Inflammation of the pancreas (pancreatitis) causes severe pain. It needs to be treated quickly to avoid permanent damage to the pancreas. Otherwise there is a risk of serious consequences, which can be avoided.
Inflammation of the pancreas (pancreatitis) can be acute or chronic. The acute form is relatively common: around 30 out of 100,000 people in western countries contract it every year. Chronic pancreatic inflammation is rarer than the acute form. About 6 out of 100,000 people fall ill each year. In this variant, the pancreas is permanently inflamed. Affected people experience persistent digestive problems that worsen over time, they suffer from recurring pain and disorders of sugar metabolism as a complication.
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Identify symptoms of pancreatitis
Patients with acute pancreatitis usually seek medical help because of severe upper abdominal pain. The pain can escalate into colic that radiates to the back. People with pancreatitis avoid lying on their backs and usually lie hunched over in bed to better endure the pain. Despite massive complaints, the abdomen is not hardened, there is no defensive tension (rubber abdomen).
Other symptoms of acute pancreatitis may include:
Chronic pancreatitis also causes recurring or permanent upper abdominal pain of varying intensity. The pain can also radiate to the back. However, they are usually less severe than in the acute variant.
In advanced stages of the disease one speaks of “burned out pancreatitis”, the following symptoms develop:
- Less pain
- Indigestion, especially when eating high-fat foods
- Fat stool (faeces with increased fat content)
- weight loss
- Diabetes mellitus (sugar diabetes) due to lack of insulin when the pancreas fails
Causes of pancreatitis: gallstones and alcohol abuse
Gallstones are an important cause of both acute and chronic pancreatitis. They block the duct from the pancreas into the intestine and the bile duct system. Acute inflammation is due to gallstones in up to 45 percent of cases. But alcohol abuse also plays a role in this form. About 35 percent of cases of acute pancreatitis can be traced back to excessive alcohol consumption.
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Exactly how alcohol triggers the symptoms has not yet been fully clarified. Researchers suspect that alcohol interferes with the escape of digestive enzymes from the pancreas into the intestines or leads to protein deposits in the duct system. A toxic effect due to metabolic products such as acetaldehyde and free radicals is also possible.
Other causes of acute pancreatitis can be:
- abdominal injuries
- Malformations of the pancreas
- Infections such as mumps
- autoimmune diseases
- Medical interventions, especially on the bile ducts (rare)
Chronic pancreatitis is related to the following factors:
- Long-term and repeated alcohol abuse (common)
- Hereditary Factors
- metabolic disorders
Sometimes no cause for the inflammation can be found. This form is called idiopathic pancreatitis.
Diagnosis of suspected pancreatitis
There are several methods that can be used to diagnose pancreatitis. Initially, those affected are asked about their medical history and current symptoms (anamnesis). The following questions are in the foreground:
Do you experience symptoms such as abdominal pain? Where would you locate these and how long have they existed?
Do you often suffer from nausea and vomiting?
Do you have digestive problems, such as flatulence?
How severe are the symptoms?
Are diseases known, for example gallstones?
Have you recently gone through an infection?
How do you eat, for example high in fat?
How much alcohol do you consume on average per day? Try to answer honestly.
If there is still a suspicion of pancreatitis, further tests will follow.
The blood test reveals elevated levels of various enzymes, such as pancreatic lipase, which breaks down fat, and pancreatic amylase, which breaks down starch and glycogen. If gallstones are the cause of the inflammation of the pancreas, there are often elevated liver and bile duct values (gamma GT, alkaline phosphatase, leucine amino peptidase = LAP).
If patients suffer from acute pancreatitis, blood sugar, urea values and hematocrit values are increased. These are considered warning signals that the course is severe and that organ failure is imminent.
Imaging methods: Ultrasound, CT and ERCP
With ultrasound (sonography), the doctor discovers swellings, calcifications or accumulations of fluid in the pancreas. Using computed tomography (CT), he/she assesses the extent of tissue destruction in the organ.
Endoscopic retrograde cholangiopancreatography (ERCP) is a combination of diagnostic and therapeutic procedures. During this examination, the doctor pushes a flexible tube with a small camera (endoscope) through the esophagus, stomach and duodenum to the point where the common duct of the gallbladder and pancreas opens. The ERCP helps identify gallstones that may be blocking the duct. This point of entry can already be widened during the examination so that the gallstone can escape into the intestine.
Rule out diseases with similar symptoms
To confirm the diagnosis of pancreatitis, doctors rule out other diseases that cause similar symptoms. These include, for example:
- intestinal paralysis
- ectopic pregnancy
- renal colic
- biliary colic
- Perforation of the stomach, intestines or gallbladder
- Heart attack
- pulmonary infarction
- tumors of the ovaries
Treatment for pancreatitis
In the case of acute pancreatitis, those affected must be treated as inpatients in a hospital. Stabilizing measures come first. For example, sick people receive infusions of liquid and electrolytes, and the often severe pain is relieved with medication. It is important to prevent organ failure and other complications and to relieve the pancreas so that it can recover.
When an operation is necessary
Surgeons remove gallstones endoscopically. In some cases further interventions are necessary. This includes:
Drainage tubes for changes in the pancreas, for example accumulation of fluid in scarred areas of the organ (pseudocysts). They are the result of chronic pancreatitis. The liquid can be removed via the drainage hoses.
Surgery for narrowed bile ducts, a blockage in the pancreatic duct, or when parts of the pancreas need to be removed.
Diet and anti-inflammatory drugs
People with an inflamed pancreas should not eat for a few days until the pain subsides and appetite returns. If the symptoms last longer, artificial nutrition makes sense so that the body gets enough nutrients. Later, the diet consists of easily digestible foods that do not burden the pancreas, such as tea, rusks, rice gruel or oatmeal. It is best for patients to avoid fatty foods for a few weeks and then only consume small amounts. Alcohol is forbidden.
People with advanced, chronic pancreatitis may need to take medications that contain digestive enzymes to normalize their digestion. It may take some time for the desired effect to set in. For mild forms, there are the digestive enzymes as tablets, for advanced disease, the drugs are injected into the muscle.
Inflammation of the pancreas often results from chronic alcohol abuse. It is therefore generally important to pay attention to alcohol consumption and limit it if necessary. Gallstones are also a major cause of pancreatitis. A balanced, low-fat diet can prevent gallstones. However, this does not apply to everyone – sometimes gallstones can also be genetic.
Source: Lifeline | Das Gesundheitsportal by www.lifeline.de.
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