Pancreatitis is a condition characterized by inflammation of the pancreas, the organs behind the stomach that synthesize digestive enzymes.
It is of two types:
- Acute Pancreatitis: It is the inflammation of the pancreas marked by severe symptoms but is reversible by proper medication & medical attention.
- Chronic Pancreatitis: It is a progressive long-standing inflammation of the pancreas that is associated with irreversible damage, structural & functional change of the pancreas.
SIGNS & SYMPTOMS OF PANCREATITS
- Severe upper abdominal pain
- Burning pain radiating to the back
- Nausea & vomiting
- Hiccup
- Elevated blood pressure
- Elevated breathing rate
- Unintended weight loss
- Fever & chills
- Fast heart beat
- Inflammation of the lining of the abdomen
- Frequent, oily, foul-smelling bowel movements.
COMPLICATIONS
- Shock
- Low blood calcium
- High blood sugar & cholesterol
- Low oxygen in the blood
- Inflammation of the lung tissue
- Fluid in the lungs
- Low blood pressure & higher chance of heart attack
- Abnormal rhythm of the heart
- Pancreatic abscess & pus
- Gastrointestinal obstruction & bleeding
- Jaundice
- Kidney failure
- Clot in the brain
- Confusion, delusion, coma
- Anemia
- Grey-Turner’s Syndrome.
CAUSES & RISK FACTORS OF PANCREATITIS
- Gallstones are the single most common cause for acute pancreatitis.
- Heavy alcohol consumption is the single most cause for chronic pancreatitis.
Some adverse effects of drugs that can contribute to pancreatitis:
- Statins
- Diuretics
- Oral contraceptives
- Hormone replacement therapy
- ACE inhibitors
- Drugs used in diabetes
- Antiretroviral drugs
- Anti-psychotic drugs
Some infections & diseases/disorders that can cause the condition:
- Hepatitis B
- Herpes Simplex Virus
- Herpes Zoster Virus
- HIV
- Mumps
- Salmonella
- Aspergillus fungus
- Ascaris parasites
- High blood calcium
- Diabetes
- High blood cholesterol
- Cancer of the pancreas
- Inflammation of the blood vessels in the pancreas
- Pancreatic stones
- Cystic fibrosis
Other factors
- Radiotherapy
- Scorpion sting
- Hypothermia
- Trauma to the pancreas
- Genetic & autoimmune diseases
- Malnutrition
- Ischemia from bypass surgery
- Pregnancy.
DIAGNOSIS
- Blood Test & Serum test:
a) Biochemical factors, like presence of elevated levels of the enzymes, amylase & lipase in the serum along with significant abdominal pain is a positive test for pancreatitis.
b) Although biochemical markers are not enough for characterizing severity of the condition.
c) The condition is termed to be alcohol mediated when lipase level rises 2-3 times that of amylase. - Imaging Tests:
a) CT scan is very important for the differentiation between the severity of the pancreatitis. It utilizes mechanism which can help in identifying necrotic tissue & damage to the organ.
b) MRI is more helpful in patients that are allergic to contrast media of CT scan. MRI is utilized for visualization of pancreatic fluid collection & vascular complications.
c) On abdominal ultrasonography, the finding of a bulky pancreas is regarded as diagnostic of acute pancreatitis.
TREATMENT OF PANCREATITIS
- Fluid Replacement: Taking into consideration the condition of the patient & comorbidities, aggressive fluid replenishment at the rate of 5-10 mL/kg per hour of isolated Lactated Ringer’s solution to be used.
- Pain management: Use of IV intervention by opioid drugs, like hydromorphone, fentanyl, morphine, etc.
- No food to be given orally, to be administered through IV route.
- Assistance in breathing by administering oxygen if level falls below 70mmHg
- Antibiotics to manage infections that are developed outside of pancreas.
- In case of presence of gallstones, an ERCP is performed within 24 to 72 hours for successful removal.
- Surgery on detection of infected necrotic tissue.
PREVENTION
- Mumps vaccine
- Reduced alcohol intake
- Stopping smoking
- Eating a diet low on fats & sugar
- Weight loss & exercise
- Management of conditions like diabetes & hypertension.