Pancreatitis is a common nonbacterial inflammatory disease caused by activation and autodigestion; a process whereby pancreatic enzymes destroy its own tissue leading to inflammation. This may or may not be accompanied by permanent anatomical and functional changes in the pancreas.
Pancreatitis is mostly caused by gallstone disease or alcoholism, a few cases result from trauma, hypercalcemia, hyperlipidemia with the remainder cases being of no identifiable cause.
There are two different types of pancreatitis namely, acute, and chronic pancreatitis.
Acute pancreatitis is a syndrome resulting from acute inflammation, it is the 3rd most common indication for hospital admissions among gastrointestinal diseases. It is associated with significant morbidity and mortality.
Acute pancreatitis has many causes but biliary tract disease and alcohol consumption accounts for most cases, with drug reactions, metabolic causes, and traumatic injuries accounting for almost all the remaining cases. In patients who do not drink alcohol, the most common cause of acute pancreatitis is biliary tract disease. Acute pancreatitis associated with biliary tract disease is more common in women, because gallstones are more common in women.
Symptoms of acute pancreatitis
- Abdominal pain
The pain of acute pancreatitis is characteristic, often described as an intense, deep, searing pain that radiates to the back. The acute attack frequently begins following a large meal and consists of severe epigastric pain, this is usually accompanied by vomiting and retching.
Almost two-thirds of patients develop fever, this is due to tissue injury, inflammation, and necrosis.
- Dehydration and increased heart rate (tachycardia)
Depending on the severity of the disease, dehydration and tachycardia may be profound.
Treating acute pancreatitis
- Fluid replacement in patients with acute pancreatitis are necessary to maintain circulation of blood and renal function.
- Antibiotics, prophylactic broad-spectrum antibiotics are often used in patients with severe pancreatitis since the likelihood of infections are high.
- Oxygen therapy is used in more than 30% of all patients who develop hypoxemia.
- Calcium and magnesium replacements are used in severe attacks of acute pancreatitis.
- Surgical treatment is generally contraindicated in uncomplicated acute pancreatitis.
Chronic alcoholism causes the most cases and accounts for 70-80% of the cases. Patients with chronic pancreatitis resulting from alcohol abuse usually have a long history (6-12 years) of heavy alcohol consumption (150-175 ml of pure alcohol a day). Other causes include bile duct obstruction due to gallstones, hypercalcemia (calcium level in your blood is above normal), hyperlipidemia (your blood has too many lipids (or fats), such as cholesterol).
Chronic pancreatitis causes irreversible damage towards the pancreas, whereas the damage in acute pancreatitis is reversable. In patients with chronic pancreatitis diabetes mellitus is commonly present.
Symptoms of chronic pancreatitis
- Abdominal pain
Chronic pancreatitis may be asymptomatic, or it may produce abdominal pain. The pain is usually felt deep in the upper abdomen and radiates through the back. Early in the disease, the pain may be episodic lasting for days to weeks and then vanishing for several months before returning.
Continued alcohol intake may increase the frequency of painful episodes
- Nausea and vomiting
- Weight loss and malabsorption
- Jaundice and diabetes mellitus
Treating chronic pancreatitis
- The treatment for chronic pancreatitis is mainly symptomatic and directed toward relieving pain.
- Discontinue the use of alcohol. Abstention from alcohol will reduce chronic pain in more than half of cases even though damage to the pancreas is irreversible.
- Diabetes in these patients usually require insulin therapy.
- Fluid replacement with calcium and magnesium replacements is also advisable in patients with chronic pancreatitis.
Endoscopic pancreatography (ERCP) – is helpful in establishing the diagnosis of chronic pancreatitis, and in the ruling out of pancreatic cancer.
Imaging studies – CT scans with contrast. MRI if suspected cause is bile duct obstruction.
Blood tests – Pancreatic function tests, Liver function tests (LFT’s), CRP (C-reactive protein), Kidney function tests