Pancreatitis-types, causes, symptoms and treatment

Pancreatitis is the inflammation of the pancreases. The pancreas is a long and slender organ in the abdomen located behind the stomach. Its primary functions are to secrete digestive enzymes (exocrine function) and insulin and glucagon hormones (endocrine function). Insulin and glucagon hormones are the main regulators of the blood glucose level in humans.

The underlying pathology of this disease can either be pancreatic duct obstruction or pancreatic cell damage due to various causes (e.g.-trauma). It activates the digestive enzymes within the gland. Whereas in the normal pancreas, the enzymes are only activated once they enter the digestive tract.

These enzymes include Proteases, Lipases, and Elastases. They digest the pancreatic tissue leading to inflammation. The leakage of these digestive enzymes and the digested products into the circulation produces systemic alterations.

There are two types of pancreatitis: acute and chronic

Acute pancreatitis

Acute pancreatitis is a sudden inflammation of the pancreas. The clinical presentation can vary from mild abdominal discomfort to a severe and life-threatening illness. In severe forms, there may be bleeding into the gland, tissue destruction, cyst formation, and infection. Moreover, the pancreatic enzymes can be released into the bloodstream as a consequence of pancreatic tissue destruction. These enzymes damage the vital organs of the body leading to multi-organ failure.  

Symptoms

• Severe abdominal pain radiating into the back is a characteristic feature of this type
• The pain relives to a certain extent by bending forwards (So patient acquire a bent position).
• The abdomen is swollen and tender to the touch.
• The patient may have nausea and vomiting.
• High fever over 38⁰ Celsius is very common.
• Rapid pulse

Chronic pancreatitis

Chronic pancreatitis is a long-standing low-grade inflammation of the pancreas. It can occur after an episode of acute pancreatitis. Also can occur due to heavy alcohol consumption.

In this, the organ undergoes fibrosis as a result of the low-grade inflammation. The hormonal and enzymatic functions of the gland are gradually lost. It almost never causes severe clinical symptoms, unless the patient suddenly develops an acute episode during the course of chronic pancreatitis.

Symptoms

Chronic pancreatitis can have symptoms of acute pancreatitis to a lesser degree. The characteristic features of chronic pancreatitis are,

• Diarrhea and weight loss – due to poor absorption of food
• Steatorrhea – Clay-colored, foul-smelling, fatty stools that don’t flush easily.
• Diabetes mellitus may occur due to insulin deficiency

Causes and risk factors

1. Gallstones and alcohol are the commonest
2. Blunt trauma to the abdomen
3. Cigarette smoking
4. Viral infections of the pancreas
5. Certain drugs
6. Pancreatic tumors/ cancers
7. Autoimmune pancreatitis

Chronic pancreatitis is mainly caused by long term alcohol use. Yet, in most patients, the exact cause is not known.

Diagnosis of pancreatitis

Diagnosis of acute pancreatitis can be done by measuring levels of two pancreatic enzymes, amylase, and lipase, in the blood. In acute pancreatitis, these enzyme levels are elevated at least three times more than the normal level.

Furthermore, pancreatic function tests can be used to find if the pancreas is making a sufficient amount of digestive enzymes.

Glucose tolerance test is used to measure the damage to the insulin secretory cells.

Ultrasound scan, CT scan, and MRI scan are used to take images of the pancreas.

More sophisticated imaging modalities like ERCP (Endoscopic Retrograde Cholangio Pancreatography) are used in certain instances.

Complications

Acute pancreatitis can be fatal. So it’s considered a surgical emergency. Within hours it can cause multi-organ failure. 

• Acute kidney failure
• ARDS (Acute respiratory distress syndrome) – A severe type of damage to the lungs.

Pancreatic pseudo-cysts are extremely common, particularly those who are having recurrent bouts of pancreatitis. Pancreatic pseudo-cysts contain necrotic debris and pancreatic enzymes. These fluid collections can rupture and cause internal bleeding and infections.

Pancreatic hemorrhage and bloody stools can happen as a result of splenic artery rupture (closely associated with the pancreas).

Treatments for acute pancreatitis

Acute pancreatitis is mainly treated supportively with Intravenous fluids and pain killers. In severe conditions, the patient is transferred to an ICU and closely monitored. If there are any obstructions in the pancreatic duct, it’s relieved by endoscopic surgery.

This kind is difficult to treat. The main targets of the treatments are to relieve the pain and to replace the deficient enzymes and hormones. Surgeries are done to relieve abdominal pain and restore pancreatic enzymes or hormones. Pancreatic enzymes may be given as supplements. If the patient is having diabetes, insulin hormone has to be given.

Generally, a low-fat diet is recommended for these patients. Also, they should cease smoking and alcohol abuse to prevent further pancreatic damage.

Author: Dr. Pulasthi MilanPulasthi Milan Lankarathna is a graduated doctor from the Faculty of Medicine, University of Colombo, Sri Lanka. Currently, he is working as a medical-officer at the National Hospital of Sri Lanka. Writing has been his passion throughout his life. He loved to read books since his childhood. He believes that the essence that he gained by reading, motivated him to be a writer. He started writing as a creative writer during his College days. He has written over hundreds of short stories, poems, and articles, etc. After graduating as a Doctor, he switched himself to write about medical topics with an idea of improving the medical knowledge among the general population.