Pancreatitis

Pancreatitis is inflammation of the pancreas, an organ that is important in digestion. Pancreatitis can be acute (beginning suddenly, usually with the patient recovering fully) or chronic (progressing slowly with continued, permanent injury to the pancreas).

The pancreas is located in the abdomen, near the liver, stomach, and duodenum(the first part of the small intestine). The pancreas is considered a gland.A gland is an organ whose main function is to produce chemicals that pass either into the main blood circulation (called an endocrine function), or passinto another organ (called an exocrine function). The pancreas is unusual because it has both endocrine and exocrine functions. Its endocrine function produces three hormones. Two of these hormones, insulin and glucagon, help the body process sugars in the diet. The third hormone, vasoactive intestinal polypeptide (VIP), affects the functioning of the stomach and intestines. In itsexocrine function, the pancreas produces a variety of digestive enzymes thatpass into the duodenum through a channel called the pancreatic duct. In the duodenum, the enzymes begin the process of breaking down proteins, fats, starches, and other components of food.

Acute pancreatitis occurs when the pancreas suddenly becomes inflamed but improves. Patients recover fully from the disease, and in almost 90% of cases the symptoms disappear within about a week after treatment. With chronic pancreatitis, damage to the pancreas occurs slowly over time. Symptoms may come andgo, but the condition does not disappear, and the pancreas is permanently damaged.

Acute pancreatitis has a number of causes. The most common, gallbladder disease and alcoholism, account for more than 80% of all hospitalizations for acute pancreatitis. Other factors, including infections, injuries to the abdomen,and certain drugs, may also contribute to pancreatitis.

Pain in the upper right hand corner of the abdomen is a major symptom in pancreatitis. The pain is usually quite intense and steady and often feels as ifit is boring through to the patient's back. Nausea, vomiting, abdominal swelling, increased heart rate, low blood pressure and slight fever also are common symptoms.

Patients who are seriously ill with pancreatitis may show classic signs of shock. Shock is a very serious syndrome that occurs when the volume (quantity)of fluid in the blood is very low. The patient's arms and legs become extremely cold, the blood pressure drops dangerously low, the heart rate is quite fast, and the patient may have changes in mental function. When shock occurs, all of body's major organs are deprived of blood (and, therefore, oxygen), resulting in damage. Kidney, respiratory, and heart failure are serious risks ofshock.

In very severe cases of pancreatitis (called necrotizing pancreatitis), the pancreatic tissue begins to die. When this happens, the pancreas becomes extremely susceptible to serious infection. As the pancreatic tissue continues tobe destroyed, many digestive functions are disturbed. The inability to digestand use proteins results in smaller muscles (wasting) and weakness. The inability to digest and use the nutrients in food leads to malnutrition, and a generally weakened condition. As the disease progresses, permanent injury to the pancreas can lead to diabetes.

Treatment of pancreatitis involves quickly replacing lost fluids through a needle inserted in a vein (intravenous or IV fluids). These IV solutions need to contain appropriate amounts of salts, sugars, and sometimes even proteins,in order to correct the patient's disturbances in blood chemistry. Pain is treated with a variety of medications. Until the gastrointestinal tract beginsfunctioning normally, the patient is not allowed to eat. The patient is carefully monitored for any complications that may develop. If infections occur, antibiotics are given through the IV. Severe necrotizing pancreatitis may require surgery to remove part of the dying pancreas.

Patients who develop chronic pancreatitis because of alcohol consumption muststop drinking alcohol entirely.

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