ACUTE AND CHRONIC PANCREATITIS: causes, symptoms and treatment of inflammation of the pancreas

There pancreatitis is an inflammatory pathology of the pancreatic gland or pancreas. There can be one acute pancreatitis, that is, short-lived but often very severe, or one chronic pancreatitis, with less severe symptoms but lasting over time. THE symptoms main are abdominal pain, which worsens after eating and radiates to the back with a characteristic "bar" distribution, nausea and vomiting, fever, weakness, distension and abdominal swelling.

There diagnosis of pancreatitis is usually done by means of blood tests and confirmed by ultrasound or CT of the abdomen. Many cases of acute pancreatitis require hospitalization for one care appropriate; however, the treatment of chronic pancreatitis can also be done on an outpatient basis. 

Complications of pancreatitis can be the onset of diabetesmellitus, pancreatic cysts or pseudocysts, neoplasm to the pancreas, as well as malnutrition, the evolution into peritonitis and the onset of bacterial infections. 

Pancreatitis can be a mild and not very debilitating disease but it can also become a disease that can be seriously life threatening and cause serious complications to other organs. 

Pancreatitis

What is pancreatitis? 

 Pancreatitis is in a pathological condition characterized by inflammation of the pancreas. The pancreas is an abdominal gland found in the upper abdomen, behind and below the stomach, and alongside the liver and duodenum. 

The main purpose of the pancreas is to secrete the hormones and enzymes that contribute to digestion (exocrine pancreas), as well as regulate blood sugar, i.e. the concentration of sugars - glucose - in the blood (endocrine pancreas).

The digestive enzymes (amylase, lipase, elastase) are released through the pancreatic duct into the small intestine, and here they are activated to help break down (break down) fats and proteins into smaller metabolites.

Insulin is glucagon, which are the hormones produced by the pancreas, they are released into the bloodstream where they help regulate blood glucose levels.

As mentioned, pancreatitis can be classified as acute or chronic. 

Acute pancreatitis

There pancreatitis acute usually develops suddenly and is usually a disease of limited duration (a few days to a few weeks), requiring hospitalization but usually resolving with appropriate medical management. Acute pancreatitis is divided into:

  • There mild acute pancreatitis: it represents over 80% of cases, and is characterized by edema of the pancreas without permanent damage or involvement, even transient, of other organs. This form of pancreatitis generally resolves spontaneously, has a low mortality (2% crica) and is not accompanied by permanent alterations of pancreatic function.
  • There severe acute pancreatitis: represents between 15% and 20% of cases of acute pancreatitis, is characterized by the presence of more or less extensive necrosis of areas of pancreatic tissue. Often there is an involvement of the whole organism that can be accompanied by organ failure not in direct contact with the pancreatic tissue, such as pleural effusion and pulmonary surfactant deficiency with respiratory failure, suffering and renal failure, liver failure) up to multi-organ failure (MOF). Mortality ranges from 10% to 40%, and increases if necrotic pancreatic tissue is superinfected, with the risk of septic shock.

There is a severe form of pancreatitis, defined fulminant pancreatitis, which can lead to a systemic involvement of the organism with the risk of death within 48 from the onset of the disease.

Chronic pancreatitis

There chronic pancreatitis, which develops in the presence of favoring factors such as alcoholism or after multiple episodes of acute pancreatitis, is a condition that persists over time, and can last for months or even for several years. 

Pancreatitis is a disease that can be present in a mild form, but if chronic and neglected it can lead to serious complications that can be life-threatening. The acute form of pancreatitis, if very severe, can have deleterious effects on many other organs in the body, such as the lungs and kidneys. 

Pancreatitis

The pancreas is a gland found near the duodenum, liver, and stomach. The pancreatic ducts flow into the biliary ones and open into the duodenal lumen. During pancreatitis, the pancreas becomes inflamed and can be severely damaged.

 Causes of pancreatitis

What are the causes of pancreatitis?  Normally, digestive enzymes released by the pancreas are not activated for the digestion of fats and proteins until they reach the small intestine. However, in some cases the digestive enzymes are activated while still in the pancreas, favoring the formation of local inflammation in the pancreas that can lead to the development of pancreatitis.

This is usually due to a difficult outflow of pancreatic juices through the pancreatic ducts (learned of Wirsung and learned of Santorini) and then in the biliary tract, due to an obstacle (gallstone, pancreatic head tumor) or to abnormalities of the ducts themselves secondary to genetic or acquired malformations.

Gallstones are contained in the gallbladder (cholelithiasis) and very often they do not give symptoms, remaining enclosed in this small saccular organ. When instead they move and wedge themselves into biliary tract is in the choledochus (choledocholithiasis), can occlude them and give a biliary colic. If the occlusion is after the opening of the pancreatic passages, the occlusion can also lead to pancreatitis.

The main ones causes leading to the pancreatitis include:  

  • Alcohol abuse 
  • Gallstones
  • High levels of triglycerides - hypertriglyceridemia
  • Exposure to harmful chemicals 
  • Injuries to the abdomen or surgery 
  • Some types of drugs 
  • Smoking 
  • Inheritance 
  • Cystic fibrosis 
  • Pancreatic cancer

 Alcohol consumption and gallstones represent the cause of pancreatitis in over 80% of all pancreatitis cases occurring in Italy. 

Pancreatitis Symptoms

Which are the most common symptoms of the pancreatitis?  Pancreatitis causes abdominal pain in the upper abdomen, pain that can range from mild and bearable intensity to severe severe pain that requires opioid therapy to be controlled. It can come on suddenly or it can develop slowly and gradually. Often, the pain begins or gets worse after you eat. Abdominal pain tends to be a hallmark symptomatology of acute pancreatitis.  So what are the signs and symptoms that can lead to suspicion of acute pancreatic involvement?

Signs is symptoms of acute pancreatitis may include the following: 

  • abdominal pain which may radiate to the back of the back 
  • nausea and vomit 
  • pain that gets worse after eating
  • signs of peritonism, i.e. pain when you snap your hand away from the abdomen after feeling it 
  • fever with even high chills
  • weakness
  • lethargy
  • constipation and intestinal blockage

 In cases of chronic pancreatitis, although abdominal pain may also be present, often this symptom of pancreatitis is not as severe and some people do not even experience any pain. 

There symptomatology of the chronic pancreatitis may include: 

  • abdominal pain (not always)
  • weight loss 
  • greasy and very unpleasant smelling stools

In particular the presence of symptoms such as greasy stools and malodorous is a symptoms of intestinal malabsorption, behind which chronic pancreatic insufficiency can often hide.

Pancreatitis Diagnosis 

How is pancreatitis diagnosed? There are a number of tests that are done for the diagnosis of this condition, either alone or in combination. 

Blood tests 

The levels of amylase and / or lipase they are typically elevated in cases of acute pancreatitis. The values of pancreatic enzymes they may not be elevated in cases of chronic pancreatitis. Blood and amylase tests are typically the first tests done to establish the diagnosis of pancreatitis, because these results are readily and quickly available. 

In other cases, the increase in amylase and lipase is accompanied by an increase in bilirubin and an increase in transaminases. This often happens when pancreatitis is secondary to a calculus that occludes both the pancreatic and subsequent biliary tracts: in this case it is referred to as acute pancreatitis lithiasic.

 Other altered exams can be the indices of inflammation, which are often raised: it will be frequent to observe altered ESR and CRP. 

In conclusion, here are the main findings from blood tests in pancreatitis:

  • high amylase
  • high lipase
  • high transaminases
  • high bilirubin
  • High CRP

In case of modest alteration of pancreatic enzymes, one speaks instead of pancreatic cleavage.

Radiological and imaging investigations

 There CT scan of the abdomen (also called computed tomography) can be done at the doctor's request to view the pancreas and to assess the extent of inflammation, as well as any of the potential complications that can result from pancreatitis, such as bleeding or the formation of pancreatic pseudo-cysts. There Abdominal CT scan, better if done with iodized contrast agent,  it can also detect the presence of gallstones (a major cause of pancreatitis) and other abnormalities of the biliary system.  The pancreas can radiologically appear enlarged and edematous.

L'ultrasound of the abdomen It can be used to look for gallstones and biliary system abnormalities. Because ultrasound imaging emits no radiation and is quick to perform, this modality is often the imaging test that is done first if the patient is suspected of having pancreatitis. 

Depending on the underlying cause of the pancreatitis and the severity of the disease, additional tests may be ordered.  An MRI scan is often required to deepen the diagnosis of the biliary tract and pancreas cholangio-wirsung MRI.

Treatment of pancreatitis

Exist therapies is remedies for pancreatitis? What is the treatment best? 

In most cases of acute pancreatitis for one proper care it's necessary hospitalization, while some cases of chronic pancreatitis can be managed on an outpatient basis. 

Depending on the underlying cause of the pancreatitis, the management it may vary to address the specific cause. In general, however, the treatment for the treatment of pancreatitis it will always be started with the following treatment regimen. 

 The initial treatment will involve: 

  • Fasting: which is used to help the pancreas rest and recover.
  • Hydration: administration of fluids to the patient to prevent dehydration during fasting.
  • Pain relievers: pancreatitis can be very painful, so administration of is often required pain medication intravenously.
  • TOntibiotics: antibiotic therapy is used to prevent collections of fluid that form in the abdominal cavity from becoming infected.
  • Octreotide: although there is no strong evidence for its efficacy, somatostatin is often used for its ability to reduce exocrine secretion from the pancreas
  • Gabesate mesylate (Foy): many guidelines do not indicate it as a first choice in pancreatitis therapy, but many doctors continue to use it for its ability to prevent pancreatic juices from activating and damaging surrounding tissues

If pancreatitis is due to gallstones wedged in the biliary tract, there is a procedure called ERCP, that stands for  endoscopic retrograde cholangio-pancreatography, which, through a probe similar to the one used during a gastroscopy, allows you to enter the bile ducts via the papilla of the Vater and it sphincter of Oddi located in the wall of the duodenum, and to remove the stones, putting them in a basket called basket of Dormia, which is then extracted from the papilla and withdrawn to the intestinal lumen.

It may be necessary later surgery to remove the gallbladder and the stones it contains (VLS cholecystectomy, i.e. videolaparoscopy). Surgery may also be required to treat a pseudo-cyst or to remove part of the diseased pancreas. 

If alcohol consumption is the underlying cause of pancreatitis, it is highly recommended abstinence from alcohol and a rehabilitation program to detoxify. 

If it is believed that a drug or chemical exposure is the cause of pancreatitis, it is recommended to stop taking the drug and avoid exposure. 

What to do in the case of hypertriglyceridemia? If high triglycerides are the trigger for pancreatitis, your doctor may prescribe medications to lower triglyceride levels. 

F.medicines for the treatment of pancreatitis 

In general, the above treatment regimen is the one indicated for the management of pancreatitis. The most commonly used antibiotics are pennicillins, such as amoxicillin / clavulanic acid (Augmentin), ampicillin / sulbactam (Unasyn), or piperacillin / tazobactam (Tazocin). Also effective is the use of third generation cephalosporins such as ceftriaxone (Rocefin or Fidato). 

The antidolotifica therapy is normally carried out using the so-called NSAIDs, that is anti-inflammatory non-steroidal drugs, which are nothing more than the normal anti-inflammatories and painkillers that we all keep in the medicine cabinet, such as:

  • ibuprofen (Brufen, Nurofen, Momento or Cibalgina)
  • ketoprofen (Oki, Orudis, Arthrosylene)
  • diclofenac (Voltaren)
  • naproxen (Momendol, Naproxen)
  • acetyl salicylic acid (aspirin).

Medicines may also be prescribed to control the nausea, such as domperidone (Peridon) or metoclopramide (Plasil). 

In cases of chronic pancreatitis, the treating physician may also prescribe pancreatic enzyme supplements (e.g. pancreolipases, Creon) to help the body digest certain nutrients, as the pancreas is not in good condition and does not work optimally. . 

 Diet for pancreatitis

There is one diet indicated for the pancreatitis? For people with pancreatitis, low-fat meals as long as they are highly nutritious are recommended, the so-called low-fat diet for pancreatitis. Adequate fluid intake is also recommended to prevent dehydration of the body.  Nutrition plays a crucial role for patients with chronic pancreatitis, who must avoid periodic flare-ups of the disease.

Complications of pancreatitis

What are the complications of the pancreatitis?  Although it often occurs in a mild form, pancreatitis can be a life-threatening disease with severe complications. Complications can include: 

  • Diabetes: damage to the pancreas can lead to diabetes, due to the cessation of insulin secretion.
  • Formation of pancreatic pseudocysts: during acute pancreatitis, fluids and debris can collect around the pancreas. If this fluid-filled pouch occurs, severe pain, infection, and internal bleeding can occur.
  • Malnutrition: pancreatic disease can lead to a decrease or absence of digestive enzymes produced, which can affect the absorption of various nutrients. This can lead to malnutrition and unwanted weight loss by the patient.
  • Pancreatic cancer: chronic pancreatitis is a risk factor for the development of pancreatic cancer.
  • Infections: individuals with pancreatitis are at risk for developing infections, which can lead to problems such as organ failure, sepsis, and eventually death.

 Prevention of pancreatitis

Pancreatitis can be prevented? Of course! Some lifestyle changes can reduce the chances of getting pancreatitis, such as not drinking alcohol and quitting smoking. Having a low-fat diet and maintaining an ideal body weight can decrease the risk of developing gallstones, an often related condition of pancreatitis. 

 Prognosis of pancreatitis

What is the prognosis of pancreatitis?  The prognosis for pancreatitis depends on many different factors, such as the underlying cause that triggered the pancreatitis, the severity of the pancreatitis, the patient's age, and the medical problems the patient may already have had. Patients with pancreatitis may make a full recovery or worsen their condition with worsening of the disease which can lead to life-threatening complications.

If an individual has repeated episodes of acute pancreatitis, they may develop chronic pancreatitis, a condition that can lead to a noticeable decrease in quality of life. 

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