Category: Treatment

What does pancreas do?

The pancreas is a long, flat gland that sits tucked behind the stomach in the upper abdomen. The pancreas produces enzymes that help digestion and hormones that help regulate the way your body processes sugar (glucose).

What is acute pancreatitis?

Acute pancreatitis is an inflammation of the pancreas that occurs suddenly. It differs from chronic pancreatitis in that there is a discrete episode.

Acute pancreatitis which may be classified as mild, moderate or severe, depending on the amount of damage and organ dysfunction caused by the pancreatitis.

What are causes or risk factor of acute pancreatitis?

Causes of acute pancreatitis are :

1. Biliary stones are the cause of 35 to 50 percent of the cases of acute pancreatitis.
2. Alcohol intake is the second leading cause of acute pancreatitis.
3. Several drugs may cause pancreatitis e.g, immunosuppressants, estrogens, acetaminophen, sulindac. tetracycline, salicylates, erythromycin, pentamidine, thiazide diuretics, furosemide and valproic acid.
4. Viral causes include hepatitis A, B, and non-A/non-B; cytomegalovirus; mumps; and coxsackievirus.
5. Bacterial causes may include Legionella, mycoplasma and mycobacterium tuberculosis.
6. Parasitic infections may also cause acute pancreatitis.
7. Pancreas divisum (a congenital defect of the pancreatic ducts).
8. Metabolic imbalances (hyperlipidemia and hypercalcemia).
9. Sphincter of Oddi dysfunction.
10. Scorpion stings.
11. Trauma to pancreas may also cause acute pancreatitis.

What are symptoms of acute pancreatitis?

1. Upper abdominal pain is main symptom. Usually it is severe and radiates to back.
2. Nausea and vomiting are the other most frequent symptoms of acute pancreatitis.
3. Fever
4. High pulse rate.
5. Few patients may have jaundice.
6. Patient may have low blood pressure and confusion or coma may occur.

Can acute pancreatitis become chronic pancreatitis?

Yes. Chronic pancreatitis results when inflammation in the pancreas has caused damage and resulted in fibrosis, calcifications and ductal inflammation. It is also possible for patients with chronic pancreatitis to have episodes of acute pancreatitis. Chronic pancreatitis is slow self propagating disease that results in slow destruction of pancreas.

How is acute pancreatitis diagnosed?

Diagnosis of acute pancreatitis is usually made clinically when patient presents with typical pain of pancreatic origin that is pain upper abdomen radiating to back. Further tests helps in confirming diagnosis e.g,

1. Increased serum amylase and/or lipase (pancreatic enzymes).
2. Ultrasound abdomen
3. CT Scan abdomen

Can I prevent acute pancreatitis?

Avoidance of known causes of pancreatitis (i.e., alcohol consumption) may help prevent the onset of the disease. Lifestyle factors such as obesity, alcoholism, hepatitis and others that contribute to a poor state of overall health lead to complications of acute pancreatitis and to a poorer prognosis for recovery.

What is treatment of acute pancreatitis?

The treatment of acute pancreatitis depends on its severity.

1. If the disease is considered mild, the patient is usually treated supportively with intravenous fluids, pain control medication, keeping close watch on patient’s general condition so that it does not deteriorates.
2. Severe pancreatitis requires close monitoring of the patient to detect possible systemic complications. The patient may be admitted to an intensive care unit. Organisms may reach the pancreas and infect it by crossing the colonic wall. Antibiotics may be used to prevent sepsis. These patients may have some organ failure thus require support for these failed systems.
3. Surgical debridement and drainage may be necessary if infected pancreatic necrosis (cell death) arises. CT scan-guided aspiration of necrotic areas may be done to identify the infecting organism so that it may be treated effectively. Surgical intervention is usually done 4 weeks after onset of pancreatitis.
4. Therapeutic endoscopic retrograde cholangiopancreatography (ERCP) may be performed in the early stages of acute pancreatitis to remove gallstones and may require sphincterotomy (cutting the sphincter muscle to allow drainage from the biliary/pancreatic tract).

What are possible complications of acute pancreatitis?

Complications can be localized or systemic.

1. Systemic complications are usually seen in severe acute pancreatitis. These include
   1. Low  blood pressure
   2. Lung failure
   3. Kidney failure
   4. Inflammation may extend to surrounding organs such as the  colon and stomach, gastrointestinal bleeding.
2. Localized complications include
   1. Fluid collections
   2. Pancreatic pseudocysts
   3. Pancreatic necrosis
   4. Pancreatic abscess

Is there hereditary link with acute pancreatitis?

No. There may, however, be genetic influence in chronic pancreatitis.

What is the difference between acute pancreatitis and chronic pancreatitis?

Acute pancreatitis is an isolated episode of abdominal pain accompanied by elevations
in blood enzyme levels. Essentially, it describes active inflammation of the pancreas.
More than 80 percent of the cases of acute pancreatitis are related to biliary stones or
alcohol use. Acute pancreatitis may lead to chronic pancreatitis.

Chronic pancreatitis is a painful disease of the pancreas in which inflammation has resolved, but with resultant damage to the gland characterized by fibrosis, calcification and ductal inflammation. It is possible for patients with chronic pancreatitis to have episodes of acute pancreatitis.

What causes chronic pancreatitis?

The most common cause of chronic pancreatitis are

1. Alcohol consumption.
2. Hyperparathyroidism (increased secretion from the parathyroid glands)
3. Trauma to the pancreas.
4. Tropical pancreatitis, a variant of chronic pancreatitis, is seen in tropical parts of
   Asia and Africa, and can affect children between 12 and 15 years of age.
5. Recurrent acute pancreatitis..

What are the symptoms of chronic pancreatitis?

Symptoms of chronic pancreatitis range widely

• Acute abdominal pain ranging from severe to mild radiating to back. The pain of chronic pancreatitis often radiates to the back, although it may radiate to both upper and lower quadrants. Sitting up and leaning forward may relieve or reduce discomfort
• Vomiting
• Epigastric tenderness
• Weight loss
• Steatorrhea( passing of undigested fat in stools)
• Glucose intolerance/ Diabetes
• Diarrhea which may be chronic (six or more bowel movements per day). The diarrhea is a result of fat malabsorption, which results in bulky, foul-smelling stools that may appear oily and float (steatorrhea).

How is chronic pancreatitis diagnosed?

Chronic pancreatitis is best diagnosed using historical information, serum enzymes,
exocrine function and radiographic studies (X-rays), ultrasound abdomen, CT/MRI scan.
Tests of exocrine function (fat absorption) are helpful.

Are there any particular complications that result from chronic pancreatitis?

Yes. Nutrient malabsorption, diabetes mellitus are main complications of chronic pancreatitis. Patients with chronic pancreatitis are also at increased risk of chronic pancreatitis.

Malabsorption is faulty absorption of nutrients from the digestive tract. In chronic pancreatitis, malabsorption occurs after the capacity for enzyme secretion is reduced by more than 90 percent. Fat absorption suffers to maximum extent in case of chronic pancreatitis.

Chronic pancreatitis affects the endocrine function of the pancreas, responsible for insulin and glucagon production.

Diabetes is common in patients with chronic pancreatitis, and the incidence increases over time with the progression of the disease. Approximately 45 percent of patients with chronic pancreatitis will develop diabetes. Fortunately, the pancreatic form of diabetes is usually mild and the usual complications (retinopathy, nephropathy and vasculopathy) are uncommon. Neuropathic complications may occur with continued alcohol abuse or malnutrition.

How is chronic pancreatitis treated?

Treatment for chronic pancreatitis includes medical, endoscopic and surgical therapy.

Can patients expect long-term relief of pain after surgery?

Surgical intervention provides long-term relief of pain in 90 percent of patients. When
patients have exhausted other avenues of treatment for pain relief, surgery should be
considered.

If I have chronic pancreatitis and am being treated, can I expect a full recovery from this disease?

The changes of chronic pancreatitis are not reversible. However, it is possible to have
control of pain and steatorrhea with medical, endoscopic, percutaneous or surgical
treatment. Surgery provides the best relief of pain in short as well as long term. In
addition to pain relief , surgery can slow down destruction of pancreas thus delaying
onset of diabetes mellitus and malabsoption.