Pancreatitis: Treatment, symptoms, advice and help
Pancreatitis is the inflammation of the pancreas that can occur in two different forms: acute pancreatitis which is sudden and chronic pancreatitis which is characterized by recurring or persistent abdominal pain.
Pancreatitis: Incidence, age and sex
Acute pancreatitis accounts for 3% of all cases of abdominal pain admitted to a hospital. It affects 2- 28 per 100, 000 of the general population and may be increasing in incidence. It affects men more commonly than women.
Signs and symptoms of pancreatitis: Diagnosis
Severe, constant upper abdominal pain which radiates to the back is the most prominent symptom. Nausea and vomiting are common. There is marked epigastric tenderness. Bowel sounds become quiet or absent as paralytic ileus develops. In severe cases the patient becomes develops hypovolemic shock with low urine output. Discoloration of the flanks (Grey Turner’s sign) or the pre-umbilical region (Cullen’s sign) is a feature of severe pancreatitis with haemorrhage. Leakage into the thoracic cavity can result in a pleural effusion or a pleuro – pancreatic fistula. Chronic pancreatitis is characterized by recurring or persistent upper abdominal pain. The sufferer may also experience abdominal pain, diarrhea, malnutrition and drastic weight loss. Often patients will develop diabetes when insulin secretion is reduced .The diagnosis of acute Pancreatitis is based upon finding raised serum amylase or lipase concentration and ultrasound or CT evidence of pancreatic swelling.
Causes and prevention of pancreatitis
Acute pancreatitis occurs as a consequence of premature activation of zymogen granules, releasing proteases which digest the pancreas and surrounding tissues. Common causes (90% of cases) are due to gallstones, alcohol, post ERCP and idiopathic. Other causes may be viral infections (mumps, pneumonia, etc.), injury, pancreatic surgery, heredity, hormone imbalances or certain medicines. Prevention can include limiting alcohol intake, avoidance of abdominal trauma, careful food preparation techniques, avoidance of aspirin in treating children to reduce risk for Reye's syndrome and immunization of children against mumps.
Acute pancreatitis is often self-limiting. In some patients, however, it is severe, with local complications such as necrosis, pseudocyst or abscess, and systemic complications leading to multi-organ failure.
The initial management is based upon analgesia using pethidine and correction of hypovolemia using normal saline and/or colloids. Hypoxic patients need oxygen and patients who develop acute respiratory distress syndrome (ARDS) may require ventilatory support. Hyperglycaemia is corrected using insulin, but it is not necessary to correct hypocalcaemia by intravenous calcium injection unless tetanus occurs. Nasogastric aspiration is only necessary if paralytic ileus is present. In chronic pancreatitis, treatment focuses on relieving pain, avoiding further aggravation to the pancreas and maximizing a person's ability to eat and digest food.