Pancreatitis

Introduction

     Pancreatitis is an inflammation or infection of the pancreas -- an elongated, tapered gland that is located behind the stomach. The pancreas secretes digestive enzymes and the hormones insulin and glucagon.

Causes
  

• Gallstones

• Chronic alcohol use

• Accident or trauma

• Abdominal surgery

• With procedures such as ERCP

• Medications such as Tetracycline, steroids, valproic acid, estrogens, Tylenol and Thiazide diuretics

• High levels of blood Calcium or triglycerides

• Infections:

• Males

• Drug abuse

• Alcohol use

• Chronic form often in older individuals > 35-40

• See cause

Symptoms
    

• Flare-ups may have all signs of acute form

• Stools may be oily, fatty and loose.

• Severe abdominal pain that is often in the middle, may radiate to the back or shoulder:
  Pain may be sharp in nature
  Pain may be worse right after meals (fatty, greasy) and alcohol

• Abdomen may be bloated, full of gas

• Heartburn or Indigestion

• Nausea

• Vomiting

• Fever

• Clammy cold or sweaty skin.

• Skin or whites of the eyes may be mildly jaundiced (yellowish)

• There may be bleeding under the skin, Bruising, or rash.

• The stool is clay-colored.

• Chest pain or flank pain (lower back)

• Discoloration around the umbilicus (belly button)

• In acute cases, pain subsides within 48 hours.

Screening and Diagnostics

• Your doctor may consult with a radiologist and a digestive diseases specialist known as a gastroenterologist (GI).

• Medical exam and a full history reveal risks symptoms and signs mentioned above.

• Blood levels of pancreatic enzymes Amylase and Lipase are often elevated.

• Blood is also sent for kidney, cell count, Electrolytes, and liver and gallbladder functions.

• Blood levels of ALT, AST, Alkaline phosphatase and Bilirubin are often elevated with liver and gallbladder involvement.

• Glucose and the number of white blood cells are increased with severe pancreatitis.

• Calcium levels decrease in severe disease.

• Blood and urine may be tested for drugs, alcohol or poisoning.

• LDH, Trypsinogen, CEA, and Magnesium levels may be altered.

• Stool may be sent for fecal fat test, which often shows fatty stool especially in the chronic form.

• Blood samples, urine, and fecal samples may be sent in cases where an infection is suspected.

• X-Rays -- Plain radiographs of the abdomen may show air bubbles in the intestine (ileus).
  Chronic form may show white areas of Calcium deposits.
  X-Rays of lungs may show fluids in the acute case.

• Ultrasound uses sound and CAT scan a computer to show a detailed image of the abdomen and the pancreas.  In the chronic form they may show small cysts and Calcium deposits.

• ERCP is a procedure in which a GI specialist inserts a flexible tube with a camera at its tip (Endoscope) into the stomach through the mouth and can reach the ducts, inject a dye and take an X-Ray.

• Special tests such as removing fluids from a cyst in the pancreas can be done by a radiologist using a CAT scan guided needle procedure.

Treatment

• Admission to the hospital is necessary for acute attacks.

• No food or fluids by mouth till pain and abdominal symptoms are resolved.

• If vomiting may need a NGT, which is a tube, passed through the nose into the stomach.

• Painkillers such as Demerol are injected.

• Intravenous fluids are given at a specific rate via a pump and through a small plastic tube placed in the veins.

• Blood levels are monitored for Calcium, Magnesium, glucose and other chemicals and levels adjusted accordingly.

• Antibiotics may be given if infection is suspected.

• A tube called the urinary catheter is placed into the urethra and passed into the bladder in sick patients who need accurate urine volume monitoring.

• In most cases symptoms resolve within 48 hours.

• Low fat and low protein food and fluids can be given as tolerated.

• In chronic cases outpatient therapy is possible.

• High protein diet and smaller meals are recommended.

• No alcohol or caffeine.

• If diabetes is present need to control sugars, use Insulin and see a dietitian for dietary advise.

• Pancreatic enzyme supplementation such as Pancrease MT may help.

• H2 blockers such as Tagamet can help in reducing stomach acid.

• Must be careful with giving people with chronic pancreatitis addictive painkillers (Codeine, Vicodin, Tylenol 3 and 4).  Try regular or extra strength Tylenol first.

• In some acute or chronic cases surgery may be needed to remove a stone, gallbladder, drain a cyst or open a blocked duct.

• Blood tests and radiographs may need to be repeated after discharge from the hospital.