Pancreatitis

Pancreatitis is a condition characterized by inflammation of the pancreas. The pancreas is the long flattened gland located behind the stomach near the small intestines. It plays a vital role in producing enzymes that facilitate digestion. It also releases hormones that regulate how the body processes glucose or sugar. 

Damage can occur when the digestive enzymes start to work even before the pancreas generates them. Among other causes, the most common triggers of pancreatitis involve consumption of alcohol and gallstones. It can either emerge or disappear within a short period even without treatment or can be severe with fatal complications. 

Functions of the Pancreas 

The pancreas is one of the most prominent glands in the body that has two significant roles:

The exocrine pancreas: Releases alkaline compounds to suppress stomach acids before the food gets into the small intestine. It also causes the enzymes to break down food into small components. The secretions pass through the pancreatic duct system as it gets into the intestine via the papilla, a small opening. Exocrine glands secrete substances that are delivered to specific targets through ducts. 

The endocrine pancreas: This produces hormones like insulin that help control the amount of glucose in the bloodstream. Diabetes may develop due to issues with the production of insulin. Endocrine typically refers to the glands which secrete substances into the bloodstream. 

Types of Pancreatitis 

Pancreatitis can either be acute or chronic. Severe cases of acute pancreatitis can lead to necrotizing pancreatitis. The severity of associated symptoms determines the treatment for each pancreatitis case. 

• Acute pancreatitis 

Acute pancreatitis is a short-term inflammation of the pancreas. It can be anything from minor pain to a serious, life-threatening disease. With proper care and treatment, the majority of people with acute pancreatitis recover fully.

Acute pancreatitis can result in bleeding, significant tissue damage, cysts, and infection in extreme cases. In addition to the pancreas, severe pancreatitis can damage other vital body organs, including the liver, kidneys, and lungs. 

• Chronic pancreatitis 

Chronic pancreatitis is long-term inflammation of the pancreas. It usually occurs after an acute pancreatitis attack. Another major factor is consuming large amounts of alcohol over a long period. Damage to the pancreas due to heavy alcohol consumption may not manifest for years. However, you can suddenly develop serious pancreatitis symptoms. 

Signs and Symptoms of Pancreatitis 

The pancreatitis signs and symptoms can vary from one person to another based on the type one has. If you have acute pancreatitis, then you are likely to experience the following; 

• Abdominal pain that can radiate towards the back 
• Upper abdominal pain 
• Abdominal pain that aggravates after eating 
• Rapid heart pulse 
• Fever 
• Tenderness feeling when you touch your abdomen
• Nausea and vomiting 

With chronic pancreatitis, the following signs and symptoms are likely to occur;

• Constant abdominal pain that radiates to the back. This type of pain can also be disabling 
• Unexplainable loss of weight and diarrhea since the pancreas is not producing sufficient to break down food. 
• Vomiting and stomach upset

Causes of Pancreatitis 

Pancreatitis develops when the digestive enzymes are stimulated while they are still in the pancreas. This causes irritation and inflammation of the pancreatic cells. 

Pancreas damage may occur as a result of prolonged episodes of acute pancreatitis, leading to chronic pancreatitis. The pancreas can develop scar tissue and eventually result in loss of function. Digestion issues, as well as diabetes, can occur due to malfunctioning of the pancreas. 

These are the common pancreatitis causes;

• Alcohol abuse 

Pancreatitis can occur in people who have consumed alcohol for a long time. An increased risk of chronic pancreatitis tends to be associated with higher intake. Inactive trypsin is a digestive enzyme generated in the pancreas.

Alcohol abuse may trigger trypsin to be active while still within the pancreas, but no one knows why. However, researchers presume that the molecules of ethanol can impact the pancreatic cells, making them activate trypsin while premature. 

• Gallstones 

Gallstones are tiny, pebble-like structures in the gallbladder that form when the bile contains too much cholesterol. Gallstones may sometimes become stuck on their way out of the bile ducts and into the intestines. 

The pancreas will be affected by this blockage, as it will be unable to release its enzymes in the intestine. When gallstones cause acute pancreatitis, the gallbladder is normally removed before the patient is discharged from the hospital.

• Infection 

Salmonellosis is a bacterium infection that can result in acute pancreatitis. It’s a form of food poisoning that occurs due to the bacterium Salmonella and Legionnaires' disease, a disorder triggered by the bacterium Legionella pneumophila. This bacterium can be found in showerheads, plumbing, and water storage tanks. 

Viruses such as hepatitis B, coxsackievirus, mumps, varicella-zoster virus, and cytomegalovirus can also cause acute pancreatitis. 

Other conditions that can contribute to pancreatitis are; 

• Abdominal operation  
• Some types of medications 
• Cystic fibrosis 
• Obesity 
• Abdominal injury 
• Pancreatic cancer 
• High levels of triglyceride in the blood 
• High levels of calcium in the blood which can occur because of an overactive parathyroid gland. 

Risk Factors of Pancreatitis 

Some of the risk factors that can increase the chances of developing pancreatitis include; 

Family history of pancreatitis: With chronic pancreatitis, the function of genetics is becoming more widely known. The chances of developing it are higher if you have a close family member who has the disease. This is particularly when combined with some other risk factors. 

Obesity: Being overweight increases the chances of developing pancreatitis.

Overindulgence of alcohol: According to research, heavy drinkers, especially those who take four to five drinks each day, have a higher risk of developing pancreatitis. 

Smoking cigarettes: In comparison to nonsmokers, regular smokers have three times the chance of developing chronic pancreatitis. However, quitting smoking is the only way to reduce the risk by almost half.  

Pancreatitis Diagnosis 

The doctor can suspect the condition depending on the symptoms you are experiencing or the risk factors like excess alcohol consumption. If some parts of the abdomen are too sensitive to touch, it could mean acute pancreatitis. The muscles of the abdominal wall tend to be rigid with acute pancreatitis. 

You are likely to undergo additional pancreatitis diagnosis procedures, which can include the following;

Diagnostic Procedures for Acute Pancreatitis 

• Blood tests

The doctor can conduct a pancreatitis blood test to check the levels of the two digestive enzymes the pancreas releases, amylase and lipase. High levels of the two enzymes show the presence of acute pancreatitis. 

On the other hand, blood tests might not be accurate if the sample is not taken on the first or second day of sickness. The level of the enzymes, lipase and amylase are high in the first few hours. It can then go back to normal within a few days. Amylase returns to normal in 3 to7 days, and lipase takes eight to14 days to return to normal.

• Imaging tests 

Alternatively, the doctor can recommend imaging tests to visualize and generate pictures of the pancreas. It can also include the surrounding organs, such as the bile duct and the gall bladder. Examples of the commonly used imaging tests include ultrasound, x-ray, computed tomography (CT) scan, or magnetic resonance imaging (MRI).

CT scan: A CT scan of the abdomen might be required to view the pancreas and assess the level of inflammation. It’s also useful in identifying any possible complications from pancreatitis. This can include bleeding or the development of a pseudocyst (a buildup of fluid). Furthermore, a CT scan can diagnose pancreatitis gallstones (a common cause of pancreatitis), and other biliary system defects.

Ultrasound imaging: The doctor can detect gallstones and biliary system defects using ultrasound imaging. Since ultrasound imaging does not produce radiation, it is widely used as the first imaging test in pancreatitis cases.

MRI scans: MRI scans take images of the abdomen using a strong magnetic field instead of radiation. A type of MRI known as MRCP can be used to obtain pictures of the pancreas ducts. It also aids in determining the cause of pancreatitis and the degree of damage. 

Diagnosing Chronic Pancreatitis 

• Secretin pancreatic function test

This test examines the reaction of the pancreas to a hormone called secretin that the small intestine produces. This secretin influences the pancreas to generate digestive juice. The doctor will put a tube into the mouth and pass it via the throat, stomach, and upper region of the small intestine. He or she will then insert secretin and analyze the reaction.  

• Endosonography (endoscopic ultrasound)

An internal (endoscopic) ultrasound provides more detailed images of the pancreas and connective ducts or tubes. It involves inserting a small tube attached to a tiny ultrasound connection into the throat, via the stomach, and small intestine. The detailed images of the pancreas, a portion of the liver, bile duct, and gallbladder are all taken using endoscopic ultrasound. 

• Oral glucose tolerance test

If the physician suspects that pancreatitis has impaired the insulin-producing pancreas cells, you may need an oral glucose tolerance test. It uses a blood test to determine how the body absorbs sugar before and after drinking a sugary beverage. 

• Stool test

To measure if your body is experiencing difficulties breaking down fat, the doctor can order a stool test using a small stool sample. 

• Endoscopic retrograde cholangiopancreatography (ERCP)

This procedure involves passing a tube attached to a small camera from the throat through the stomach. It is then directed into the small intestine and up to the ampulla region, where both the pancreas and bile duct open. The pancreas duct or the bile duct is injected with dye. 

This enables the doctor to view inside your pancreas and bile duct. A gallstone or pancreas stone, for example, might be removed if it is blocking the pancreas or bile duct.

Pancreatitis Treatment

The pancreas is the main factor that contributes to the digestion process; hence it requires rest to recover. As such, the treatment of both acute and chronic pancreatitis usually includes hospitalization. The initial forms of pancreatitis treatment in the hospital can consist of the following; 

Pain-relieving drugs: Pancreatitis can be very painful. Due to this, the medical doctor will prescribe medicines to help reduce and manage your pain.

Fasting: While in the hospital, the doctor will ask you to stop eating for a few days to allow your pancreas to heal. You will start taking clear liquids and consuming bland foods until the inflammation in the pancreas is under control. You should gradually return to your regular diet with time. At times, the doctor may suggest a feeding tube to enable you to receive nutrition if the condition perseveres and you feel pain while eating. 

Fluids administered intravenously (IV): You can be dehydrated as your body allocates energy and fluids towards the repair of your pancreas. As a result, during hospitalization, the doctor will administer extra fluids via a vein in the arm. 

The health care team will begin addressing the root cause of pancreatitis once your condition is under control. Treatment options for pancreatitis vary depending on the trigger. They can include; 

Removal of the bile duct obstruction:

Pancreatitis that occurs due to blocked or narrowed bile duct might need bile duct widening or opening procedures. As stated earlier, endoscopic retrograde cholangiopancreatography (ERCP) is a technique that examines the pancreas and bile ducts using a tube with a camera at the tip. The camera captures and sends images of the digestive system to a computer as the tube passes down the throat. 

ERCP can help diagnose and resolve issues with the bile duct or pancreatic duct. It can as well cause acute pancreatitis for some people, especially the elderly.

Gallbladder surgery:

Gallbladder surgery is a procedure to remove the gallbladder. If gallstones are the cause of pancreatitis, the doctor can recommend gallbladder removal surgery (cholecystectomy).

Pancreas surgery:

The medical provider can suggest a pancreatitis surgery procedure to help drain fluid from the pancreas or take out diseased tissue.

Alcohol dependence treatment: 

Pancreatitis can occur because of consuming too many drinks every day for quite an extended period. If this is the main cause of your health problem, the doctor can suggest joining an alcohol addiction treatment program. Continued drinking can aggravate your pancreatitis and cause severe complications. 

Additional Chronic Pancreatitis Treatment Options 

Chronic pancreatitis might need additional treatments based on your current situation. They can include;

• Management of pain. Consistent abdominal pain is a symptom of chronic pancreatitis. Your doctor can prescribe pain-relieving medications or refer you to a professional pain expert. Endoscopic ultrasound or an operation can be used to alleviate severe pain. It helps block nerves that transmit pain signals from the pancreas to your brain. 
• Changes in your eating habits. The provider can refer you to a dietitian who can assist you in creating a low-fat, high-nutrient diet plan. 
• Boost the digestion with enzymes. Supplementing with pancreatic enzymes will enable your body to break down as well as process the nutrients in the food. With every meal, pancreatic enzymes are ingested. 

Complications of Pancreatitis 

Pancreatitis can result in severe health complications such as;

Pseudocyst: Fluid and debris may accumulate in the cyst-like pockets within the pancreas as a result of acute pancreatitis. If a large pseudocyst ruptures, it may result in infection and internal bleeding. 

Infection: Your pancreas can become susceptible to bacteria or infection if you have acute pancreatitis. Pancreatic infections are dangerous and need aggressive care, including a surgical operation to remove contaminated tissue.

Kidney failure: At times, acute pancreatitis can lead to kidney failure. Dialysis might be necessary to treat the problem, especially if it is serious and persistent. 

Breathing difficulties: Acute pancreatitis might trigger changes of chemicals in the body that alter lung function. This could result in dangerously low oxygen levels in your blood. 

Diabetes: Chronic pancreatitis causes damage to insulin-producing cells in the pancreas. This can result in diabetes, a condition that affects how the body uses blood sugar or glucose.

Malnutrition: Acute and chronic pancreatitis can trigger the pancreas to release fewer enzymes, which are necessary for breaking down and processing nutrients from food. So even if you consume the same foods or a similar amount of food, this still can cause malnutrition, weight loss, and diarrhea. 

Pancreatic cancer: Chronic pancreatitis, which causes long-term inflammation in the pancreas, is a risk factor for pancreatic cancer. 

Pancreatitis Pain 

Pancreatitis pain can last anywhere from a few minutes to many hours at a time. Chronic pancreatitis can cause persistent pain in serious cases. It's possible that the discomfort would worsen after eating or while you lie down. You should thus try leaning forward or sitting upright to make yourself more relaxed.

Yoga, meditation, and acupuncture are some of the activities that can help with pancreatitis pain. To help alleviate pain, you can take pain medicine or antioxidant supplements.

Surgery is usually only used as a last resort to treat pancreatitis. However, studies published in 2013 stated that conducting surgery earlier during the treatment course might be helpful with pain relief.

Preventing Pancreatitis 

The best method of preventing pancreatitis is to adjust to a better healthy lifestyle. Some of the effective lifestyle changes you should make include; 

Stop consuming alcoholic drinks: If you can't quit drinking alcohol on your own, seek medical assistance. The doctor might be able to refer you to particular local services that will assist you in quitting drinking.

Quit smoking: You should quit smoking if you're a smoker. Also, do not start smoking if you have never done it before. If you are unable to stop on your own, seek medical assistance. You might quit smoking with the help of medications and some counseling.

Increase your fluid intake: Dehydration is a risk factor of pancreatitis; hence you should drink plenty of fluids during the day. Keeping a water bottle or glass with you can be beneficial.

Make a low-fat diet a priority: Limit your fat intake and prioritize fresh fruits and vegetables, whole grains, and lean protein in your diet.

Pancreatitis Diet 

In order to recover from pancreatitis, you should consider a low-fat, balanced diet. With pancreatitis, the pancreas function usually gets impaired. Therefore, patients with chronic conditions must be cautious about the amount of fat they take. Try as much as possible to avoid or limit taking foods such as;  

• Red meat 
• Full fat dairy
• Fried food
• Sugary desserts 
• Caffeine
• Alcohol
• Sweetened beverages

To avoid a lot of stress on the digestive system, consider eating small meals during the day. Keep hydrated by eating foods rich in protein and antioxidants and drinking plenty of water or other fluids. The doctor can also prescribe vitamin supplements to make sure that you get the nutrients you require. 

Alternative Pancreatitis Therapies 

While alternative therapies cannot cure pancreatitis, they can help you manage and cope with the pain related to the disease. Chronic pancreatitis patients can experience persistent pain that is difficult to manage with medications. Combining complementary and alternative drug therapies with prescription pancreatitis medications from the doctor can make you feel in control of the pain.

Some of the alternative therapies you might want to consider include; 

• Acupuncture 
• Meditation 
• Yoga 
• Relaxation exercise 

Pancreatitis Prognosis 

A number of factors determine the pancreatitis prognosis. They include the underlying condition that caused pancreatitis, the patient's age, the seriousness of pancreatitis, and any underlying health conditions. 

Pancreatitis can range from a short self-limited sickness with complete recovery to a prolonged course of illness with life-threatening complications or even death. If a person suffers from acute pancreatitis continuously, they can get chronic pancreatitis. This is a lifelong disease that can affect one's quality of life.

Bottom Line 

Pancreatitis is a rare condition that occurs when your pancreas gets irritated and inflamed, or swollen. There are many causes, but gallstones and heavy alcohol consumption are the most common. The condition can be a one-time occurrence or a long-term issue that can result in permanent harm.

Pancreatitis is generally a debilitating condition, but you can recover completely with the right care and lifestyle changes. This can also help avoid more acute pancreatitis episodes. Although chronic pancreatitis does not go away, your doctor can help you control the symptoms and prevent complications.