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Pancreatitis

Pancreatitis is an inflammatory, auto-digestive process of the pancreas which affects the gastrointestinal system. It can be classified as either acute or chronic. The complications associated with acute pancreatitis vary a lot. Exocrine and endocrine functions are affected in acute cases temporarily. Chronic pancreatitis is a functional deteriation of the pancreas which happens progressively and results in permanent deficiencies of both exocrine and endocrine functions, as well as the replacement of pancreatic parenchyma by fibrous scar tissue. Occurring predominantly in adults 35-45 years, it’s rate of occurrence in the U.S. is 22/100,000 in urban areas and 10/100,000 in rural areas. Causes of pancreatitis include alcoholism and acute intoxication, medications, cholelithiasis/choledocholithiasis, metabolic hypercalcemia, hypertriglyceridemia, penetrating peptic ulcers, trauma or surgery, and viral infections. Other conditions which may lead to pancreatitis are endoscopic retrograde cholangiopancreatography, biliary tract disease, tumors, systemic lupus erythematosus, mumps, salmonella, streptococcus, cytomegalovirus, and cystic fibrosis. Regardless of the cause, if not treated, pancreatitis can lead to multiple organ system failure and even death.

Symptoms

Pancreatitis is often characterized by abdominal pain. Usually, the pain is epigastric, in the upper left quadrant, however it can radiate to the back or be perceived as pleural, cardiac, scapular, or periumbilical pain. Some patients may experience pain relief by sitting forward or assuming the fetal position. Nausea, vomiting, minor abdominal distention, and a mild to moderate fever are also common. Flank and umbilical discoloration, pleural effusion, and slight jaundice can indicate this condition. In addition, anorexia, weight loss, diarrhea, steatorrhea, azotorrhea, and dehydration have been noted. Hypotension or shock has been shown to result in 40% of the cases.

Management/Treatment

In most cases of acute pancreatitis, the patient is hospitalized. Pain is usually treated with meperidine, shock is prevented with IV fluids, calcium is monitored, a renal evaluation is performed, and a nasogastric tube is used for vomiting. Pulmonary function is ensured, oral feeding avoided, and surgery performed if necessary. Three surgical approaches to the management of pain in chronic pancreatitis include ductal drainage, pancreatic resection, and denervation procedures. Typically, bedrest is required, although sitting in a chair may be more comfortable. Progression occurs as the patient is able. A high carbohydrate, low fat, and low protein diet is implemented after the pain and tenderness have resolved. In cases of chronic pancreatitis, treatment is usually on an outpatient basis. The pain is treated with analgesics. It has been shown that abstinence from alcohol will ease the pain, however is difficult to convince the patients of this, especially those who suffer from alcoholism. When possible, narcotics are avoided to prevent the formation of an addiction. Maldigestion is treated with pancreatic enzyme supplements and H2-blockers. If the cause is diabetes mellitus, insulin is provided. Activity is not restricted in chronic cases, however, small, high protein meals are suggested.

Although chronic pancreatitis is not common in young people, it is not exclusive to adults. In addition, acute pancreatitis is a condition common to all ages. For these reasons, it is important to have a basic knowledge of the condition. Any person complaining of the above symptoms should be further evaluated and referred to a physician if pancreatitis is suspected. In acute cases, the person will be unable to participate in activities initially, however activity is not limited in chronic cases.

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