Pancreatitis

Types of Pancreatitis

When digestive juices or enzymes attack the pancreas it causes redness and swelling (inflammation) of the pancreas. Types of pancreatitis include:

1. Acute pancreatitis

Acute pancreatitis is a serious condition where the pancreas becomes inflamed over a short period of time. In acute pancreatitis, inflammation lasts for a short duration (a week). In this condition, the pancreas returns to normal afterward.

 

Note: Acute pancreatitis is more common in middle-aged and elderly people, but it can affect people of any age.

2. Chronic pancreatitis

This is a condition where the pancreas becomes permanently damaged from inflammation. In chronic pancreatitis, inflammation lasts for a long duration that comes and goes over time. It often causes scarring of pancreatic tissue. It may also cause the pancreas to stop making enzymes and insulin in severe cases.

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Symptoms Of Pancreatitis 

Pancreatitis symptoms vary depending on the type. The main symptom is generally pain due to the upper left side or middle of the stomach that may spread to your back. Symptoms based on the type include:

1. Symptoms of acute pancreatitis

In acute pancreatitis pain begins slowly or suddenly in your upper abdomen, and usually spreads to the back. This pain can be mild or severe and may last for several days. Other symptoms include:

• Fever
• Nausea and vomiting
• Jaundice (yellowing of the skin and the whites of the eyes)
• Tenderness or swelling of the stomach (abdomen)
• Rapid heartbeats

2. Symptoms of chronic pancreatitis

In chronic pancreatitis pain is present in the upper abdomen that may spread to your back, which is constant and severe. The intensity of pain may become worse after eating. Other symptoms include:

• Diarrhea
• Nausea
• Greasy, foul-smelling stools
• Vomiting
• Weight loss
• Back pain

Causes Of Pancreatitis

The pancreas is a gland that plays two important roles: 

• Helps in making enzymes and sends them into your small intestine. These enzymes help break down food.
• Makes the hormones insulin and glucagon and releases them into your bloodstream. These hormones control your body’s blood sugar level.

Most of the time, the enzymes are active only after they reach the small intestine.

These enzymes can degrade pancreatic tissue if they start to function inside the organ. This harms the organ's blood arteries and produces swelling, bleeding, and damage.

In acute pancreatitis, the pancreas's digestive enzymes are not effectively secreted, which causes auto-digestion and pancreatic inflammation (swelling). Certain diseases, surgeries, and habits make you more likely to develop this condition.

Risk Factors For Pancreatitis

The most common causes of both acute and chronic pancreatitis are:

1. Gallstones

Gallstones are the most common cause of pancreatitis. Gallstones obstruct the bile and enzyme drain when they exit the gallbladder and enter the bile ducts. The bile and enzymes "back up" into the pancreas and cause swelling.

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2. Heavy alcohol use

Alcohol is the second most common factor associated with acute pancreatitis after gallstones. Excessive alcohol consumption can initiate an episode of acute pancreatitis and increase the susceptibility to chronic pancreatitis. 

3. Genetic disorders of your pancreas

Some people also have a genetic susceptibility to pancreatitis. Mutations (changes) in the number of genes disrupt the normal function of the pancreas and make the pancreas more vulnerable to the harmful effects of alcohol.

4. Infections

Mumps, hepatitis A or B, and certain bacteria or viruses (such as varicella-zoster virus, herpes simplex virus, salmonella, aspergillus, etc.) are also responsible for pancreatitis.

5. Injury to your pancreas

Accidental damage or injury to the pancreas or stomach (for example during a procedure to remove gallstones or examine the pancreas) can lead to pancreatitis.

6. Pancreatic cancer

Cancerous tumors in the pancreas can sometimes block the pancreatic duct, which hinders the entry of pancreatic enzymes to the gut to digest food. This ultimately may lead to chronic pancreatitis.

7. Certain diagnostic procedures

Some of the procedures used to diagnose gallbladder and pancreas problems like endoscopic retrograde cholangiopancreatography (ERCP) or ultrasound-guided biopsy damage the pancreas leading to chronic pancreatitis.

8. Pancreas divisum

This is a birth defect in which parts of the pancreas do not join together. This congenital defect has been associated with chronic pancreatitis.

9. Medications

Specific medications like some antibiotics or chemotherapy medication (especially estrogens, corticosteroids, sulfonamides, thiazides, and azathioprine) have been linked to acute pancreatitis as their side effects.

10. Blockage in pancreatic duct

Blockage of the bile ducts or pancreatic ducts (that form an important part of the digestive system) can cause pain and may lead to chronic pancreatitis.

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11. High levels of lipids

Elevated level of lipids (body fat) in the blood and may cause harm to the pancreatic cells due to continuous inflammation. This ultimately leads to pancreatitis. 

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12. High calcium levels

High levels of calcium can cause depositions in the pancreatic duct leading to pancreatitis. 

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13. Autoimmunity

People with other autoimmune conditions are at higher risk of getting autoimmune pancreatitis. These are uncommon disorders that cause your immune system to attack healthy cells in your pancreas. 

14. Smoking

The number of cigarettes a person smokes and the number of years they have smoked affect a person's chances of incurring pancreatitis. Smoking accelerates disease progression. It is advisable to quit smoking at any age to reduce the risk of developing pancreatitis. 

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Diagnosis Of Pancreatitis

The detailed evaluation of a patient is required to diagnose pancreatitis. It includes:

1. History

The doctor in charge of your care will ask you about the history of your symptoms. They may also carry out a physical examination. If you have acute pancreatitis, certain areas of your abdomen will be very tender to touch. The doctor may ask about a detailed history of medical conditions such as:

• Gallbladder stones
• Alcohol abuse
• Medication use
• History of weight loss
• History of diabetes
• Previous surgery or trauma
• Hypertriglyceridemia or hypercalcemia (high levels of lipids and calcium)
• Autoimmune disease
• Genetic causes

2. Laboratory evaluation

• Blood test: A blood test will be carried out to detect signs of acute pancreatitis which involves the release of pancreatic enzymes. These include:
  
  

  1. Elevated amylase level in the blood

  2. Elevated serum blood lipase level (a more specific indicator of pancreatitis than amylase levels)

  3. Increased urine amylase level

  4. Other tests include: Complete blood count, serum lactate, serum triglycerides, c-reactive protein (CRP), blood urea nitrogen (BUN).

• Pancreatic function test (PFT): This test measures how your pancreas responds to secretin, a hormone made by the small intestine.

• Stool test: This test is done to find out if a person has a problem with the absorption of fats.

• HbA1c level: It is a blood test that measures your average blood sugar levels over the past 3 months. 

• Genetic testing: It is done to know the genetic history or if the patient has any kind of genetic disorder.
  
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3. Imaging Tests

The following imaging tests that can show swelling of the pancreas may be done, such as-

• Ultrasound: This test involves the use of high-frequency ultrasounds to visualize the organs and structures within the pancreas.
  
  
• Computed tomography (CT) scan: These are the standard non-invasive imaging techniques used to assess people who may have chronic pancreatitis.
  
  
•  Magnetic resonance imaging (MRI) scan: MRI and MR cholangiopancreatography (MRCP) are recommended, especially in patients without specific changes detected on CT scans. 
  
  
• Endoscopic retrograde cholangiopancreatography (ERCP): It is carried out to look for fibrosis (thickened and stiff tissues) in patients with chronic pancreatitis.
  
  
• Magnetic resonance cholangiopancreatography (MRCP): It involves injecting you with a substance known as a contrast agent that makes your pancreas and surrounding organs show up very clearly on a magnetic resonance imaging (MRI) scanner.

 

4. Biopsy

A biopsy involves taking a small sample of cells from the pancreas and sending it to a laboratory, so it can be checked under a microscope for the presence of cancerous cells.

Prevention Of Pancreatitis

A healthy lifestyle can reduce your chances of developing this medical condition. Acute pancreatitis is often caused by gallstones or excessive alcohol consumption. You may lower your risk of new or repeat episodes of pancreatitis by taking the following steps:

1. Eat right

The most effective way of preventing gallstones is eating a healthy balanced diet that includes fresh fruits and vegetables. Try to include wholegrains as they lower the bad cholesterol level in the blood and avoid eating too many fatty foods with a high cholesterol content.

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2. Focus on your weight

Try to maintain a healthy weight, otherwise, it may increase the risk of forming gallstones. It is advised to have regular exercise to avoid developing this condition.

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3. Cut down your alcohol

You can reduce your risk of developing acute pancreatitis by limiting your alcohol intake. This helps to prevent damage to the pancreas and other medical conditions also such as liver cancer.

4. Get the necessary treatment

High cholesterol levels are associated with the development of pancreatitis. Hence. treat medical problems that lead to high blood levels of triglycerides to prevent the condition.

5. Do not neglect vaccinations

Make sure children receive vaccines to protect them against mumps and other childhood illnesses so that the chances of development of pancreatitis are reduced.

6. Say Yes to No smoking

According to studies, smoking is related to increasing the risk of developing gallstones which can cause pancreatitis.

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Specialists To Visit

The specialists you can visit to get the diagnosis and treatment include:

• General surgeon
• Radiologist
• Gastroenterologist
• Intensivist
• Pulmonologist
• Endocrinologist

A radiologist is a doctor who uses X-rays or other high-energy radiation, especially a doctor specializing in radiology.

A gastroenterologist is a specialist who treats all the organs in your digestive system.

An intensivist is a board-certified physician who provides special care for patients who are critically ill.

A pulmonologist is a doctor who has special training in diagnosing and treating diseases of the lungs.

An endocrinologist is a doctor who has special training in diagnosing and treating disorders of the glands and organs that make hormones.

To get the right diagnosis, it is important to consult the right doctor. Consult India’s best doctors online. 

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Treatment Of Pancreatitis

Acute pancreatitis is treated in hospital, where you'll be closely monitored for signs of serious problems and given supportive treatment, such as fluids and oxygen. The treatment consists of:

1. Medications

The doctor may prescribe you some medications such as steroids (like corticosteroids), and mild to strong painkillers (like paracetamol, morphine, etc.) to get relief in severe abdominal pain.

Note: You may also need pancreatic enzyme supplements to help digest your food.

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2. Management of alcoholism and tobacco abuse

After recovering from acute pancreatitis, you should completely avoid alcohol if this was the cause of the condition. For this, you can have one-to-one counseling with a doctor or medicine such as acamprosate that helps to hinder alcohol cravings.

For smokers, anti-smoking treatment, such as nicotine replacement therapy (NRT) or bupropion (a medication used to reduce cravings for cigarettes), is recommended.

3. Surgery

Depending on the exact cause of your pain, there are a variety of surgical techniques that may be used to treat chronic pancreatitis, such as-

• For gallstone-associated pancreatitis: You may need a procedure called endoscopic retrograde cholangiopancreatography (ERCP), or gallbladder removal surgery (to remove your gallbladder).
  
  
• Endoscopic surgery: It is done for patients with stones in the pancreatic duct. This treatment is called lithotripsy (it involves using shock waves to break the stone into smaller pieces).
  
  
• Pancreatic resection: In this procedure, specific parts of the pancreas that are inflamed and causing severe pain are removed surgically. It is used if endoscopic treatment is ineffective.
  
  
• Total pancreatectomy: In serious cases of chronic pancreatitis, the whole pancreas is damaged, in such a situation the entire pancreas is removed.
  

4. Supportive care

• Fluid resuscitation: Fluid resuscitation or fluid replacement is the medical practice of replenishing bodily fluid lost through sweating, bleeding, or other pathological processes.
  
  
• NG tube (nasogastric tube): It can be used to remove fluid and air and give your pancreas more time to heal. It can also be used to put liquid food into your stomach as you heal.
  
  
• Oxygen administration: To ensure your vital organs have enough oxygen, it will usually be supplied through tubes into your nose. The tubes can be removed after a few days, once your condition is improving.

Home-care For Pancreatitis

If you are suffering from pancreatitis pain, natural methods along with your medical treatment can bring you greater comfort and relief. Home care remedies for pancreatitis relief includes:

1. Turmeric (Haldi): It is a powerful antioxidant that reduces inflammation and provides relief from the symptoms of an inflamed pancreas.


2. Ginger (Adrak): It also contains antioxidants that help control swelling and boost the enzymes needed for proper digestion.


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3. Coconut oil (Nariyal ka tel): It is rich in omega-3 fatty acids. It not only reduces swelling, and repairs damaged tissue but also boosts nutrient absorption.


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4. Spinach (Palak): Apart from being rich in antioxidants, spinach also contains vitamins A, B, C, and E, iron, and selenium, which is very essential for pancreas health.


5. Mushrooms: It has an anti-inflammatory and analgesic effect that helps in relieving the symptoms of pancreatitis.


Read about 6 surprising reasons to add mushrooms to your food more often
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Complications Of Pancreatitis

Pancreatitis, if left untreated may lead to various complications, such as:

• Pseudocysts (fluid that can develop on the surface of the pancreas)
• Infected pancreatic necrosis (interruption to the blood supply of your pancreas)
• Systemic inflammatory response syndrome (SIRS- inflammation affecting the pancreas spreads throughout the body)
• Chronic pancreatitis
• Diabetes
• Pseudoaneurysms (when a blood vessel wall is injured)
• Splenic vein thrombosis (blood clotting within splenic vein)
• Recurrent acute pancreatitis
• Risk of progression to pancreatic cancer
• Acute respiratory distress syndrome (ARDS- fluid collects in the air sacs of the lungs)
• Compartment syndrome (pressure builds up within the muscles)
• Acute kidney injury (AKI)
• Disseminated intravascular coagulation(DIC- blood's inability to clot and stop bleeding)

Alternative Therapies For Pancreatitis

It is suggested that no one should begin an alternative therapy without speaking with their physician. Alternative therapies that can help manage symptoms of chronic pancreatitis include:

1. Yoga

Studies show that practicing yoga at least 3 times a week improves pain, reduces the need for pain medication, and also improves the quality of life.

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2. Therapeutic touch

It is a process of energy exchange, in which the practitioner uses the hands as a focus to help the healing process. It helps in relaxation giving a sense of comfort and well-being that is effective in decreasing anxiety and altering the perception of pain.

3. Massage therapy

It involves part of a body or a full body massage using different techniques of stroking or kneading the muscles of the body. It improves blood circulation, reduces swelling, and helps manage pain. 

4. Physical exercise

It improves the overall functioning of the body and quality of life.Reduces stress, pain, nausea, fatigue, and depression, and affects hormonal balance.

5. Acupuncture

It involves the stimulation of points on the body by a variety of techniques to relieve pain from pancreatitis and pancreatic cancer.

Living With Pancreatitis

Pancreatitis symptoms can appear unexpectedly and be painful, uncomfortable, inconvenient, and embarrassing. Eating healthy, exercising regularly, reducing weight, limiting alcohol intake, quitting smoking, etc. can go a long way in managing the condition. Pancreatitis patients may experience a wide range of emotions as a result of their condition.
It can be managed by the following:

• Talking to the loved ones
• Joining support groups
• Understanding the physical limitations
• Starting palliative care to get relief from other symptoms
• Coping with practical issues like financial expenses, childcare, and work issues
  

Role of caregivers

Caregivers play a very important role in the overall disease outcome of the patient diagnosed with Pancreatitis. The important role of caregivers is:

• Making decisions about disease management options.
• Participating in doctor appointments and keeping regular follow up with the doctor.
• If the surgery has been carried out, giving the medicines to the patient on time, changing dressings, helping to take bath, and checking the surgery sites.
• Helping with meals.