallbladder, and pancreatic and bile ducts prominently.

Treatment

The treatment of pancreatitis will, obviously, bank on the severity of the pancreatitis itself. General Guidelines of treatments are-

1. Provision of pain relief. The chosen analgesic is morphine for acute pancreatitis. Earlier, pain relief was given favorably with meperidine (Demerol), but now it is not regarded as better to any narcotic analgesic. Moreover, meperidine\’s has generally poor analgesic charactersitics and its high potential for toxicity is harmful; it should not be recommended for the treatment of the pain of pancreatitis.
2. Provision of enough substitute of fluids and salts (intravenously).
3. Control of oral intake (with dietary fat restriction, the most vital point). NG tube feeding is the ideal method to avoid pancreatic stimulation and probable infection complications caused by bowel flora.
4. Observing and assessment for, and treatment of, the various complications mentioned above.
5. ERCP is required if gallstone pancreatitis develops.

Treatment for acute pancreatitis necessitates a few days’ stay in the hospital for intravenous (IV) fluids, antibiotics, and medication to lessen the pain. If the person eats or drinks the pancreas can not rest and is therefore forbidden. If the person vomits, a tube may be inserted through the nose into the stomach in order to remove fluid and air.

Acute pancreatitis usually cures in a few days unless complications crop up. In serious cases, the person may feel the need of nasogastric feeding in which a special liquid is passed through a long, thin tube inserted through the nose and throat and into the stomach for several weeks while the pancreas heals.

Prior to get released from hospital, the person will be advised not to smoke, drink alcoholic beverages, or eat fatty meals. In several cases, the cause of the pancreatitis is apparent, but in others, more tests are required after the person is discharged and the pancreas is healed.

ERCP(Therapeutic EndoscopicRetrograde Cholangiopancreatography) for Acute and Chronic Pancreatitis

Shortly after hospitalization of a person suspected with narrowing of the pancreatic duct or bile ducts, a doctor with specialized training performs ERCP.

After lightly sedating the patient and providing medication to numb the throat, the doctor inserts an endoscope—a long, flexible, lighted tube with a camera—through the mouth, throat, and stomach into the small intestine. The endoscope is connected to a computer and screen. The doctor conducts 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.

The following proceedings can be carried out using ERCP:

Sphincterotomy. Using a small wire on the endoscope, the doctor locates the muscle that enfolds the pancreatic duct or bile ducts and makes a small cut to broaden the duct opening.

The presence of pseudocyst drains the duct.

Gallstone removal. The endoscope is also applied to remove pancreatic or bile duct stones with a tiny bin. Gallstone removal is at times performed together with a sphincterotomy.

Stent placement. Using the endoscope, the doctor puts a small 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 contain a small balloon that the doctor uses to dilate, or extend, a narrowed pancreatic or bile duct. A transitory stent can be situated for a few months to keep the duct open.

People who experience therapeutic ERCP are at minor risk for complications, such as severe pancreatitis, infection, bowel perforation, or bleeding. Complications of ERCP are more frequent in people with acute or persistent pancreatitis. A patient who suffers from fever, trouble swallowing, or increased throat, chest, or abdominal pain after the procedure should inform a doctor immediately.

Treatment for chronic pancreatitis comprise of hospitalization for pain management, IV hydration, and nutritional support. Nasogastric feedings may be essential for more than a few weeks if the person continues to lose weight.

When people start to take normal diet, the doctor may recommend synthetic pancreatic enzymes if the pancreas is unable to produce enough of its own. The enzymes should be taken with every meal to help the person digest food and regain some weight. The next step is to follow the instructions of a good dietitian along with the physician who plan a nutritious diet that is low in fat and includes small, frequent meals. Drinking plenty of fluids and restraining caffeinated beverages is very important.

People suffering from chronic pancreatitis are strongly recommended not to smoke or ingest alcoholic beverages, although the pancreatitis is mild or in the nascent stages.

ERCP is used to diagnose acute pancreatitis and treat complications related with chronic pancreatitis like gallstones, pseudocysts, and narrowing or obstruction of the ducts. Chronic pancreatitis also can cause calcification of the pancreas, which indicates that the pancreatic tissue solidifies from deposits of insoluble calcium salts. Surgery may be required to eliminate part of the pancreas.

Once pancreatic tissue is damaged in chronic pancreatitis and the insulin-producing cells (beta cells) of the pancreas have been damaged, diabetes may grow. People with a family history of diabetes tend to develop the disease. To control the diabetes, insulin or other medicines are needed to normalize the blood glucose.