Normally, the gland functions without much notice. But when something goes wrong, the gland can send out debilitating pain to its human carrier that lasts for days. You may be able to endure it, and it will go away on its own. But if pain becomes a chronic problem, you may develop some life-threatening issues. Those who develop acute cases are definitely exhibiting illness, and most require up to five days of hospitalization and monitoring. The treatments include intravenous fluids and pain control.
At its most basic, pancreatitis describes inflammation of the pancreas. It is mainly caused by stones in the gallbladder area. The gallstones enter the small intestine through a common duct bile connecting the gallbladder to the small intestine. But the stones may get lodged in the duct, blocking the flow of pancreatic juices and damaging the pancreas. There may also be a backflow of bile from the duct, causing the pancreas to react.
The Cleveland Clinic estimates that 32 to 44 new cases of acute pancreatitis per 100,000 people appear each year, a number that has increased worldwide over the past 10 years. It is the number-one cause of hospitalizations for gastrointestinal issues, with 274,000 recorded since 2012.
Of those cases, about 20 percent are considered severe, and about 5 percent of sufferers die from the condition. Between 16.5 percent and 25 percent of patients who have one episode of acute pancreatitis have a relapse within several years. It is estimated that the public cost of the overall admission is more than $2 billion.
Symptoms and Tests
Of course, trying to stop recurrent attacks is the top goal of treatment. Beyond the formation of gallstones, medical professionals believe acute pancreatitis can develop as a reaction to certain medicines, high triglyceride levels and/or high calcium levels in the bloodstream, and particularly from heavy alcohol consumption. Chronic alcoholics can die if they keep drinking after experiencing an attack.
Victims of acute pancreatitis typically arrive at emergency rooms with a very swollen abdomen and have a high fever, sometimes accompanied by a rapid pulse. They may have already vomited or are extremely nauseous.
Beyond administering fluids and trying to curb the pain, doctors may request a blood test for amylase or lipase digestive enzymes. These are usually highly elevated during a pancreatitis attack, sometimes tripling the normal levels in the bloodstream. In some cases, doctors may request a computer tomography of the abdominal area to rule out other causes of the distress.
Once the diagnosis is confirmed, the patient will be tested for gallbladder stones using a transabdominal ultrasound. As the name indicates, sound waves are reflected off the pancreas, liver, gallbladder and other organs to create a sonogram image. The gallbladder stone locations are then pinpointed by the video image created.
In certain cases, doctors may also request an endoscopic ultrasound. This requires a thin, flexible tube to be passed into the stomach. A small camera and ultrasound probe are then used to take images of the pancreas, gallbladder and liver areas. The imaging can pick up on stones that may have been too small to show up on the external ultrasound or were hidden in a corner of the bile ducts. The test is also used to take a look at the pancreas and determine whether any abnormalities can be discovered.
Doctors may also ask for a magnetic resonance cholangiopancreatography, which uses magnetic resonance imaging. This non-invasive procedure will create images of various parts of the body. While under light sedation, the patient is inserted into a long tube, while the technician injects dye into the patient’s veins. This illuminates the pancreas, bile ducts and gallbladder and can be used to develop an evaluation.
Finally, another test that may be ordered is the computerized tomography, which creates three-dimensional images of body parts. This is a test that is only used when doctors are uncertain of the diagnosis after observing the patient for several days. It is a good tool to determine the extent of damage to the pancreas during an acute attack.
The danger in all cases of acute pancreatitis comes from the shutdown of other organs in the body and the possibility of an infection that spreads. This can result in catastrophic organ failures and underlines why it is important to get to a hospital if you suspect an acute attack.
The Treatments
Getting a lot of fluids into the patient is one of the first defenses when an acute pancreatitis attack is suspected. This is done to prevent dehydration and to get blood and other fluids flowing, ideally helping to stem the swelling and inflammation and providing ways to get stones moving.
Patients are also injected with intravenous narcotic pain relievers, bringing down distress levels and hopefully corralling the nausea that many pancreatitis patients suffer. This is done not only for comfort, but also to slow down the digestive system and bowels.
Most patients are in no mood to eat, and generally hospitals refrain from providing any nutrition during the first 24 hours to 48 hours of hospitalization. It is a time used to calm the body, including the gastrointestinal tracts. However, because healing requires calories, patients may start to feed through tubes after a certain period, a method considered safer than intravenous nutrition.
The biggest decision is what caused the attacks. A thorough patient history will be taken, with a focus on alcohol consumption and diet. If the patient is developing gallstones, doctors will ask about medications being taken and calcium being consumed, all of which play a role.
If gallstones are too large to be passed, doctors may recommend a series of invasive procedures to remove or facilitate the passage of stones. These can include an endoscopic retrograde cholangiopancreatography, which uses a thin tube with a camera to examine he bile ducts and pancreas exits. A small catheter can be used to remove gallstones that may be lodged in these channels or can be used to administer anti-inflammatory drugs directly to the pancreas.
In conjunction with the endoscopic retrograde cholangiopancreatography, doctors may perform a sphincterotomy, which enlarges the muscle around the pancreatic duct or bile duct using a small wire. This aids in getting to the gallstones and any cysts present can be drained. Physicians also may place a metal or plastic stent into the bile or pancreatic ducts to enlarge their opening. They may insert a balloon for the same purpose, or a temporary stent.
Whatever decisions are made, it’s almost certain that a change in lifestyle, diet and particularly alcohol consumption will be recommended. The goal is to stop gallstone formations and to avoid any future pancreatitis attacks. Patients are usually willing to comply, given the severe pain consequences of not following the doctor’s recommendation.