Pancreatitis is a condition that causes inflammation of the pancreas, a gland that helps in digestion and blood sugar regulation. Pancreatitis can be acute or chronic, depending on how long it lasts and how severe it is. Acute pancreatitis is a sudden and severe attack that usually goes away within a few days with proper treatment. Chronic pancreatitis is a long-term condition that causes permanent damage to the pancreas and affects its function. Both types of pancreatitis can cause serious complications if not treated promptly and properly.
Causes and Risk Factors
The most common causes of pancreatitis are gallstones and alcohol abuse. Gallstones are hard deposits that form in the gallbladder, a small organ that stores bile, a fluid that helps in digestion. Gallstones can block the duct that connects the gallbladder to the pancreas, preventing the flow of digestive enzymes from the pancreas to the small intestine. This can cause the enzymes to back up and damage the pancreatic tissue, leading to inflammation and pain. Alcohol abuse can also damage the pancreas by triggering the production of toxic substances that inflame and scar the gland.
Other causes and risk factors for pancreatitis include:
High levels of triglycerides (a type of fat) in the blood
High levels of calcium in the blood
Certain medications, such as steroids, antibiotics, and diuretics
Infections, such as mumps, hepatitis, or HIV
Trauma or injury to the abdomen
Genetic mutations or inherited conditions, such as cystic fibrosis or hereditary pancreatitis
Smoking
Obesity
Symptoms
The main symptom of both acute and chronic pancreatitis is abdominal pain that radiates to the back. The pain may be mild or severe, constant or intermittent, and may worsen after eating or drinking, especially fatty or alcoholic beverages.
Other symptoms may include:
Nausea and vomiting
Fever
Rapid heartbeat
Swollen or tender abdomen
Changes in stool colour or texture (such as oily, greasy, or yellow stools)
Weight loss
Jaundice (yellowing of the skin and eyes)
Diabetes (high blood sugar levels)
Diagnosis
To diagnose pancreatitis, your doctor will ask you about your medical history, symptoms, and risk factors. They will also perform a physical examination and order some tests, such as:
Blood tests: To measure the levels of pancreatic enzymes (amylase and lipase), blood sugar, calcium, triglycerides, and liver function.
Urine tests: To check for increased levels of amylase in the urine.
Stool tests: To check for fat in the stool, which indicates malabsorption due to pancreatic insufficiency.
Imaging tests: To visualise the pancreas and look for signs of inflammation, damage, or complications. These may include ultrasound, computed tomography (CT) scan, magnetic resonance imaging (MRI), endoscopic retrograde cholangiopancreatography (ERCP), or endoscopic ultrasound (EUS).
Biopsy: To take a small sample of pancreatic tissue for microscopic examination.
Treatment
The treatment of pancreatitis depends on its type, severity, and complications. The main goals are to relieve pain, reduce inflammation, prevent infection, restore pancreatic function, and address the underlying cause.
For acute pancreatitis:
You may need to be hospitalised for observation and treatment.
You may need to fast for a few days to rest your pancreas and allow it to heal.
You may receive intravenous fluids to prevent dehydration and electrolyte imbalance.
You may receive painkillers to ease your discomfort.
You may receive antibiotics to prevent or treat infection.
You may receive enzyme supplements to help you digest food.
You may need surgery to remove gallstones or drain fluid from your abdomen if they are causing obstruction or infection.
For chronic pancreatitis:
You may need to follow a low-fat diet to reduce stress on your pancreas and avoid triggering attacks.
You may need to limit or avoid alcohol consumption to prevent further damage to your pancreas.
You may need to take enzyme supplements with every meal to help you digest food and prevent malnutrition.
You may need to take insulin or other medications to control your blood sugar levels if you have diabetes.
You may need surgery to relieve pain, improve drainage of pancreatic juices, remove damaged tissue, or transplant a healthy pancreas.
Prevention
To prevent pancreatitis or reduce its recurrence:
Avoid or limit alcohol consumption.
Maintain a healthy weight and exercise regularly.
Eat a balanced diet that is low in fat and high in fibre.
Drink plenty of water and stay hydrated.
Quit smoking or avoid exposure to secondhand smoke.
Follow your doctor’s advice on managing your medical conditions, such as diabetes, high triglycerides, or high calcium levels.
Take your medications as prescribed and inform your doctor of any side effects or interactions.
Seek medical attention promptly if you experience any symptoms of pancreatitis.
Complications
Pancreatitis can cause serious and life-threatening complications, such as:
Pseudocysts: Fluid-filled sacs that form in or around the pancreas, which can rupture, bleed, or become infected.
Necrosis: Death of pancreatic tissue due to lack of blood supply, which can lead to infection, bleeding, or organ failure.
Abscess: A collection of pus that forms in the pancreas, which can cause fever, pain, and sepsis (a severe infection that spreads throughout the body).
Pancreatic cancer: A rare but aggressive type of cancer that develops from the cells of the pancreas, which can cause jaundice, weight loss, and abdominal pain.
Diabetes: A condition that occurs when the pancreas cannot produce enough insulin or the body cannot use it properly, which can cause high blood sugar levels, thirst, hunger, frequent urination, and fatigue.
A condition that occurs when the body does not get enough nutrients from food due to poor digestion and absorption, which can cause weight loss, weakness, anaemia, and vitamin deficiencies.
Conclusion
Pancreatitis is a serious condition that requires prompt diagnosis and treatment. By knowing its causes, symptoms, and risk factors, you can take steps to prevent it or reduce its severity. If you have pancreatitis or suspect you may have it, consult your doctor immediately and follow their recommendations. Remember that pancreatitis can be managed with proper care and lifestyle changes. You can also seek support from your family, friends, or a support group to cope with the physical and emotional challenges of living with pancreatitis.
References
https://www.hopkinsmedicine.org/health/conditions-and-diseases/pancreatitis
About the author
Dr Nikhil Nanjappa M.S., FRCS Ed., M.IPD Ed., M. FST Ed., is a consultant surgical gastroenterologist and colorectal surgeon in Mysore & Coorg. He recently returned from the United Kingdom after serving as a Consultant Surgeon at St. James’s University Hospital, Leeds. He has a unique insight into the sub-specialist evidence-based management of pancreatitis, built from his experience learning from legendary pancreatic surgeons in India & the UK. He is known for his extensive expertise in gastrointestinal, colorectal, laparoscopic, robotic and emergency general surgery.
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