Pancreatitis

Pancreatitis: Overview

Pancreatic enzymes play an important role in digestion.  The enzymes travel to the small intestine, where they break down protein, fats and other nutrients.  If pancreatic enzymes are unable to pass into the intestine, they begin to work on surrounding tissue, resulting in an inflamed pancreas.  An inflamed pancreas, or pancreatitis, presents as both acute and chronic conditions.

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Hereditary Pancreatitis. Heredity accounts for approximately 1% of pancreatitis cases.  If heredity is responsible for the disease, inflammation is likely to be chronic, and to strike at relatively early ages.  Hereditary inflammation also appears to increase the likelihood of pancreatic cancer; by age 70, 40% of people suffering from hereditary pancreatitis display some symptoms of cancer.

Incidence; Causes and Development

Acute pancreatitis affects over 80,000 people in the United States every year.  Acute pancreatitis affects men more often than women.

Acute Pancreatitis. Some 60-80% of acute pancreatitis cases can be traced to two causes: gallstones and alcohol damage.  Gallstones can block central ducts, preventing digestive enzymes from leaving the pancreas.  Over time, alcoholism damages the gland and hinders its ability to function.

Certain medications and infections can also trigger acute attacks of the disease.  In up to 15% of cases, however, the cause of the inflammation is unknown.

Chronic Pancreatitis is a series of recurring inflammatory attacks that gradually causes irreversible damage to the pancreas and surrounding tissue.  Alcoholism is the primary cause of chronic inflammation: between 70% and 80% of cases can be traced to excessive, habitual alcohol consumption.  Damage caused by alcoholism takes years to develop: most chronic pancreatitis symptoms don't appear until people are in their thirties or forties.

While alcoholism is the primary cause of chronic inflammation, the condition can be traced to other causes: cystic fibrosis, drugs, genetic disposition and radiation therapy may all trigger the disease.  In some cases, no cause can be determined.

Pancreatitis develops when gallstones travel out of the gallbladder into the bile ducts, where they block the opening that drains the common bile duct and pancreatic duct (ampulla).

Signs and Symptoms

Chronic pancreatitis symptoms resemble those of an acute inflammatory attack, but recur over time.  Although upper abdominal pain is usually present, some people don't experience pain at all.  Those with acute pancreatitis often look ill and have a fever, nausea, vomiting, and sweating.  Other possible symptoms include:

Physical signs include:

  • Abdominal tenderness or lump (mass)
  • Fever
  • Low blood pressure
  • Rapid heart rate
  • Rapid breathing (respiratory) rate

Diagnosis and Tests

Pancreatic enzyme tests are used to assess how much inflammatory damage the gland has endured.  Blood tests that measure levels of lipase and amylase may indicate inflammation.  Lipase and amylase are both pancreatic enzymes.  If the pancreas function is affected due to inflammation, tests for the two enzymes may be as high as three times normal levels.

Ultrasound imaging is often used to detect duct-blocking gallstonesAbdominal CT scans can help detect signs of infection or damage to glandular tissue.  Ultrasound, CT scans and other diagnostic imaging tools can also detect physical problems associated with chronic inflammation, including calcification of the pancreatic tissue (calcium deposits may build up in the gland, causing tissues to harden).

Blood tests (CBC), urine analysis, stool samples and comprehensive metabolic panel can help monitor advanced chronic inflammation and the disease's progress.  These tests might show:

  • Increased blood amylase level
  • Increased serum blood lipase level
  • Increased urine amylase level

Treatment and Prevention

For most acute attacks, pain management with analgesics is all that is required.  If infection causes the inflammation, treatment may include antibiotics.  Surgery may be required to remove gallstones, drain obstructed bile ducts or remove fluid-filled cysts.

After treatment, alcohol abstinence is highly recommended.  Heavy meals should also be avoided, as they place greater demands on the pancreas to produce digestive enzymes.

When alcoholism is the cause of the inflammation, complete abstinence from alcohol is required.  People suffering from alcoholism may need to seek therapy or support groups to stop drinking.  A low fat, high carbohydrate diet, which requires fewer enzymes to digest, is recommended.  If damage to the gland is severe, enzyme supplements to aid digestion can be taken with meals.  Surgical options include draining blocked ducts, and in advanced cases, removal of a portion of the gland.

Complications

Hypoxia may occur as a result of pancreatitis.  Hypoxia occurs when the body's cells do not receive enough oxygen, and is usually treated by administering oxygen through a facemask.  Although rare, complications from an inflamed pancreas can be fatal.  Lung, kidney and heart failure may all occur in severe cases.

Without treatment, chronic inflammation gradually destroys the pancreas' ability to function.  Reduced digestive enzymes cause malabsorption of nutrients, leading to both weight loss and poor quality bowel movements.  If insulin-producing islet cells are damaged, diabetes may develop.  Chronic inflammation carries with it a heightened risk of pancreatic cancer.

Signs, symptoms & indicators of Pancreatitis:

Symptoms - Abdomen

Meals worsen epigastric pain

The main symptom of pancreatitis is pain felt in the upper left side or middle of the abdomen.  The pain often begins or worsens after eating.  It may be worse within minutes after eating or drinking at first, especially if foods have a high fat content.

Meals worsen top-left abdomen pain

The main symptom of pancreatitis is pain felt in the upper left side or middle of the abdomen.  The pain often begins or worsens after eating and may become worse within minutes, especially if foods have a high fat content.

Moderate/severe/significant left hypochondriac pain or mild left hypochondriac discomfort

One of the most common pancreatitis symptoms is upper abdominal pain, usually centered in the upper middle or upper left part of the abdomen.  It often radiates from the front of the abdomen to the back or below the left shoulder blade and typically lasts for several days.

Moderate/severe/significant epigastric pain or mild epigastric discomfort

One of the most common pancreatitis symptoms is upper abdominal pain, usually centered in the upper middle or upper left part of the abdomen.  It often radiates from the front of the abdomen to the back or below the left shoulder blade and typically lasts for several days.

The pain may come on suddenly or build up gradually.  If the pain begins suddenly, it is typically very severe.  If the pain builds up gradually, it starts out mild but may become severe.  It may become chronic, and may be aggravated by eating or drinking.

Untreated, the pain becomes constant and more severe.  It may be worse when lying flat on one's back.

Symptoms - Bowel Movements

Symptoms - Gas-Int - General

Chronic/recent onset nausea or nausea for 1-3 months

Most cases of acute pancreatitis resolve within a week; chronic pancreatitis does not resolve itself and results in a slow destruction of the pancreas.

Symptoms - Skin - General

(Possibly) jaundiced skin

Jaundice may be due to blockage of the bile duct from the inflamed pancreas.

Conditions that suggest Pancreatitis:

Metabolic

Ascites

Pancreatic ascites can be seen in people with chronic pancreatitis.

Symptoms - Metabolic

Risk factors for Pancreatitis:

Addictions

Alcohol-related Problems

The most common cause of chronic pancreatitis is prolonged alcohol abuse.

Hormones

Lab Values

High Levels Of Triglycerides

If the initial level of fasting triglycerides is 500mg/dL or higher, the initial focus is on triglyceride lowering to prevent pancreatitis because it can be a life-threatening condition.

Symptoms - Food - Beverages

Moderate/high alcohol consumption

The most common cause of pancreatitis is long term excess alcohol consumption.

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Pancreatitis suggests the following may be present:

Addictions

Alcohol-related Problems

The most common cause of chronic pancreatitis is prolonged alcohol abuse.

Pancreatitis can lead to:

Tumors, Malignant

Pancreatic Cancer

Long-term pancreatitis has been linked to an increased risk of pancreatic cancer.  The reason for this association is not clear, but it is strongest in patients with inherited chronic pancreatitis.

Recommendations for Pancreatitis:

Botanical

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