Pancreas and Pancreatitis


by Dr. Tan Huck Joo

The pancreas is a leaf-shaped gland located behind your stomach. It is considered part of your digestive system as it produces 2 pints of digestive juices a day. These enzymes break down carbohydrate, protein, and fat from the foods you eat.

Without a healthy pancreas, you could be consuming a tonne of food but still be malnourished.



The pancreas also produces hormones such as insulin, which converts sugar in the blood into energy to be stored in the liver, keeping your blood sugar level under control.



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What is Pancreatitis?

Pancreatitis means inflammation of the pancreas. When the pancreas is inflamed, the digestive enzymes it secretes – usually active only upon reaching the small intestine – become active within the gland and start digesting the pancreatic tissue. This causes further damage to the pancreas.

Pancreatitis may be acute (sudden, short-term) or chronic (ongoing, long-term), but either type can become severe and lead to serious or even life-threatening complications. Acute pancreatitis is more common than chronic pancreatitis.

Acute Pancreatitis

Acute pancreatitis (AP) usually manifests as a sudden attack of pain. In most cases, it is mild and usually gets better and heals on its own over time. However, some patients develop severe AP, where inflammation, tissue damage, and even infection in the pancreas can occur.

Patients with severe acute pancreatitis may also have other organ involvement, such as the kidneys and lungs. Severe AP must be treated promptly to prevent complications and death.


Causes

The most common causes of AP are gallstones and long-term alcohol abuse. Together they contribute about 80% of all acute cases. Prolonged over-consumption of alcohol can damage the pancreatic cells and trigger inflammation, while gallstones (formed in the gallbladder) can block the pancreatic duct or bile duct, trapping the digestive juices inside the pancreas.

Other less common causes of AP include abdominal injuries, after ERCP (a procedure to remove gallstones from the bile duct), medications, abnormalities of the pancreas, and very high levels of triglyceride (a type of fat) in the blood.

Symptoms and Complications

* Upper abdominal pain – is the primary symptom of AP although many people often mistake it for gastric pain

* Pain that radiates to the back of the body – tends to spread to the back of the body, where the pancreas is located

* Pain after eating or drinking – Intense upper abdominal pain that gets worse right after eating or drinking, particularly after a high-fat meal

* Nausea and vomiting


Other symptoms of AP include fever, distended abdomen, rapid heartbeat, dehydration, and low blood pressure.

If not treated quickly, severe AP can give rise to complications, such as kidney failure, breathing difficulties, and, when the blood pressure drops too low, shock.

Treatment

In general, the type of treatment depends on the severity and cause of the pancreatitis. A physical examination, several blood and imaging tests (e.g. ultrasound or computed tomography scan) are used to diagnose and assess AP. After that, patients are mainly given supportive treatment and the underlying cause is treated.

Supportive treatment aims at supporting body functions and helping the patient feel better, while allowing the pancreas to recover. Some examples of supportive treatment are:

# Drinking and eating are refrained for a few days to allow the pancreas to rest

# Intravenous (IV) fluid is given to replace water lost from vomiting. Sometimes, medications or nutritional supplements are also given via IV fluids

# Antibiotics are given if infection is present

# Oxygen is given for patients who have trouble breathing

# If severe pain or vomiting does not improve, a nasogastric tube (a thin, flexible plastic tube inserted through the nose and throat down into the stomach) may be needed to remove the contents of the stomach.

# Analgesia to treat the pain


The underlying cause of AP needs to be treated accordingly :

* Stop alcohol consumption if AP is triggered by alcohol

* Endoscopic removal (ERCP) of gallstones if pancreatic or bile duct is blocked

* Surgery is also necessary to remove dead or infected pancreatic tissues in the most severe cases, known as necrotising pancreatitis

Chronic Pancreatitis

When inflammation of the pancreas does not heal or there are repeated episodes of AP, it can lead to chronic pancreatitis (CP) that slowly destroys the pancreas. Long-term heavy alcohol consumption is the biggest risk factor for CP.

Common symptoms and complications of CP include :

# Upper abdominal pain – may or may not be felt in CP. When there is pain, it is not as intense as in AP, but can be more persistent

# Weakness and fatigue

# Oily stools – excess oil in the faeces is due to the lack of fat digestive enzymes. The stools float in the toilet bowl and is more difficult to flush away

· Unexplained weight loss – The body does not produce enough pancreatic enzymes to digest food, so nutrients are not absorbed properly

# Diabetes – the insulin-producing cells in the pancreas are damaged, and are unable to produce sufficient insulin

Treatments for CP include medication to relieve pain, or pancreatic enzyme supplements to replenish enzyme deficiency. Patients will also be advised to eat a high-carbohydrate, low-fat diet, eat small and frequent meals, and stop alcohol consumption. If diabetes is present, anti-diabetic medication will also be given.


When Do You See the Doctor?

* If you experience intense, constant abdominal pain that radiates to the back, or other symptoms of acute pancreatitis, see you doctor quickly.

* If you are suffering from chronic upper abdominal pain or notice oily stools, seek medical help quickly.

Prevent Pancreatitis

# If you are an alcohol drinker, keep your alcohol consumption to moderate amounts only.

# Stones within the gallbladder will not cause acute pancreatitis. AP will only occur if gallstones block the bile duct. Therefore patients with symptomatic gallstones should have the gallbladder and stones removed to prevent AP.

# If you experience any of the symptoms, seek medical help quickly. Treating it promptly will help prevent it from getting worse and avoid life-threatening complications.


More info on PANCREATITIS here.






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