• The pancreas is a large gland behind the stomach and next to the small intestine. The pancreas does two main things:
- It releases powerful digestive enzymes into the small intestine to aid the digestion of food.
- It releases the hormones insulin and glucagon into the bloodstream. These hormones help the body control how it uses food for energy.
What is Pancreatitis?
• Pancreatitis is a disease in which the pancreas becomes inflamed. Pancreatic damage happens when the digestive enzymes are activated before they are released into the small intestine and begin attacking the pancreas.
• Acute pancreatitis is a sudden inflammation that lasts for a short time.
• It may range from mild discomfort to a severe, life-threatening illness.
• Most people with acute pancreatitis recover completely after getting the right treatment.
• In severe cases, acute pancreatitis can result in bleeding into the gland, serious tissue damage, infection, and cyst formation. Severe pancreatitis can also harm other vital organs such as the heart, lungs, and kidneys.
• Chronic pancreatitis is long-lasting Inflammation of the pancreas. It most often happens after an episode of acute pancreatitis.
Symptoms of Acute Pancreatitis
• Upper abdominal pain that radiates into the back. It may be aggravated by eating, especially foods high in fat
• Swollen abdomen
• Nausea and vomiting
Symptoms of Chronic Pancreatitis
• The symptoms of chronic pancreatitis are similar to those of acute pancreatitis
• Frequently constant pain in the upper abdomen that radiates to the back
• Weight loss caused by poor absorption (mal absorption) of food
• Diabetes may develop if the insulin-producing cells of the pancreas are damaged
• Diarrhoea due to poor absorption of the food
- Viruses: Coxsackie,Cytomegalo,HepatitisB,Herpes-simplex,Mumps,Varicella-zoster
- Bacteria: Legionella,Leptospira,Mycoplasma,Salmonella
- Fungi: Aspergillus
- Parasite: Ascaris,Cryptosporidium,Toxoplasma
• Metabolic disorders
• Autoimmune disease
• High blood calcium
• Endoscopic retrograde cholangiopancreatography (ERCP)
• Pancreas divisum (Congenital malformation of the pancreas)
• Diabetes mellitus type 2
• Pancreatic cancer
• Pancreatic duct stones
• Vasculitis (Inflammation of the small blood vessels in the pancreas)
• Coxsackievirus infection
• Porphyria—particularly acute intermittent porphyria and erythropoietic protoporphyria
• Medications - Corticosteroids, HIV drugs, Diuretics, Anticonvulsant, Chemotherapeutic agents, etc.
• Hereditary disorders of the pancreas
• Cystic fibrosis
• High triglycerides
• Blood Biochemistries (S.Amylase,S.Lipase)
• CT scan
• Endoscopic USG
Complications of Acute Pancreatitis
• Systemic inflammatory response syndrome
• Low blood calcium
• High blood glucose
• Blood loss
• Fluid leaking into the abdominal cavity (ascites) can lead to kidney failure
• Respiratory (Pleural effusion)
• Lung collapse
• Severe inflammation can lead to intra-abdominal hypertension and abdominal compartment syndrome
• Impairing renal and respiratory function and potentially requiring management with an open abdomen (laparostomy) to relieve the pressure
• Recurrent pancreatitis
• Development of pancreatic pseudocysts—collections of pancreatic secretions that have been walled off by scar tissue
• Acute necrotizing pancreatitis can lead to a pancreatic abscess
Complications of Chronic Pancreatiitis
• Abdominal Pain
• Poor nutrition
• Weight loss
Treatment of Acute Pancreatitis
• Surgery – for the complications of Pancreatitis (like – bleeding, infection, pseudocyst etc.)
• Principles of Management -
- Provision of pain relief
- Provision of adequate replacement fluids and salts(intravenously)
- Diet – oral / Nasogastric tube / Jejunostomy
- Monitoring and assessment for, and treatment of, the various complications. • When necrotizing pancreatitis ensues and the patient shows signs of infection it is imperative to start antibiotics. These patients may require surgery/repeated surgeries, some patients may need prolonged hospital stay & may not be saved even after intensive medical &/or surgical managements.
Treatment of Chronic Pancretiitis
• Control of pain by -
- Endoscopic Stenting
- Surgery (Lateral Pancreatico-Jejunostomy(LPJ), Whipple’s surgery etc.)
• Nutrition – (high protein and low fat)
• Control of Diabetes
Prevention of Recurrence of Pancreatitis
Possible in many cases-by controlling the causative factors
• Surgery for Gallbladder stone
• Avoidance of Alcohol
• Control of Hypercholesterolemia