Pancreatitis: Overview and More

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Pancreatitis is an inflammation of the pancreas. The condition can be acute, appear suddenly and resolve after about a week, or chronic, worsen over time and require long-term treatment. Serious complications can occur with pancreatitis that can be life-threatening. Therefore, prompt diagnosis and treatment, possibly surgery, are critical.

Pancreatitis is the most common cause of gastrointestinal hospitalization in the United States .

The role of the pancreas

The pancreas is a large gland behind the stomach located next to the duodenum, the first section of the small intestine. The pancreas secretes powerful digestive enzymes that enter the small intestine through a duct, which then travels to the duodenum. These enzymes help in the digestion of fats, proteins, and carbohydrates.

The pancreas also releases the hormones insulin and glucagon into the bloodstream. These hormones play an important role in the metabolism of sugar.

Pancreatitis occurs when digestive enzymes are activated while still in the pancreas to attack the organ, causing inflammation and ultimately damage if it persists.

Acute pancreatitis

  • Comes suddenly

  • It usually goes away in a week or two.

  • It can cause many serious complications, but most people make a full recovery after treatment.

Chronic pancreatitis

  • May follow acute pancreatitis

  • It develops gradually and gets worse over time.

  • It does not heal or improve

  • It causes permanent organ damage, which can lead to digestive and metabolic problems.

Acute pancreatitis

An estimated 40 to 50 cases of acute pancreatitis occur per 100,000 people in the United States each year. This condition occurs when the pancreas suddenly becomes inflamed and then improves.

Some people may have multiple attacks, but make a full recovery after each attack.

Causes

Acute pancreatitis is usually caused by:

Gallstones are the most common cause of acute pancreatitis in the United States, and the risk of gallstone-associated pancreatitis increases with age; it is also higher in women than in men.

Other causes of acute pancreatitis include:

  • Prescription drugs
  • Injury to the abdomen
  • Abdominal surgery
  • Hypertriglyceridaemia ( high levels of triglycerides , fat in the blood)
  • Viral infections such as mumps.
  • Bacterial infections such as salmonella.
  • Vascular abnormalities such as vasculitis (inflammation of the blood vessels)
  • Hypercalcemia (high levels of calcium in the blood)
  • Hereditary abnormalities of the pancreas or intestine
  • Pancreatic tumors or cancer.
  • High exposure to agricultural chemicals such as organophosphate insecticides.
  • Autoimmune diseases such as inflammatory bowel disease or celiac disease.

In about 15% of cases, the cause is unknown. Risk factors for acute pancreatitis include smoking, obesity, and uncontrolled diabetes. Type 2 diabetes also increases the risk of a severe case of pancreatitis.

Symptoms

Acute pancreatitis usually begins with pain in the upper abdomen that can last for several days. The pain is usually severe, but can be mild. It can be a constant pain only in the abdomen or it can reach the back and other areas.

The pain can be sudden and severe, or it can start as a dull ache that gets worse with eating and gradually worsens. Other symptoms include:

  • Swelling
  • Tender belly
  • Nausea
  • Threw up
  • Diarrhea
  • Hiccup
  • Indigestion
  • Hot
  • Incrise of cardiac frecuency
  • Feeling or looking very sick
  • Jaundice , yellowing of the skin and whites of the eyes
  • Clay stools

Approximately 15% of patients with acute pancreatitis develop a serious illness .

In severe cases, there may be bleeding in the gland, severe tissue damage, infection, and cysts. Enzymes and toxins can enter the bloodstream and seriously damage organs such as the heart, lungs, and kidneys.

The patient may become dehydrated and have low blood pressure . In the most severe cases, bleeding may occur in the pancreas, leading to shock and sometimes death .

Diagnostics

During acute attacks, blood tests show high levels of amylase and lipase, digestive enzymes produced in the pancreas. Lipase is more specific for pancreatic inflammation than amylase. Changes in blood levels of calcium, magnesium, sodium, potassium, and bicarbonate can also be seen.

Patients may also have high amounts of sugar and lipids (fats) in the blood. These changes help the doctor diagnose pancreatitis. Once the pancreas is restored, the blood levels of these substances usually return to normal .

Watch out

The treatment a patient will receive depends on the severity of the attack. Unless complications arise, acute pancreatitis usually resolves on its own, so treatment is supportive in most cases. Usually the patient is hospitalized.

The doctor prescribes an intravenous fluid to restore blood volume. The kidneys and lungs can be treated to prevent failure. Other problems, such as pancreatic cysts, may also require treatment.

Sometimes the patient cannot control vomiting and needs to pass a tube through the nose into the stomach to remove fluid and air. In mild cases, the patient may not eat for three to four days, but fluids and pain relievers are given intravenously. In severe cases, the patient can receive nutrition through the veins for three to six weeks while the pancreas slowly heals.

An acute attack usually lasts only a few days, unless the ducts are blocked by gallstones.

If complications such as infection, cysts, or bleeding occur, surgery may be required. Antibiotics may be prescribed if signs of infection appear.

Seizures caused by gallstones may require removal of the gallbladder or surgery on the bile ducts, which are tubes that connect the liver to the small intestine. The bile ducts carry stones in the gallbladder and blockages can occur.

When there is a serious injury with tissue death, surgery may be done to remove the tissue.

Between 16% and 25% of patients with acute pancreatitis will develop within a few years. Prevention of this recurrence is the main goal of treatment .

Once all signs of acute pancreatitis are gone, the doctor will determine the cause and try to prevent future attacks. In some patients, the cause of the attack is clear; in other cases, additional tests are needed .

Your prevention plan will depend on the cause, but it may include some dietary changes, such as limiting fried foods and heavy meals and avoiding alcohol.

When there are gallstones

Ultrasound is used to detect gallstones and can give an indication of the severity of pancreatitis. When gallstones are found, surgery is usually required. This usually includes cholecystectomy (removal of the entire gallbladder).

If a gallstone blocks one of the pancreatic ducts, it must also be removed. If the disease is mild, surgery should be done within seven days of acute pancreatitis. If the condition is severe, you may be advised to wait until active inflammation has subsided to try to prevent future episodes of pancreatitis.

Computed tomography (CT) can also be used to determine what is happening in and around the pancreas and to determine the severity of the problem. This is important information that your doctor will use to determine when to remove gallstones.

Once the gallbladder stones are removed and the inflammation subsides, the pancreas usually returns to normal .

Chronic pancreatitis

Chronic pancreatitis can develop after a single acute attack, especially if the ducts are damaged or if damage to the pancreas continues. Ultimately, this condition affects a person's ability to digest food and produce pancreatic hormones.

Illustration by Joshua Song. © Get Drug Information, 2018.

An estimated 5 to 12 cases of acute pancreatitis occur annually per 100,000 people .

Causes

The causes of chronic pancreatitis include:

  • Prolonged consumption of alcohol in large quantities.
  • Blockage of the pancreas or bile ducts.
  • Cystic fibrosis gene mutations
  • Autoimmune disorders
  • An inherited form of pancreatitis that can be caused by enzyme abnormalities.

Damage to the pancreas from alcohol consumption can be asymptomatic for many years, and then suddenly a person has an attack of pancreatitis .

Chronic pancreatitis has many causes, but between 70% and 80% of cases are associated with chronic alcohol abuse.

Damage to the pancreas from alcohol consumption can be asymptomatic for many years, and then suddenly a person has an attack of pancreatitis. It is more common in men than women and often develops between the ages of 30 and 40.

Hereditary forms of chronic pancreatitis appear to be associated with abnormal enzymes in the pancreas that cause them to digest the organ on their own .

Symptoms

In the early stages, the doctor may not always be able to determine whether the patient has an acute or chronic illness. The symptoms can be the same.

People with chronic pancreatitis may have the following symptoms :

  • Pain in the upper abdomen
  • Nausea
  • Threw up
  • Diarrhea
  • Weightloss
  • Greasy or greasy stools
  • Clay or pale stools

Some patients do not feel pain, but most do. The pain can be constant in the back and abdomen; for some, attacks of pain are incapacitated.

In some cases, abdominal pain goes away as the condition progresses. Doctors believe this is because the pancreas no longer produces pancreatic enzymes.

Patients with this condition often lose weight even if their appetite and eating habits are normal. This is because the body does not release enough pancreatic enzymes to break down food, so the nutrients are not absorbed normally. Poor digestion leads to loss of fat, protein, and sugar in the stool.

Diabetes can also develop at this stage if the insulin-producing cells in the pancreas (islet cells) are damaged .

Diagnostics

Diagnosis can be challenging, but several new techniques are helping. Pancreatic function tests help the doctor decide if the pancreas can make enough digestive enzymes. A doctor can see pancreatic abnormalities using several imaging techniques:

In the later stages of the disease, when diabetes and malabsorption (a problem due to a lack of enzymes) occur, the doctor may use a series of blood, urine, and stool tests to help diagnose chronic pancreatitis and monitor its progression. . states .

Watch out

Treatment of chronic pancreatitis generally includes pain relief and nutritional and metabolic problems. The patient can reduce the amount of fat and protein lost in the stool by reducing fat intake and taking pills containing pancreatic enzymes. This will lead to better nutrition and weight gain.

Sometimes insulin or other medications are needed to control a patient's blood sugar.

In some cases, surgery is required to relieve pain by draining the dilated pancreatic duct. Sometimes part or most of the pancreas is removed to relieve chronic pain.

Patients with chronic pancreatitis should stop drinking, follow the prescribed diet, and take the proper medications so that they have fewer attacks and are lighter .

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