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ACUTE PANCREATITIS

The pancreas is a large gland behind the stomach and next to the small intestine. The pancreas does two main things:

1. It releases powerful digestive enzymes into the small intestine to aid the digestion of food.

2. It releases the hormones insulin and glucagon into the bloodstream. These hormones help the body control how it uses food for energy.

Pancreatitis is a disease in which the pancreas becomes inflamed. Pancreatic damage happens when the digestive enzymes are activated before they are released into the small intestine and begin attacking the pancreas. There are two forms of pancreatitis: acute and chronic.

Acute pancreatitis – Acute pancreatitis is a sudden inflammation that lasts for a short time. It may range from mild discomfort to a severe, life-threatening illness. Most people with acute pancreatitis recover completely after getting the right treatment. In severe cases, acute pancreatitis can result in bleeding into the gland, serious tissue damage, infection, and cyst formation. Severe pancreatitis can also harm other vital organs such as the heart, lungs, and kidneys.

Chronic pancreatitis –Chronic pancreatitis is long-lasting inflammation of the pancreas. It most often happens after an episode of acute pancreatitis. Heavy drinking is another big cause. Damage to the pancreas from heavy intoxication use may not cause symptoms for many years, but then the person may suddenly develop severe pancreatitis symptoms.

Symptoms of acute pancreatitis:

1. Upper abdominal pain that radiates into the back; it may be aggravated by eating, especially foods high in fat.

2. Swollen and tender abdomen

3. Nausea and vomiting

4. Fever

5. Increased heart rate

Symptoms of chronic pancreatitis:

Pancreatitis causes upper abdominal pain which can range from mild to severe. The pain may come on suddenly or it may develop gradually. Often, the pain will start or worsen after eating, which can also occur with gallbladder or ulcer pain. Abdominal pain tends to be the hallmark of acute pancreatitis. People with acute pancreatitis usually feel very ill. Signs and symptoms of acute pancreatitis may include:

1. Abdominal pain that may radiate to the back

2. Nausea and vomiting

3. Worsening pain after eating

4. Tenderness to touch of the abdomen

5. Fever and chills

6. Weakness and lethargy

In chronic pancreatitis, abdominal pain also can be present, but it is often not as severe, and some people may not have any pain at all. Signs and symptoms of chronic pancreatitis may include:

1. Abdominal pain

2. Unintentional weight reduction

3. Foul smelling, oily stool

Cause

Normally, digestive enzymes released by the pancreas are not activated to break down fats and proteins until they reach the small intestine. However, when these digestive enzymes are activated while still in the pancreas, inflammation and local damage to the pancreas occurs leading to pancreatitis.

The causes of pancreatitis include:

1. Liquor consumption

2. Gallstones

3. High triglyceride levels

4. Abdominal injury or an operation

5. Exposure to certain chemicals

6. Family history of pancreatitis

7. Cystic fibrosis

8. Pancreatic tumor

Liquor consumption and gallstones account for over 80% of all cases of pancreatitis.

Risk Factors for Pancreatitis

Pancreatitis can happen to anyone, but it is more common in people with certain risk factors. Risk factors of acute pancreatitis include:

1. Gallstones

2. Heavy liquor drinking

Acute pancreatitis may be the first sign of gallstones. Gallstones can block the pancreatic duct, which can cause acute pancreatitis. Risk factors for chronic pancreatitis include:

1. Heavy liquor drinking for a long time

2. Certain hereditary conditions, such as cystic fibrosis

3. Gallstones

4. Conditions such as high triglycerides and lupus

People with chronic pancreatitis are usually men between ages 30 and 40, but chronic pancreatitis also may occur in women.

Diagnosis

To diagnose acute pancreatitis, phsycians measure levels in the blood of two digestive enzymes, amylase and lipase. High levels of these two enzymes strongly suggest acute pancreatitis. Phsycians may also use other tests, such as:

1. Pancreatic function test to find out if the pancreas is making the right amounts of digestive enzymes

2. Glucose tolerance test to measure damage to the cells in the pancreas that make insulin

3. Ultrasound, CT scan, and MRI, which make images of the pancreas so that problems may be seen

4. ERCP to look at the pancreatic and bile ducts using X-rays

5. 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, physicians may use blood, urine, and stool tests to confirm the diagnosis.

Pancreatitis Treatment

Treatment for acute pancreatitis

People with acute pancreatitis are typically treated with IV fluids and pain relief in the hospital. In some patients, the pancreatitis can be severe and they may need to be admitted to an intensive care unit (ICU). In the ICU, the patient is closely watched because pancreatitis can damage the heart, lungs, or kidneys. Some cases of severe pancreatitis can result in death of pancreatic tissue.

In these cases, an operation may be necessary to remove the dead or damaged tissue if an infection develops. An acute attack of pancreatitis usually lasts a few days. An acute attack of pancreatitis caused by gallstones may require removal of the gallbladder or an operation of the bile duct. After the gallstones are removed and the inflammation goes away, the pancreas usually returns to normal.

Treatment for chronic pancreatitis

Chronic pancreatitis can be difficult to treat. Physicians will try to relieve the patient’s pain and improve the nutrition problems. Patients are generally given pancreatic enzymes and may need insulin. A low-fat diet may also help. An operation may be done in some cases to help relieve abdominal pain, restore drainage of pancreatic enzymes or hormones, treat chronic pancreatitis caused by blockage of the pancreatic duct, or reduce the frequency of attacks.

Prevention

Because most cases of pancreatitis are caused by liquor abuse, prevention is directed at responsible drinking or no drinking at all. If heavy drinking is a concern, talk to your physician or health care professional about a referral to an liquor treatment center. Also, you may benefit from a support group.