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The Pancreas and Pancreatitis

The pancreas is soft spongy-form, leaf-shape organ that situated behind the stomach in the upper left abdomen. It is surrounded by other organs including the small intestine, liver, and spleen. It is broadly separated into three parts i.e. head, body and tail. It is surrounded by major blood vessels like superior mesenteric artery and vein, celiac artery and portal vein that provide blood supply to pancreas and surrounding organ. It has two main functions, an exocrine function which plays crucial role in digestion and endocrine function that helps to regulate blood sugar.

Disease of the pancreas

Pancreatitis

Pancreatitis is inflammation of the pancreas that occurs when pancreatic enzyme secretions build up and begin to digest the organ itself. It can occur as acute painful attacks lasting a matter of days, or it may be a chronic condition that progresses over a period of years.

Acute pancreatitis

Acute pancreatitis refers to symptoms (usually abdominal pain) that develops suddenly, most often as a result of gallstones or alcohol ingestion. In rare circumstances, certain medications, trauma, and infectious causes can also lead to acute pancreatitis. Acute pancreatitis can be life threatening, but most patients recover completely.

Causes of acute pancreatitis

Acute pancreatitis is most commonly caused by gallstones or heavy alcohol consumption. Other causes include trauma, injury or surgery , ingestion of certain drugs (steroids, azathioprine and etc), lipid disorder and infection.  Up to 15% of patients the cause of acute pancreatitis is unknown.

Symptoms of Acute Pancreatitis

  • Severe, steady pain in the upper-middle part of the abdomen, often radiating into the back
  • Jaundice
  • Low-grade fever
  • Nausea or vomiting
  • Lowered blood pressure
  • Clammy skin
  • Unusual abdominal hardness or mass that can be felt
  • Abdominal bloating and tenderness
  • Bruising (ecchymosis) in the flanks and midsection
  • The tissue of the pancreas may become necrotic (tissue death)
  • Pancreatic abscess
  • Pancreatic pseudocyst, which is an abnormal deposit of tissue, fluid and debris that can result after episodes of acute pancreatitis, typically 1 to 4 weeks after onset

Treatment of acute pancreatitis

Treatment of acute pancreatitis is mainly supportive. This include pain control and intravenous (IV) fluids, antibiotic and sometime nutrition. Surgery is rarely required for treatment of complication from acute pancreatitis.

Chronic pancreatitis

Chronic pancreatitis refers to continuous process in which the pancreas continues to sustain damage and lose function over time. The majority of cases of chronic pancreatitis result from ongoing alcohol abuse and smoking, but some cases are hereditary or genetic mutations.

Caused of Chronic Pancreatitis

It is caused by long-term abuse of alcohol, which leads to damage and scarring of the pancreas. Other people may develop chronic pancreatitis as a result of hereditary causes, obstruction from gallstones, autoimmune condition, or high triglyceride levels. Some patients could not have the cause identified. Evidence suggests that some cases of unidentified chronic pancreatitis may be associated with atypical genetic mutation  

Symptoms of Chronic Pancreatitis

Symptoms may develop over a period of time without the sudden dramatic occurrence of an acute attack. There is a decrease in the secretion of enzymes needed for digestion and absorption of dietary fats, resulting in fatty stools. This is called exocrine insufficiency. Recurrent abdominal pain may be accompanied by nausea and weight loss. Diagnostic scans may find stones or areas of calcified tissue within the pancreas.

  • Abdominal and/or back pain
  • Weight loss
  • Nausea and vomiting
  • Onset of diabetes mellitus
  • Pale colored, oily stools

Treatment of chronic pancreatitis

The principles of treatment for chronic pancreatitis are to maintain nutritional status from exocrine insufficiency and to optimize pain control. In severe cases, surgery may be indicated. If there is endocrine insufficiency with development of diabetes, patient will benefit from endocrinologist input. 

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Gastro Liver SC

Gastro Liver SC

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