What is pancreatitis, its causes and its treatment?
What is pancreatitis?
Pancreatitis is inflammation of the pancreas, an essential organ of the digestive system.
The pancreas is a long, cone-shaped gland that sits behind the stomach.
The pancreas is in charge of manufacturing and secreting digestive enzymes, as well as the organ responsible for the production of the hormones insulin and glucagon, fundamental in the processing of sugars.
What is the cause that causes it?
Pancreatitis involves irritation and inflammation of the pancreas, either temporarily or with permanent damage.
There are two basic types of pancreatitis:
- Acute pancreatitis. Acute (sudden) inflammation of the pancreas resolves with the correct treatment without leaving sequelae.
80% of cases are due to diseases of the bile ducts ( gallstones or gallstones ) or alcoholism.
- The remaining 20% is due to:
- Drugs (azathioprine, estrogens, furosemide, hydrochlorothiazide, pentamidine, sulfonamides, didanosine, corticosteroids, tetracycline, or valproic acid).
- Metabolic diseases (hyperlipemia, hyperparathyroidism or hypercalcemia ).
- Some scans (on the pancreas itself).
- Surgical interventions in the abdomen (stomach, bile duct).
It tends to recur, with increasingly permanent damage, becoming chronic pancreatitis.
- Chronic pancreatitis. Inflammation of the pancreas progresses slowly, with persistent damage even after the cause has been removed and clinical symptoms have been controlled. The most common cause is cystic fibrosis in children and alcoholism in adults.
What incidence does it have?
Acute pancreatitis has 20 to 80 cases per year incidence 100,000 inhabitants.
Chronic pancreatitis has approximately an incidence of 6 cases per year per 100,000 inhabitants and is more frequent in men than in women (5 to 1), probably due to greater alcohol consumption in men.
What are the symptoms of pancreatitis?
The typical symptoms of pancreatitis are an acute abdomen, a picture of maximum abdominal pain that radiates to the back similar to perforation or peritonitis, of sudden onset and lasting from a few hours to several days. It is accompanied by nausea, vomiting, low-grade fever and significant general malaise.
How can it be detected?
The following tests can be performed to diagnose pancreatitis:
- Physical exam: Pain and tenderness when palpating the abdomen.
- Pancreatic enzymes in the blood: Presence enormous amounts of pancreatic amylase and lipase in the blood, especially on the first day.
- Other blood tests: White blood cells are increased in the blood, and blood sugar ( hypoglycemia ) and calcium ( hypocalcemia ) may be low. Bilirubin may be elevated.
- Radiographic studies: It is usually necessary to perform a simple abdominal x-ray, an abdominal ultrasound or a computerised axial tomography (CAT or Scanner) to rule out other causes of acute abdomen and to detect underlying causes of pancreatitis. All of these procedures are painless.
- Endoscopic studies: It may be necessary to check the permeability of the papilla or ampulla (the small hole through which both the pancreas and the gallbladder drain their contents into the digestive tract) through a procedure that includes an endoscopy (exploration of the digestive tract with a tube flexible fibre optic) and X-rays with contrast. This mixed procedure is called endoscopic retrograde cholangiopancreatography (ERCP), which can be uncomfortable.
What is the recommended treatment?
The recommended treatment depends on the type of pancreatitis:
Acute pancreatitis. It is a medical emergency, and treatment consists of:
- Absolute fasting and aspiration of the stomach contents with a tube.
- Pain management with powerful analgesics IV (intravenous) or IM (intramuscular).
- Intravenous replacement of fluids and salts (serum).
- Early treatment of all possible complications.
- If there is no improvement in the first hours or days, transfer to an Intensive Care Unit (ICU) is usually necessary.
Chronic pancreatitis. Episodes of exacerbation of chronic pancreatitis are treated the same as acute pancreatitis. Subsequently, it is essential to abandon alcohol forever. Treatment of chronic pain with analgesics, antacids, or pancreatic enzymes may be necessary.
Complicated pancreatitis. Complications such as pancreatic pseudocyst or secondary infection often require surgery. The pancreatic pseudocyst is a collection of pancreatic fluid rich in enzymes, separated from the surrounding organs by a fibrous capsule, which can rupture and become infected.
What is the diagnosis of the illness?
In an episode of pancreatitis, the pancreas enzymes become massively activated, causing the death of the pancreatic tissue itself and often bleeding around the dead tissue.
Pancreatitis is a severe condition, which can get complicated quickly, and without treatment, it can cause the death of the affected person in a few days. Early death may be due to shock (persistent low blood pressure that can damage the kidney and heart), kidney failure (inability of the kidney to make urine), or respiratory failure.
After the first week, there are still significant possibilities of complications, such as infection of dead pancreatic tissue or the so-called pancreatic pseudocyst.