Pancreatitis
When the pancreas, a digestive organ situated behind the stomach, becomes inflamed, the condition is referred to as pancreatitis. The inflammation may be acute or chronic, and is thought to result from an abnormal activation of certain digestive enzymes produced by the pancreas. Instead of waiting until they teach the small intestine to begin their digestive functions, the enzymes start working in the pancreas itself, leading to swelling, bleeding, inflammation, and sometimes tissue death.
Researchers have identified a number of factors that may trigger the process: alcoholism, gallstones, elevated blood lipids, excessive production of parathyroid hormones, hepatitis and various other viral infections, an adverse drug reaction, and injury to the pancreas, such as from surgery and invasive diagnostic procedures.
An acute attack produces an upper abdominal pain that bores from front to back and often radiates to the chest, flanks, and lower abdomen. The pain intensifies with coughing, deep breathing, and lying supine, and may be alleviated by sitting with the knees drawn up. Other symptoms include nausea, vomiting, abdominal swelling, a rapid heartbeat, low blood pressure, and perhaps shock. Acute hemorrhagic pancreatitis may result in vomiting of blood.
Recurrent attacks of pancreatitis can evolve into a chronic condition marked by abdominal pain, digestive problems, possible nutritional deficiencies, weight loss, diarrhea, and passage of bulky, foul-smelling, fatty stools. Diabetes develops if the islet cells within the pancreas cease 10 produce insulin.
Diagnostic Studies and Procedures
Various blood tests will be ordered. Elevated blood levels of the digestive enzyme amylase or lipase confirm acute pancreatitis. In chronic pancreatitis, the level of these enzymes might be normal, but there may be other abnormalities, such as elevated blood glucose levels.
X-rays or a CT scan may show areas of calcification, a sign of chronic pancreatitis, or enlargement typical of an acute attack. Endoscopy, an examination using a lighted viewing device inserted through the throat into the stomach and small intestine, may be ordered to determine if gallstones might have triggered the condition.
Medical Treatments
Acute pancreatitis is a life-threatening emergency that demands immediate hospitalization for intensive care. The goal is to rest the pancreas and allow it to heal itself. The patient is put on a strict fasting regimen in which neither food nor fluids are taken by mouth. Fluids are given intravenously until the inflammation subsides, which usually takes three to seven days, then a clear liquid diet is started; a normal diet can be resumed usually two or three days later. Painkillers are administered as needed and antibiotics are added to the regimen if there is a bacterial infection.
In some cases, a suction tube is inserted through the nose and into the stomach to remove stomach acids, a procedure called nasogastric suction. Severe, unremitting pancreatitis may be treated with washing, or lavage, of the peritoneal cavity to remove damaging secretions from the pancreas. If an obstructive gallstone is responsible for the attack, it can be removed by endoscopy (see Ulcers).
In many cases, chronic pancreatitis can be controlled by diet, as described below, plus painkillers, and large replacement doses of pancreatic enzymes, which are taken with meals. If pancreatic ducts become obstructed, or if a cyst or abscess is present, surgery may be performed to remove the obstruction, cyst, or abscess.
Alternative Therapies
Because alcohol abuse is frequently a contributing factor in both acute and chronic pancreatitis, medical and alternative therapies are directed to helping patients overcome any drinking problem.
Acupuncture, self-hypnosis, and meditation may be helpful, not only in abstaining from alcohol but also in alleviating the pain of the disease.
Nutrition Therapy. A clinical dietitian should be consulted to devise a low-fat, nutritionally balanced diet. Small, frequent meals may be advisable to prevent overworking the pancreas. Vitamin and mineral supplements may be needed also to correct any nutritional deficiencies in the diet.
Some naturopathic nutritionists recommend taking pancreatin, a preparation of enzymes made from pig pancreases and other natural enzymes, such as bromelain from pineapples and papain from papayas. You should consult a doctor before taking any enzyme preparations, to make sure that they do not interact with the body's own pancreatic enzymes.
Self-Treatment
As noted earlier, abstaining from alcohol is critical. Joining Alcoholics Anonymous or a similar self-help program can prove life saving. Otherwise, self-care is directed to preventing an acute attack or controlling a chronic condition. Taking sodium bicarbonate and prescribed pancreatic enzymes with meals may alleviate digestive problems. However, antacids that contain calcium carbonate or magnesium hydroxide should be avoided because they may worsen diarrhea.
Other Causes of Pancreatic Symptoms
Disorders that can produce symptoms similar to those of pancreatitis include a perforated ulcer, peritonitis, gallbladder disease, intestinal obstruction, and a dissecting aortic aneurysm. Some inflammatory diseases, such as lupus or inflammation of the aorta, can also mimic pancreatitis.