It’s the worst stomachache you’ve ever had. The pain in your upper abdomen seems to bore right through to your back. You double over, which helps somewhat, and ask to be taken to the emergency room.

That’s a good idea. Pain like this can occur with acute pancreatitis, which is a sudden inflammation of your pancreas. Acute pancreatitis warrants immediate medical care to avoid complications that can be fatal.

            Pancreatitis can also be chronic, involving progressive inflammation of the pancreas over years. This is often associated with excessive alcohol consumption.

An Important Gland

            The pancreas is a long, flat gland tucked behind the lower part of your stomach. The pancreatic duct comes out of the pancreas and joins with the common bile duct leaving the gallbladder. The combined duct empties into the upperpart of the small intestine (duodenum). The pancreas has two major functions:

• Producing digestive juices and enzymes that help bre4ak down proteins, carbohydrates, and fats in your small intestine.
• Secreting insulin and glucagon hormones into the bloodstream to help regulate how your body metabolizes sugar (glucose).

Acute Attacks

                Mild attacks of pancreatitis –which account for about 85 percent of cases –often improve on their own or with supportive care. They usually don’t permanently affect digestion or blood sugar levels. However, a single severeattack can causepermanent damage and scarring of the cells that produce both enzymes and insulin.

            The pain may be nearly constant for hours or even days and is likely to become worse when you drink alcohol or eat. Bending forward or curling into a fetal position may provide temporary relief. Other signs and symptoms of acute pancreatitis include:

• Nausea and vomiting
• Fever
• Rapid pulse
• Swollen, tender abdomen

You may have repeated episodes of acute pancreatitis and recover fully from each one. Nevertheless, every attack is a serious illness that can damage your pancreas and cause life –threateningcomplications.

Chronic Progression

                Ongoing inflammation of your pancreas can cause destruction of the pancreas and nearby tissues, although it may be years before signs and symptoms appear. In the early stages of chronic pancreatitis, you may experience mild to severe episodes similar to acute pancreatitis.

            The pain of an attack may be sharp and last for a few hours or may be a continuous, dull ache that last for weeks –or even years. Rarely, some people with chronic pancreatitis have no discomfort. Ongoing damage to enzyme -producing tissue in chronic pancreatitis leads to poor absorption of nutrients –especially fats –to weight loss, and to oily, foul-smelling tools. Damage to or destruction of insulin-producing cells means blood sugar isn’t metabolized properly, which often leads to diabetes. Chronic pancreatitis also can cause:

• Nausea and vomiting
• Fever
• Bloating and gas
• Weight loss, even with normal appetite and eating habits

Diagnosis and Treatment

                Because diagnosing pancreatitis can be difficult, several tests can help pinpoint the problem. For acute pancreatitis, blood tests and imaging tests, such as ultrasound or computerized tomography (CT), may be done. Imaging tests can scan for gallstones blocking the pancreatic duct, a duct problem, or inflammation of the gland.

            Diagnosing chronic pancreatitis, especially in the early stages, can be challenging because some tests ma yield normal results, even though you have the disease. Blood and stools tests, pancreatic function tests, and imaging tests may be used.

            Severe acute pancreatitis requires a hospital stay. Because the pancreas goes into action when you eat, you won’t be able to eat or drink until pain stops. You may receive fluids and nutrition through a feeding tube, and if that’s not tolerated, through a vein (intravenously).

            If the attack is caused by gallstones blocking the pancreatic duct, your doctor may recommend a procedure to remove the stones. You may eventually need surgery to remove your gallbladder if gallstones caused the pancreatitis.

            Mild cases of acute pancreatitis generally improve in aweek or less. Severe, cases take longer, sometimes even several weeks, severe acute pancreatitis can lead to complications that may require further treatment. These complications include fluid collections in and around the pancreas containing pancreatic juice, dead tissue, or pus. The main goals of treatment for chronic pancreatitis are to control pain and improve nutrient absorption.

            Persistent pain can be the biggest challenge of chronic pancreatitis. In addition to pain relievers, pancreatic enzymes can be prescribed. Increasing levels of enzymes in the duodenum in turn decreases the secretion of enzymes by the pancreas and may help digestion. This is thought to reduce secretion pressure pain within the pancreas.

            For severe pain that can’t be controlled, treatment options may include surgery to remove damage pancreas or to drain the obstructed pancreatic duct. Or procedures can be done in which nerve fibers near the pancreas are identified and injected with a substance to destroy them.

Going Easy on Your Pancreas

Most people with acute pancreatitis recover completely. But even if you experience no lingering symptoms, it’s important to take steps to keep your pancreas as healthy as possible.

·         Avoid alcohol. If you can’t voluntarily stop drinking alcohol, get treatment for alcoholism. Abstaining may or may not reduce your pain, but it will reduce your risk of dying of your disease. ·         Eat smaller meals. The more you eat, the greater the amount of digestive juices your pancreas must produce. Instead of large meals, eat smaller, more frequent meals. ·         Limit fat in your diet. This will help reduce loose and oily stools the result from a lack of pancreatic enzymes. A healthy diet emphasizes fresh fruits and vegetables, whole grains, and lean protein sources. ·         Follow a high-carbohydrate diet. Carbohydrates give you energy to help fight fatigue. Try to get most of your daily calories from complex carbohydrates found in grains, vegetables, and legumes.   If you have diabetes, a dietician can help you plan an appropriate diet.

Two Causes of Pancreatitis Stand Out

In about 20 percent of people with chronic pancreatitis, and about 10 percent to 25 percent of people with acute pancreatitis, there’s no apparent cause. Known causes include:

·         Long term alcohol abuse. About 70 percent of chronic pancreatitis cases and about 35 percent of acute pancreatitis cases are linked to excessive alcohol consumption.   ·         Gallstones. About 30 percent to 50 percent of peoplewith acute pancreatitis have gallstones. Theses can block the pancreatic duct and the flow of pancreatic juices into the duodenum. Digestive enzymes then become active in the pancreas “digesting” healthy tissues, rather than in the duodenum, wherethey normally break down food.

A number of less common factors also may cause or contributeto pancreatitis. Those you may be able to control or adjust include:

·         Increased levels of fats called triglycerides or of calcium (hypercalcemia) in your blood ·         Smoking, especially if you also drink alcohol ·         Certain medications, including blood pressure lowering drugs in the thiazide diuretic class, antibiotics such as tetracyclines and sulfonamides, and some drugs that treat cancer and autoimmune diseases, such as azathioprine (Azasan, Imuran).

 

By: Mrs. Melissa N. Mizon | Guidance Councilor III | Bonifacio Camacho National High School | Abucay, Bataan