Pancreatitis

Pancreatitis: Description

Pancreatitis (inflammation of the pancreas) can in principle develop either acutely - here we must distinguish between mild and severe acute pancreatitis - or else become chronic. The pancreas - which sits diagonally in the upper abdomen behind the stomach - regulates metabolism, and is also of vital importance in digestion. The endocrine part of the gland regulates blood sugar levels via hormone production (e.g. insulin) while the exocrine part produces digestive enzymes which are activated in the intestine. In pancreatitis these enzymes become prematurely active in the pancreatic duct and attack the pancreatic tissue, leading to autodigestion ("self-digestion"), which leads to inflammation of the organ. Acute pancreatitis can take a very painful course and become life-threatening for the person affected.

Pancreatitis: Symptoms

The symptoms of acute pancreatitis are sudden sharp pains in the upper abdomen, radiating like a belt around the back and chest. These symptoms may be accompanied by nausea, vomiting, constipation and fever. The abdomen is extremely sensitive to pressure, bloated (meteorism/tympanites) and firmly elastic ("rubber belly"). The loss of fluid in the blood vessels can also cause low blood pressure. In rare cases, ascites or jaundice may occur.

In chronic pancreatitis there are repeated pains in the area of the upper abdomen. Nausea and vomiting, maldigestion, steatorrhea and cachexia are further symptoms of the chronic disease.

Pancreatitis: Causes and Risks

Acute pancreatitis can have several causes, but the most common are impacted gallstones in the bile duct opening of the duodenum, and excessive or chronic alcohol abuse. Other causes include medications, hereditary factors, metabolic diseases, autoimmune diseases and pancreatic tumors.

The most important cause of chronic pancreatitis in over 80 percent of cases is alcohol abuse. Smoking is also a major risk factor.

Pancreatitis: Examination and Diagnosis

Normally, the attending physician can glean evidence of pancreatitis in a medical history interview with the patient, in which descriptions of current complaints, any pre-existing conditions, or possible clues about alcohol consumption etc are helpful. But the most important analysis for the diagnosis is determining various blood levels, including among others those for the enzymes lipase and amylase, the protein lactate dehydrogenase (LDH) and C-reactive protein (CRP). Abdominal ultrasound, computer tomography (CT) or magnetic resonance imaging (MRI), which can also help reveal possible causes, can be arranged as required. If chronic pancreatitis is suspected, measuring the elastase (less than 200 µg/g) via a stool examination may give hints as to the existence of the disease.

Pancreatitis: Treatment

The treatment of pancreatitis depends on the course of the disease. Since the acute form is potentially life threatening, medical monitoring of the patient is necessary. Increased hydration and pain management are the top priority here. Pain relief is accomplished via opioids, and antibiotics are also sometimes administered to counteract any complicating infections. If there is risk of thrombosis, supplemental use of heparin is recommended.

Besides pain therapy, in chronic pancreatitis and the ensuing pancreatic insufficiency, pancreatic enzymes and possibly insulin injections must be taken at mealtimes to maintain the pancreatic functions. Endoscopic surgeries are often used to deal with complications of acute and chronic pancreatitis. Surgery may especially be needed in cases of chronic pancreatitis.

Pancreatitis: Course and Prognosis

In principle, the disease's course and the prognosis are determined individually, depending on its form - acute or chronic. Both forms can lead to quite serious complications. Although acute pancreatitis can be life-threatening, as a rule patients do recover from the disease.

With the chronic form, which often involves alcohol consumption, alcohol abstinence is the causal treatment. But because the disease usually persists over several years, the life expectancy of those affected is significantly shortened due to numerous concomitant diseases and complications. Patients often suffer from chronic diarrhea, and the subsequent weight loss thus caused weakens the whole body and makes the person affected prone to infection.