Pancreatitis - Causes and Symptoms

Pancreatitis - Causes and Symptoms
By Dr. Pavana M. Joseph

 

Quietly but diligently, the pancreas keeps working in aiding digestion and metabolism of food. This leaf-shaped organ situated between the stomach and the small intestine, produces some of the most important enzymes that are required to digest our food. It has small islands of cells that produce these digestive juices that are poured into the small intestine at timely intervals. Inflammation of the pancreas is termed as pancreatitis. It can be an acute or chronic disease.

The causes of pancreatitis are numerous. It can be due to a pancreatic infection like mumps; hereditary pancreatitis; pancreatic tumor involving the head of pancreas; hypertriglyceridemia; obesity; alcohol; gallstone obstructing ampulla of Vater; hypercalcemia; renal failure; opportunistic infections; abdominal trauma; post-ERCP; post-operative pancreatitis; penetrating peptic ulcer; medications like valproic acid and furosemide; connective tissue disease like lupus; etc. Commonest causes are alcohol and gallstones. Once the pancreas is damaged, there can be recurrent episodes of acute exacerbations beyond an underlying chronic pancreatitis.

The pain of an acute episode of pancreatitis has a characteristic onset. It typically starts after a heavy meal or a binge of alcohol. There is sharp, shooting or boring pain above the umbilical region on the abdomen, radiating to the back. The pain is so intense, that the patient must lie still and avoid all movements that worsen it especially lying on the back. Along with the pain, there might be intense sensation of nausea which may or may not precipitate into vomiting. Sudden high fever is common too. Severe abdominal tenderness, bluish discolouration near the umbilicus and red nodules under the skin are seen in advanced cases of pancreatitis. A mass may be felt in the upper abdominal region during a physical examination.

The diagnosis is usually made by the characteristic symptoms, signs and corroboration by elevated serum amylase, serum lipase and white blood cell count. Serum amylase rises 3 times above normal usually. Most patients have elevated serum glucose levels and decreased calcium levels. Outcome becomes poor if there is significantly low oxygen in blood, obesity, diabetes, gastro-intestinal bleed, organ failure etc. Pancreatitis can be confirmed on a CT scan of the abdomen. It is visualised as an enlarged and edematous pancreas. Abdominal x-ray can show intestinal perforation or obstruction due to pancreatitis, but does not help visualise the pancreas itself. Similarly, an abdominal ultrasound may help detect a gallstone or pancreatic cyst or a tumor that might be causing the pancreatitis.

Complications of pancreatitis range from pleural effusion (water around lungs) to cardiac failure to necrotizing pancreatitis. Thus, immediate hospitalisation is mandatory. The patient is prohibited from taking any oral intake for the next 3 days. An intra-venous line is inserted and a normal saline drip is started. The patient is given pain-killers like meperidine and antibiotics if there is confirmed infection. Correction of metabolic abnormalities is done by giving calcium for hypocalcemia etc. if the patient is symptomatic. There is complete bed rest for a week and oral intake of a strict pancreatic diet is started only after the 4th day.

Knowledge of correct diet is the key to the proper management of chronic pancreatitis. Learn about the Do's and Dont's that are a must know for a healthy and safe revival: http://healthadvisor.co.in/pancreatitis-diet/