Pancreatitis is inflammation of the pancreas, a glandular organ that produces several enzymes to aid in the digestion of food, as well as the hormone insulin, which controls the level of sugar (glucose) in the blood. The pancreas is located in the upper abdomen, behind the stomach; a duct connects it to the duodenum, the first part of the small intestine. Pancreatic enzymes and bile produced by the liver enter the duodenum at the same location.
Pancreatitis may be either acute (sudden and severe) or chronic. Both acute and chronic pancreatitis can cause bleeding and tissue death in or around the pancreas. In a single episode of acute pancreatitis, the gland usually heals without causing functional or structural changes, but in the case of recurring pancreatitis, long-term damage is common. In chronic pancreatitis, smoldering attacks result in a slow deterioration of the structure of the pancreas and loss of pancreatic function.
Necrotizing pancreatitis (which involves death of pancreatic tissue) can lead to cyst-like pockets and abscesses. Because of the location of the pancreas, inflammation spreads easily. In severe cases, fluid containing toxins and enzymes leaks from the pancreas through the lining of the abdomen. This can damage blood vessels and lead to internal bleeding, which may be life threatening.
Signs and SymptomsCommon signs and symptoms of pancreatitis include the following:
- Severe, ongoing, sharp abdominal pain, often radiating to the back
- Nausea and vomiting
- Abdominal tenderness
- Rapid heart rate
- Rapid breathing
What Causes It?There are several possible causes of pancreatitis:
- Disease of the biliary tract. The biliary tract is the system of organs and ducts (including the liver, gallbladder, and bile ducts) that creates, transports, stores, and releases bile into the duodenum for digestion. The formation of stones in the biliary tract can block the main duct of the pancreas as it enters the duodenum.
- Heavy alcohol use over a long period of time, which can raise protein levels in pancreatic juices. Over time, the protein can form plugs, blocking small pancreatic ducts. Alcohol also allows enzymes to pass more easily through duct walls and damage the pancreas. Biliary tract stones and alcoholism are the most common causes of pancreatitis.
- The drugs azathioprine, sulfonamides, corticosteroids, nonsteroidal anti-inflammatories (NSAIDs), and tetracyclines
- Infection with mumps, hepatitis virus, rubella, Epstein-Barr virus (the cause of mononucleosis), and cytomegalovirus
- Abnormalities in the structure of the pancreas or the pancreatic or bile ducts, including pancreatic cancer
- High levels of triglycerides (fats) in the blood
- Surgery to the abdomen, heart, or lungs that temporarily cuts off blood supply to the pancreas, damaging tissue
- Injury resulting in compression of the pancreas against the spine
Who's Most At Risk?These conditions or characteristics increase the risk for pancreatitis:
- Biliary tract disease
- Binge alcohol use and chronic alcoholism
- Recent surgery
- Family history of high triglycerides
- Age (most common between ages 35 and 64)
- African-Americans are at higher risk than Caucasians and Native Americans.
What to Expect at Your Provider's OfficeYour healthcare provider will examine you for signs and symptoms of pancreatitis. He or she may also perform blood tests, take X rays, and use ultrasound, computed tomography (CT) scans, and other procedures to determine the severity of your condition and decide which treatment options are most appropriate.
Treatment PlanMild edematous pancreatitis (marked by buildup of fluid in the pancreas) can usually be treated with intravenous fluids and by fasting, along with careful monitoring by the healthcare provider. Nasogastric suction (suction of the stomach using a tube inserted through the nose) reduces stomach secretions and prevents stomach contents from reaching the small intestine. This procedure is sometimes used although there is no proven benefit. Parenteral nutrition (nutrients given through the veins, muscles, or skin rather than orally) may be needed if the patient does not adequately recover within several days. For those with low blood pressure, low urine output, low levels of oxygen in the blood, or increased levels of red blood cells, more aggressive therapy may be required. For pancreatitis from high triglycerides, treatment includes weight loss, exercise, fat-restricted diet, control of blood sugar for diabetics, and avoidance of alcohol and medications that can raise triglycerides, such as thiazide diuretics and beta-blockers.
Drug TherapiesPainkillers such as meperidine may be prescribed. Antibiotics, such as ampicillin, ceftriaxone, and imipenem, may be given to treat or prevent infection in some cases.
Surgical and Other ProceduresDifferent types of surgical procedures may be necessary, depending on the cause of the pancreatitis. With infected pancreatic necrosis (tissue death), surgery is virtually always required to remove damaged and infected tissue. Surgery may also be required to drain an abscess. For hemorrhagic (bleeding) pancreatitis, surgery will stop the bleeding and help restore pancreatic function. For chronic pancreatitis with pain that won't respond to treatment, a section of the pancreas may need to be removed. If the pancreatitis is a result of gallstones, a procedure called endoscopic retrograde cholangiopancreatography (ERCP) may be necessary. In ERCP, a specialist inserts a tube-like instrument through the mouth and down into the duodenum where he or she can gain access to the pancreatic and biliary ducts.
Complementary and Alternative TherapiesA number of studies have explored the role of oxidative stress in pancreatitis. Oxidative stress results from the production of free radicals, which are by-products of metabolism that are harmful to cells in the body. Several ways to neutralize these deleterious effects have evolved over time. Antioxidants, for example, help rid the body of free radicals. Insufficient antioxidant levels in the blood (including reduced amounts of vitamin A, vitamin E, selenium, and carotenoids), though, may lead to chronic pancreatitis due to the destructive effects of increased free radical activity. Antioxidant deficiency and the risk of developing pancreatitis may be particularly relevant in areas of the world with low soil concentrations or low dietary intake of antioxidants. In addition, the cooking and processing of foods may destroy antioxidants. Alcohol-induced pancreatitis is linked to low levels of antioxidants as well. There is also some evidence that antioxidant supplements may eliminate or minimize oxidative stress and help alleviate pain from chronic pancreatitis.
As explained, low levels of antioxidants in the blood may make an individual more prone to develop pancreatitis; at the same time, someone who already has pancreatitis is more likely to develop deficiencies of the following nutrients:
- Magnesium – particularly in the case of chronic alcoholism
- Vitamin A
- Vitamin C
- Vitamin E
- Vitamin B12; levels may be low with pancreatitis; works best in this case if given by injection.
- Soybeans; extracts of soybeans known as polyunsaturated phosphatidylcholines (PCs) work as antioxidants and have demonstrated prevention of damage to the pancreas in animal studies.
- Emblica officinalis (Indian gooseberry) is a traditional Ayurvedic medicinal plant used to treat pancreatic disorders. It is the richest natural source of vitamin C. Animal studies further suggest that this herb can be used to prevent development of pancreatitis.
- Licorice root (Glycyrrhiza glabra)
- Ginger root (Zingiber officinale)
- Asian ginseng (Panax ginseng),
- Peony root(Paeonia officinalis)
- Cinnamon Chinese bark (Cinnamomum verum)
- Bupleurum (Bupleri falcatum L)
- Pinelliae tuber (Pinelliae ternata)
- Chinese skullcap (Scutellariae baicalensis)
- Jujube (Zizyphi jujuba)
The value of acupuncture for treating pancreatitis is controversial. There are case reports stating that acupuncture has helped relieve pain from pancreatitis and pancreatic cancer. But a review of several studies finds that results of acupuncture and electroacupuncture (small electrical currents applied through acupuncture needles) for pancreatitis are mixed with some concluding that there is no benefit with the addition of either of these modalities for people with pancreatitis.
Prognosis/Possible ComplicationsPossible complications of pancreatitis include infection of the pancreas; cyst-like pockets that can become infected, bleed, or rupture; the failure of several organs (heart, kidney, lungs) and shock due to toxins in the blood; and diabetes. In mild edematous pancreatitis, with inflammation in the pancreas alone, the prognosis is excellent. Fewer than 5% of people with this form die. With severe tissue death and bleeding, or where inflammation is not confined to the pancreas, the death rate is 10 to 50% or higher, due to infection and other serious complications. In chronic pancreatitis, recurring attacks tend to become more severe.
Following UpPatients with chronic pancreatitis should eat a low-fat diet, abstain from alcohol, and avoid abdominal trauma to prevent acute attacks and further damage. Those with high triglyceride levels should lose weight, exercise, and avoid medications, such as thiazide diuretics and beta-blockers, that increase triglyceride levels. Given the recent reports suggesting that oxidative stress may contribute to the development of pancreatitis and that antioxidant supplementation may be of some benefit, healthcare providers may begin recommending antioxidant nutrients to their patients with pancreatitis.
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