Rajen's Easytips: PANCREATITIS

PANCREATITIS

1. What is pancreas and pancreatitis?

Pancreas is a gland situated behind the stomach that produces hormones namely insulin, glucagons that help in metabolism.
Pancreas also produces other hormones and essential enzymes to aid digestion of fats, proteins and carbohydrates.
These enzymes reach the upper part of small intestine (duodenum) through the pancreatic duct.
Pancreatitis means the inflammation of pancreas.
Inflammation occurs when these digestive enzymes leak out of the pancreatic duct and damage the pancreas.
This can develop suddenly or over a period of time like years.

2. Cause of pancreatitis

The main cause is the leakage of enzymes within the pancreas, leaking from it and causing internal or external damage.
Normally, pancreas and the duct prevent the enzymes from leaking but in certain conditions, it leaks and oozes out which may cause damage to the pancreas and the pancreatic duct.

3. What is acute pancreatitis?

Most of the acute pancreatitis cases are due to the stones present in the gall bladder which prevent the proper flow of pancreatic enzymes through the duct in to the intestines.
The other reason for this is the excessive consumption of alcohol.
This usually occurs after continuous abuse of alcohol on the body or many episodes of heavy drinking of alcohol.
Even though it is not established how stones in gall bladder cause pancreatitis but they may block the common bile duct joining pancreatic duct at an opening to the small intestine.
Like blocked drain can throw the fluid back, the enzymes can back flow into the pancreas and cause damage.
These enzymes digest the food but also damage the tissues to great extent, causing additional inflammation.
The other causes include the hereditary aspect, mumps, high level of triglycerides (fat) or calcium in blood, surgery or other procedures done on the pancreas like ERCP (Endoscopic Retrograde Cholangiopancreatography), tumors of pancreas, trauma, toxins like scorpion venom, some times medications too.

4. What are the indications of pancreatitis?

Pancreatitis usually appears as a sudden onset (acute) attack of gripping pain, in the upper epigastric region, of the abdomen.
At this point of time, the disease can be mild to severe.
The severity is gauged with "Scoring System" considering the age, result of tests, symptoms, causes and other complications.
Most of the cases have milder version of acute pancreatitis.
This does not affect the other parts of the body usually.
Patients can recover without problems what so ever with pain relieving medication and some intravenous fluids.
Once the pain subsides, pancreas starts functioning normally.
In some cases, when pancreatic enzymes start circulating in other parts of the body, this may cause complications like infection, shock or pseudo cyst (collection of fluid and pancreatic enzymes enclosed in a wall of tissue).
In many cases, the pancreatic tissue is inflamed but not destroyed, and this is known as Interstitial Pancreatitis.
In serious complications like pancreatic necrosis (death), the pancreatic tissue dies.
The risk to the life of the patient suffering is greater with this kind of pancreatitis than the interstitial pancreatitis.

5. Risk factors of pancreatitis

Presence of even one stone in the gall bladder smaller than 5 mm may block the flow of the enzymes in to the small intestine.
Excessive consumption of alcohol.
Blood containing high levels of triglycerides (fat), which can be due to family history too.
Having hyperactive parathyroid glands may cause excessive calcium in blood.
Structural problem of the pancreas, pancreatic duct or the bile, especially in a condition where the pancreas is divided and has two main ducts (pancreas divisum).
Pancreatitis can be life threatening if one has severe abdominal pain with vomiting which does not subside in few hours, or mild abdominal pain which does not respond to home remedies within a couple of days or so.
These symptoms may be that of a pancreatitis condition and should be treated by a specialist immediately.

6. Diagnosis

It varies from patient to patient based on the symptoms narrated by him and taking in account the family history and other factors.
Blood tests to analyse the enzymes are:

Serum Amylase: increase in the level of this enzyme by three fold indicates pancreatitis.
Serum Lipase: Acute condition always raises the levels of this enzyme in blood.

Other blood tests are also done like:

Complete Blood Count: Some times the number of white blood cells increase dramatically.
Liver Function Test: Increase in liver enzymes is noticed due to pancreatitis.
Serum Bilirubin: When there is a blockage in common bile duct, bilirubin may increase in blood.

Imaging and Scan tests:

Ultra sound scan or Computer aided Tomography Imaging (C.T.) scan or Magnetic Resonance Imaging (M.R.I) scan: to get a correct picture and situation of the damage done.

7. Treatment

Treatment for pancreatitis depends on the condition of the pancreas.
In initial stages of pancreatitis, the treatment may be supportive and allowing the pancreas to heal on its own.
Pain killers may be given to take care of pain aspect, some Intra venous fluids to compensate the loss of body fluids and other medication to tackle medical imbalance like blood pressure etc.
For allowing the pancreas to rest, one may not be allowed to eat food and be kept on fluids to supplement the energy of the body for about a week's time.
If it is found that pancreatitis is due to the presence of gall stones in the gall bladder, then E.R.C.P (Endoscopic Retrograde Cholangiopancreatography) may be advised to remove the stones from the common bile duct.
Once this is done, one may be advised a surgery removal of gall bladder, "Cholecystectomy", either open or laparoscopic.
This may prevent further occurrence of pancreatitis.

8. Prevention

Pancreatitis due to gall stones cannot be absolutely prevented.
One can reduce the risk of forming gallstones bye timely surgery and proper diet control and regular exercise.
Avoiding alcohol can prevent further complications.
In chronic pancreatitis one should totally abstain from alcohol.
Consult the doctor for avoiding those medications that can inflame the pancreas.

9. Medications

Medication differs in different conditions of pancreatitis like Acute pancreatitis and Chronic pancreatitis.
But in general the medications are for:
a)    Pain management with pain killers.
b)    Infections with antibiotics.
c)    Suppressing pancreatic enzymes.
d)    Suppressing stomach acid like H2 receptor blockers.
e)    Supplementing enzymes.
f)    Avoiding chance of being affected with diabetes when the pancreas stops producing insulin.

PANCREATITIS

Pancreas is a gland situated behind the stomach that produces hormones namely insulin, glucagons that help in metabolism.

Pancreas also produces other hormones and essential enzymes to aid digestion of fats, proteins and carbohydrates.

These enzymes reach the upper part of small intestine (duodenum) through the pancreatic duct.

Pancreatitis means the inflammation of pancreas.

Inflammation occurs when these digestive enzymes leak out of the pancreatic duct and damage the pancreas.

This can develop suddenly or over a period of time like years.

2. Cause of pancreatitis

The main cause is the leakage of enzymes within the pancreas, leaking from it and causing internal or external damage.

Normally, pancreas and the duct prevent the enzymes from leaking but in certain conditions, it leaks and oozes out which may cause damage to the pancreas and the pancreatic duct.

3. What is acute pancreatitis?

Most of the acute pancreatitis cases are due to the stones present in the gall bladder which prevent the proper flow of pancreatic enzymes through the duct in to the intestines.

The other reason for this is the excessive consumption of alcohol.

This usually occurs after continuous abuse of alcohol on the body or many episodes of heavy drinking of alcohol.

Even though it is not established how stones in gall bladder cause pancreatitis but they may block the common bile duct joining pancreatic duct at an opening to the small intestine.

Like blocked drain can throw the fluid back, the enzymes can back flow into the pancreas and cause damage.

These enzymes digest the food but also damage the tissues to great extent, causing additional inflammation.

4. What are the indications of pancreatitis?

Pancreatitis usually appears as a sudden onset (acute) attack of gripping pain, in the upper epigastric region, of the abdomen.

At this point of time, the disease can be mild to severe.

The severity is gauged with "Scoring System" considering the age, result of tests, symptoms, causes and other complications.

Most of the cases have milder version of acute pancreatitis.

This does not affect the other parts of the body usually.

Patients can recover without problems what so ever with pain relieving medication and some intravenous fluids.

Once the pain subsides, pancreas starts functioning normally.

In some cases, when pancreatic enzymes start circulating in other parts of the body, this may cause complications like infection, shock or pseudo cyst (collection of fluid and pancreatic enzymes enclosed in a wall of tissue).

In many cases, the pancreatic tissue is inflamed but not destroyed, and this is known as Interstitial Pancreatitis.

In serious complications like pancreatic necrosis (death), the pancreatic tissue dies.

The risk to the life of the patient suffering is greater with this kind of pancreatitis than the interstitial pancreatitis.

5. Risk factors of pancreatitis

Presence of even one stone in the gall bladder smaller than 5 mm may block the flow of the enzymes in to the small intestine.

Excessive consumption of alcohol.

Blood containing high levels of triglycerides (fat), which can be due to family history too.

Having hyperactive parathyroid glands may cause excessive calcium in blood.

Structural problem of the pancreas, pancreatic duct or the bile, especially in a condition where the pancreas is divided and has two main ducts (pancreas divisum).

Pancreatitis can be life threatening if one has severe abdominal pain with vomiting which does not subside in few hours, or mild abdominal pain which does not respond to home remedies within a couple of days or so.

These symptoms may be that of a pancreatitis condition and should be treated by a specialist immediately.

6. Diagnosis

It varies from patient to patient based on the symptoms narrated by him and taking in account the family history and other factors.

Blood tests to analyse the enzymes are:

Serum Amylase: increase in the level of this enzyme by three fold indicates pancreatitis.

Serum Lipase: Acute condition always raises the levels of this enzyme in blood.

Other blood tests are also done like:

Complete Blood Count: Some times the number of white blood cells increase dramatically.

Liver Function Test: Increase in liver enzymes is noticed due to pancreatitis.

Serum Bilirubin: When there is a blockage in common bile duct, bilirubin may increase in blood.

Imaging and Scan tests:

Ultra sound scan or Computer aided Tomography Imaging (C.T.) scan or Magnetic Resonance Imaging (M.R.I) scan: to get a correct picture and situation of the damage done.

7. Treatment

Treatment for pancreatitis depends on the condition of the pancreas.

In initial stages of pancreatitis, the treatment may be supportive and allowing the pancreas to heal on its own.

Pain killers may be given to take care of pain aspect, some Intra venous fluids to compensate the loss of body fluids and other medication to tackle medical imbalance like blood pressure etc.

For allowing the pancreas to rest, one may not be allowed to eat food and be kept on fluids to supplement the energy of the body for about a week's time.

If it is found that pancreatitis is due to the presence of gall stones in the gall bladder, then E.R.C.P (Endoscopic Retrograde Cholangiopancreatography) may be advised to remove the stones from the common bile duct.

Once this is done, one may be advised a surgery removal of gall bladder, "Cholecystectomy", either open or laparoscopic.

This may prevent further occurrence of pancreatitis.

8. Prevention

Pancreatitis due to gall stones cannot be absolutely prevented.

One can reduce the risk of forming gallstones bye timely surgery and proper diet control and regular exercise.

Avoiding alcohol can prevent further complications.

In chronic pancreatitis one should totally abstain from alcohol.

Consult the doctor for avoiding those medications that can inflame the pancreas.

9. Medications

Medication differs in different conditions of pancreatitis like Acute pancreatitis and Chronic pancreatitis.