Pancreatitis

Pancreatitis means that the pancreas is inflamed. The pancreas lies behind the stomach and is the most powerful digestive organ in the body. It has two functions: (1) secreting insulin and glucagon for sugar metabolism; (2) producing enzymes or chemicals that enter the small intestine for the digestion of food.

Diabetes is the most common form of pancreatic disease, and pancreatitis – inflammation of the pancreas – is probably the second most common disease of this organ. In pancreatitis, it is as if the factory that manufactures and stores the digestive enzymes for transport into the intestine explodes, and the enzymes escape into the unprotected surrounding tissues, where they cause damage. The result is considerable swelling or inflammation and increased amounts of blood in the pancreatic vessels.

It can be very serious and can even be fatal. Repeated attacks may cause continued damage to the pancreas. Then you may have a chronic or permanent form of the disease.

By no means. The precise figures aren’t known.

No, but it is by far the leading cause, especially of chronic pancreatitis. Gallstones, biliary tract disease and other conditions that obstruct the pancreatic duct can cause acute pancreatitis. Other factors that can cause the disease include nutritional deficiencies, prolonged use of certain drugs, such as diuretics and oral contraceptives, cigarette smoking and disturbances of fat metabolism. Hereditary pancreatitis can occur. In some cases, the cause cannot be determined, and is called idiopathic pancreatitis. Some causes, other than alcohol consumption, can be corrected without much difficulty. For example, gallstones, the second leading cause of the disorder, can be removed in a routine operation.

Yes. They will be afflicted by some of the less common types of acute pancreatitis such as those due to hereditary and metabolic abnormalities. Since alcoholism and gallstones are the principal causes of the disorder, most acute patients, and almost all chronic patients are middle aged or elderly.

Alcohol is a powerful stimulant of hydrochloric acid, the acid secreted by the stomach to digest food. While the precise mechanism of the action is not known, it is suspected that the increased level of gastric acid, in turn, stimulates the pancreas to secrete excessive amounts of the enzymes that do the damage in pancreatitis. Alcohol may also directly injure the pancreatic tissue.

Attacks of acute pancreatitis are usually signaled by severe abdominal pain. The abdomen may also be swollen and extremely tender. Other symptoms include vomiting, constipation, fever, and jaundice. In very severe cases, the pancreas may hemorrhage, resulting in shock.

In the chronic form of the disease, abdominal pain may be constant. Despite normal appetite, weight loss is common, due to malabsorption of food as a result of destruction of the pancreas. If the pancreas has been extensively damaged, it may be unable to produce sufficient insulin and diabetes may develop.

In some cases of pancreatitis, both acute and chronic, there may be no clear symptoms. The danger here is that the condition may go undetected until it is in an advanced and irreversible stage.

The level of pancreatic enzymes in the blood quickly rises above normal a few hours after the onset of acute pancreatitis. Blood tests, which measure the degree and duration of enzyme elevation, are widely used to make the diagnosis of pancreatitis. The presence of high amounts of sugar in the blood and urine occur in about half of the cases. To exclude the possibility that the condition may be a perforated ulcer, appendicitis, intestinal obstruction or some other abdominal emergency with similar symptoms, radiological (X-ray) examinations are often performed.

A history of previous attacks of acute pancreatitis often leads to the diagnosis of chronic pancreatitis. The presence of elevated serum enzyme and sugar levels in the blood will support the diagnosis. The patient is often diabetic with impaired digestion, resulting in greasy stools, that is, increased excretion of fat in the stools.

Treatment of acute pancreatitis is directed primarily toward reducing pancreatic secretion. These drugs work on the nerves and tissues which influence acid secretion by the stomach.

For the relief of pain, narcotics are usually prescribed. In milder cases, this may be the only treatment. In severe cases, especially in those involving shock, blood transfusion and replacement of fluids lost by the body may be necessary. In those relatively few cases that do not respond to treatment or where hemorrhage occurs, surgery may be indicated. X-ray studies will usually preceed surgery.

With prompt and proper treatment, patients with mild to moderate acute pancreatitis usually recover in several days. To prevent future attacks, they are placed on a low-fat diet, and small frequent meals, which do not over-stimulate the pancreas, are recommended. If alcohol is responsible for the pancreatitis, abstinence is strongly advised. If the condition is caused by some other factor, such as gallstones or a metabolic disturbance, this is corrected surgically or treated medically.

Similar treatment measures are administered to patients with chronic pancreatitis. Diabetes, steatorrhea and other complications can usually be controlled by medications. A variety of operations are available to relieve pain and halt the progression of the disease.

Most chronic patients respond to treatment. For them, the outlook is good – if they give up alcohol. If they don’t the prospects are grim.

Yes. Blood enzyme tests, the chief diagnostic procedure for detecting pancreatitis – are not perfect. Recent studies indicate that measurements of certain fractions of the enzymes, called isoenzymes, may greatly improve diagnostic accuracy.

Endoscopic instruments are now available for access to the pancreas. With refinements, these sophisticated tools provide not only better visualization of the pancreas than can be obtained by x-ray and other present techniques, but may also take biopsies of pancreatic tissue. Tissue cultures, developed from these biopsies, would enable scientists for the first time to examine the fundamental aspects of various cell types – what they produce, how they are regulated, and so forth – and thus greatly increase our understanding and control of pancreatic disease.

There is evidence that pancreatitis, particularly if chronic, predisposes a person to an increased risk of cancer of the pancreas.

Generally excellent…..if you abstain from alcohol; this cannot be emphasized too much. Alcohol is especially toxic – poisonous – to you and to the great majority of other patients with acute and chronic pancreatitis.