Pancreatitis

Pancreatitis is an inflammation (swelling) of the pancreas, a glandular organ located in the abdomen.

The pancreas is a long gland with a flat pear shape that it is important in digestion. The primary function of the pancreas is to produce and secrete digestive enzymes. Additionally, it produces hormones such as insulin and glucagon, essential for the metabolism of carbohydrates.

Pancreatitis refers to the irritation and inflammation (swelling) of the pancreas. It can lead to temporary or permanent damage on the pancreas.

There are two basic types of pancreatitis:

1. Acute pancreatitis. Acute (sudden) inflammation of the pancreas that usually improves with the proper treatment and has a full recovery.
   1. The main cause (80% of the cases) are due to a gallbladder disease (such as gallstones) or alcoholism.
   2. The remaining 20% of the cases are due to:
      • Certain drugs (azathioprine, didanosine, estrogens, furosemide, hydrochlorothiazide, pentamidine, sulfonamides, corticosteroids, tetracycline or valproic acid)
      • Infections
      • Metabolic diseases (hyperlipidemia, hyperparathyroidism, or hypercalcemia)
      • Screening tests or exams on the pancreas
      • Gastrointestinal surgical procedures (on stomach, bile duct).
      Acute pancreatitis tends to be recurrent, with an increase damage to the pancreas and it may finally become chronic.
2. Chronic pancreatitis. It is a long-term progressive inflammation of the pancreas. It usually produces a persistent damage to the pancreas, although the underlying cause was being properly treated. The most common cause of chronic pancreatitis is alcoholism in adults and cystic fibrosis in children.

Acute pancreatitis has an incidence of 20 to 80 cases per 100,000 inhabitants per year.

Chronic pancreatitis has an incidence of 6 cases per 100,000 inhabitants per year. Chronic pancreatitis is more common in males than in females (male-to-female ratio is 5 to 1), probably due to a greater intake of alcohol in males.

The typical symptoms of pancreatitis are those of an acute abdomen. Typically, a severe abdominal pain is present and the pain is often felt all way through the back of the patient. The pain is similar to the one of a bowel perforation or a peritonitis. It usually has an abrupt onset and lasts from a few hours to several days.

The pain may be followed by nausea and vomiting, fever and discomfort.

Tachycardia (rapid or fast heartbeat) and low blood pressure are also common.

For the diagnosis of pancreatitis, the following tests may be performed:

• Physical examination: Pain and tenderness during palpation of the abdomen.
• Pancreatic enzymes in the bloods: Abnormal amounts of pancreatic amylase and lipase in the blood, especially on the first day.
• Other blood tests: White blood cell count (WBC count) is increased, while sugar and calcium are decreased (hypoglycemia and hypocalcemia). Bilirubin may be also high.
• X ray tests: A plain abdominal X-ray, ultrasound examination of the abdomen, or a computed tomography (CT) scan may reveal the underlying cause of pancreatitis or any other cause of acute abdomen. All these procedures are painless.
• Endoscopy: It may be necessary to check the permeability ampulla of Vater or the major duodenal papilla (the spot where the pancreatic and bile ducts release their secretions into the intestines). The ampulla is checked using a procedure called endoscopic retrograde cholangiopancreatography (ERCP). The doctor uses a medical instrument fitted with a fiber optic camera to inspect the area. The ERCP procedure can be uncomfortable for the patient.

The recommended treatment depends on the type of pancreatitis:

1. Acute pancreatitis. It is considered a medical emergency. The treatment includes:
   • Fasting and gastric or stomach pumping (empty the content of your stomach).
   • Pain is treated with a variety of medications. For example, using antibiotics through the I.V. (intravenous) or I.M. (intramuscular) analgesic therapy.
   • Intravenous fluid therapy: These IV solutions need to contain appropriate amounts of salts, sugars, and sometimes even proteins.
   • Early treatment of all possible complications.
   • If there is no improvement in the first hours or days, it is necessary to transfer the patient to an Intensive Care Unit (ICU).
2. Chronic pancreatitis. Exacerbated episodes of a chronic pancreatitis are treated similar to an acute pancreatitis. It is mandatory to avoid alcohol intake in the future. Treatment of chronic pain may be necessary using analgesics, antacids or pancreatic enzymes.
3. Complicated pancreatitis. Complications such as pancreatic pseudocyst or secondary infection usually require surgery. Pancreatic pseudocysts are fluid collections that are rich in amylase and other pancreatic enzymes. Pancreatic pseudocysts are usually surrounded by a fibrous fibrous capsule that can break open (rupture) or become infected.

An episode of pancreatitis is often associated with pancreatic necrosis (death of pancreatic tissue). The dead (necrotic) tissue can then become infected, which may lead to life-threatening complication.

Pancreatitis is a serious condition that may develop quickly. In such case, a quick development can lead to potentially fatal complications in a few days like shock (very low blood pressure that can damage the kidney and the heart), kidney failure (kidney lose their filtering ability) or respiratory failure.

After the first week, an infection of the necrotic pancreatic tissue or the formation of pancreatic pseudocysts are complications that must be considered.