Disease of the Week – Pancreatitis
Tue, Jan 26, 2010
This week, I’ll be sharing some information based on a project that I have at school. In one of my classes, we have weekly cases where we need to come up with a differential diagnosis for each one. It’s essentially a list of possible conditions that the patient may have. In this case, I’ll be talking about chronic and acute pancreatitis.
The pancreas is actually a pretty important organ/gland, more so than what we usually give it credit for. It’s a gland located behind the stomach and the initial portion of the small intestines. It’s function is to release the hormones insulin (functions to get glucose out of the blood and to our tissue for usage and storage) and glucagon (gets glucose out of its stored form and into the blood) and enzymes that help with digestion.
Like most “itis-es” it’s inflammation, in this case, of the pancreas. There isn’t too much of a difference between acute and chronic pancreatitis. We’ll start with chronic pancreatitis just because the case from class looks like they may have this.
Chronic pancreatitis is when the pancreas becomes so damaged over time that it starts to lose it’s function. Other than the severe abdominal (and back) pain that fades in and out over the period of hours or days that eventually becomes continuous, eating and drinking can actually make it worse because it stimulates digestion. Similar to the acute variety, alcohol can make it worse and typically is the cause of it. We’ll discuss that in a bit. You may even notice other digestive problems like no bowel sounds (called adynamic ileus), vomiting undigested food, and the presence of fatty stools. So much so, that they may actually float in the toilet. In severe cases, the stool may be pale/tan colored, looking like a gallbladder/biliary obstruction.
As I said earlier, chronic pancreatitis is usually caused by heavy alcohol consumption because excess alcohol can squeeze the Sphincter of Oddi shut. The Sphincter of Oddi is where the bile and enzymes from the gallbladder, liver, and pancreas that digest food come out of. When it’s closed, but the body gets the signal to release those enzymes, however, they end up back flowing to the organs like the pancreas and digesting the organ instead.
Generally, CP is when the body can’t digest food, especially fattier foods. The pancreas gets destroyed in the process and can lead to insulin problems and diabetes. Tests to perform to confirm the diagnosis would be fecal fat tests, and blood work looking for the enzymes amylase, lipase, and trypsinogen (all produced by the pancreas). Abdominal CT scans or ultrasounds can also be done to look for any calcium deposits or any profuse damage to the pancreas.
Chronic pancreatitis is extremely dangerous and most often leads to death, but can be treated if early enough. This is done with analgesics and medicine to decrease stimulation to the pancreas as well as getting a low-fat diet. Obviously, alcohol being the main contributor, needs to be cut out.
Acute pancreatitis is actually very similar, but rather than being relatively gradual, it is much more abrupt. So binge drinking, gallstones obstructing the Sphincter of Oddi, recent surgery to the area, certain drugs (such as estrogens, corticosteroids, thiazide diuretics, and azathioprine), infections and even a family history can increase your chances of this. So again, the enzymes of the pancreas end up digesting the pancreas instead of the food that was eaten.
The tests for this are pretty identical to chronic pancreatitis: blood tests, CT scans, ultrasounds, etc. The treatments are also similar with pain control, stopping pancreas stimulation, and IV’s to replace fluid.
In AP, it does tend to resolve itself (re-occurrence is quite common), but it can still be life-threatening in some cases.
I’d say that if you’re experiencing these symptoms go see your doctor ASAP. Chances are you probably would have, so keep in mind this possible condition during your visit.
Image Credit: http://lpig.doereport.com
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Tags: class project, diabetes, GI
You are doing a disservice by reporting that pancreatitis is predominantly caused by alcohol. I have CP-caused by unknown reasons. I do not drink. I’ve met hundreds of people (WOMEN) I might add, that are not alcoholics that have chronic pancreatitis. The fact-is the medical community doesn’t really know what causes pancreatitis in many cases. It’s linked to alcohol because many alcoholics come down with pancreatitis. HOWEVER, there is greater population with ideopathic pancreatitis. We are treated inhumanly by the medical community which further perpetuates this nonsense by thinking only alcohol causes pancreatitis.
Hi Deb,
You are right on the fact that there other causes of pancreatitis (chronic and acute have the same causes), many of which I mentioned in the post above – “gallstones obstructing the Sphincter of Oddi, recent surgery to the area, certain drugs, infections and even a family history.” The family history portion I lumped in with the idiopathic/auto-immune pancreatitis.
It is true that many alcoholics do acquire pancreatitis (as it appears to be in the case study for one of my classes as I mentioned at the beginning of the post). I would hope that people focus on the signs and symptoms of these Disease of the Week post and recognize the risk factors that are attributed to the cause. In the end, it’s the recognition of those symptoms that I hope makes people think more about it before they ignore them and gets people to see their doctor.