Pancreatitis – Causes, Sypmtons, Signs, Investigations, Prevention, Treatment, Complication

What is pancreatitis?

It is an inflammatory process of the pancreas in which the powerful digestive enzymes are activated while still in the pancreas and auto digest the gland itself.

What is pancreas?

It’s a large gland-behind the stomach to small intestine . It produces the hormones insulin and glucagon which regulate blood sugar levels. It also produces and contains digestive enzymes which help in digestion of food in the small intestine.

Due to various reasons theses enzymes get activated in the pancreas itself and start digesting the gland. This process is known as auto digestion.

There are 2 types of pancreatitis -:

  • Acute pancreatitis is sudden short term inflammation of the pancreas.
  • Chronic pancreatitis is long term inflammation of pancreas resulting in irreversible damage.

What causes pancreatitis?

Most common cause is gall stones which blocks the passage of enzymes in the small intestine.

Second most common cause is alcohol consumption.

Other causes are -:

  • Smoking
  • ERCP
  • High fat diet
  • Abdominal trauma
  • Infections
  • Certain drugs
  • High blood calcium levels
  • Cystic fibrosis

In 20% of cases the cause is not found. This is called as idiopathic pancreatitis.

Recurrent attacks of acute pancreatitis due to causes of acute pancreatitis leads to chronic pancreatitis.

What are the symptoms?

Hallmark symptoms of acute pancreatitis is sudden intense pain in upper abdomen radiating to back

Other symptoms are :-

  • Vomiting
  • Fever
  • Shortness of breath

What are the investigations?

To establish the diagnosis :-

  • Blood analysis
  • Blood lipase
  • Ultrasonography of abdomen
  • CT Scan of abdomen
  • To further identify the cause and complications
  • Liver function tests
  • Renal function tests
  • Complete blood count
  • Blood calcium
  • Blood triglyceride
  • Blood CRP
  • MRCP
  • ERCP

If chronic pancreatitis is suspected microscopy of pancreatic tissue and stool test for fat content and pancreatic enzymes are done.

How is pancreatitis managed?

Once confirmed , immediate hospitalization is necessary. To manage acute pancreatitis , prompt intravenous hydration is of utmost importance. Monitor urine output as a marker of acute hydration.

  • Initially no food and water is given orally.
  • Low fat soft diet is started only
  • In absence of nausea and vomiting
  • When patient feels hungry
  • He/she starts passing flatus
  • Intensity of pain decreases

When patient cannot meet their caloric needs orally, nutrition in form of total parental nutrition is given , directly through vein of patient. To control pain opioids are used as continuous infusion or tablets. Antibiotics are only administered if infection is suspected.

At home pain in chronic pancreatitis is managed with ibuprofen tablets. Antioxidants and oral pancreatic enzyme therapy is also given.

To relieve obstruction in pancreatic duct endoscopic therapy is done in both in acute and chronic pancreatitis.

When is surgery needed?

In gallstone induced pancreatitis, pancreatic duct disruption, pseudo cysts, infected pancreatic necrosis.

What are the complications?

  • Pseudo-cysts
  • Pancreatic cancer
  • Infection
  • Gastrointestinal bleeding
  • Multiple organ dysfunction

What diet to eat?

Have a small, low fat diet multiples times a day. Prefer food rich in proteins and low in fat, which contains antioxidants like fruits, vegetables , lentils and lean meat. Small amounts of coconut oil and palm kernel oil can also be taken.

How to prevent pancreatitis?

To prevent pancreatitis basically avoid the cause, like staying away from alcohol, smoking , drug which caused it and avoid high fat diet.

Dr. Rishab Sharma

Dr. Rishab Sharma MBBS, MD (Internal Medicine) He is associated with Fortis Escorts Hospital, Jaipur. Dr. Rishab has wide experience in managing a variety of diseases, as well as managing critical care units in large government and corporate hospitals.

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