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Pancreatitis
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Pancreatitis is an inflammation of the pancreas, a tube-shaped gland that fits under the stomach in the upper aspect of the abdomen. Normally the pancreas makes enzymes important in the process of digestion. It also contains pancreatic islet cells that make insulin, which is important in sugar metabolism. Pancreatitis can be acute pancreatitis that appears suddenly and lasts several days. It can also be chronic pancreatitis, which can last for several years and comes on gradually. Pancreatitis, if mild, can disappear without treatment; however, if it is severe, it can be deadly.
Signs and symptoms of acute pancreatitis differ slightly from chronic pancreatitis. This includes having pain in the upper abdomen, pain that radiates to the back, pain that is relieved by curling up into a ball and pain that is exacerbated by eating. Nausea and vomiting are common and when the doctor palpates the abdomen, it is tender in the upper area.
If a person has chronic pancreatitis, they have pain in the upper abdomen that is usually not as severe as pain in acute pancreatitis. Chronic indigestion is common as is loss of weight, even if the person isn't trying to lose weight. Stools contain a lot of fat, a condition called steatorrhea, which leads to smelly, oil stools.
Pancreatitis happens when there is overproduction of digestive enzymes so that they become activated too soon. Normally, digestive enzymes are inactive until they pass through to the duodenum. If they are activated too soon, they cause inflammation and irritation of the pancreas. Eventually, with repeated bouts of this condition, the pancreas becomes scarred so that it doesn't work really well. If the pancreas fails to work well, it causes chronic pancreatitis. Digestion can be poor and the individual develops diabetes.
The causes of pancreatitis are many and include having gallstones, being an alcoholic, having certain kinds of abdominal surgery that damages the pancreas, taking some medications, smoking cigarettes, having cystic fibrosis, having treatment for gallstones using ERCP, an endoscopic technique or having a family history with family members having pancreatitis. High blood calcium can cause pancreatitis, having high triglycerides, having pancreatic cancer and having an infection in the pancreas or injury to the pancreas.
There can be serious complications to having acute or chronic pancreatitis. For example, pancreatitis can cause problems breathing, low oxygen levels, diabetes, infection in the blood and in the pancreas itself, having severe kidney failure, being malnourished due to poor digestion, getting pancreatic cancer and getting what's called a pseudocyst or cysts in and around the pancreas that can result in internal bleeding or secondary infection.
Tests for amylase and lipase can tell if the pancreas is inflamed and tests of the stool can tell if there is too much fat in the stools. A CT scan can show a swollen and inflamed pancreas as can an endoscopic ultrasound and abdominal ultrasound. MRI scans can be done in place of a CT scan and can show the size and shape of the pancreas.
The treatment of pancreatitis usually revolves around hospitalization for IV fluids and pain control. The doctor will have you stop eating in order to give the pancreas a rest. Pain medications are given because pancreatitis is usually very painful. Pain medications are usually given by IV or IM. IV fluids help to prevent dehydration.
Doctors then attempt to stop the underlying cause of pancreatitis. If there are bile obstructions, these need to be relieved in order to help the pancreatitis go away. An ERCP can be done to remove biliary obstructions. An ERCP is an endoscopic retrograde cholangiopancreatography. A camera is used to look into the bile canals and blockages can be relieved. The doctors can also remove the gallbladder, which helps in some cases. Pancreatic pseudocyst surgery is done in other cases. Doctors also provide enzymes to aid digestion and make recommended dietary changes to help settle down the inflammation of the pancreas.