Chronic pancreatitis: What you need to Know

Chronic pancreatitis is a long-term, progressive pancreatic inflammatory disease that leads to a permanent deterioration of the pancreatic structure and function.

The pancreas is an organ of the gland which is found in the belly, behind the stomach and under the ribcage. It specializes in the development of significant enzymes and hormones that help break down food and digest it. It also allows insulin that reduces blood sugar levels.

Long-term alcohol abuse is the most common cause– it is estimated to account for 70 to 80 percent of all incidents.

In the United States, chronic pancreatitis results in more than 122,000 doctor visits and 56,000 hospitalizations annually.

Particularly more men are affected than women.

Treatment

pancreas in human body
The pancreas produces important enzymes and hormones that help break down foods.

The following treatments are commonly recommended for chronic pancreatitis.

Lifestyle changes

People with chronic pancreatitis will need to undergo some lifestyle changes. These will include:

  • Stopping alcohol consumption: Giving up drinking will help prevent further damage to the pancreas. It will also contribute significantly towards relieving the pain. Some people may need professional help to quit alcohol.
  • Stopping tobacco use: Smoking is not a cause of pancreatitis, but it can accelerate the progression of the disease.

Pain management

Treatment should focus not only on helping to ease the symptoms of pain but also on depression that is a common consequence of long-term pain.

Doctors will usually use a step-by-step approach that prescribes mild pain relievers, gradually becoming stronger until pain becomes manageable.

Insulin

If the damage is severe, the pancreas may stop producing insulin. It is probable that the person has developed type 1 diabetes.

Routine insulin therapy for the rest of the person’s life will become a part of the treatment. Type 1 diabetes caused by chronic pancreatitis requires needles, not capsules, since the digestive system will most likely not be able to break them down.

Surgery

Often severe chronic pain doesn’t respond to painful medicines. The ducts in the pancreas may have become blocked, causing digestive juices to accumulate which puts pressure on them and causes intense pain. Another source of chronic and severe pain might be inflammation of the pancreatic head.

Multiple types of surgery to treat more severe cases may be recommended.

Endoscopic surgery

Inserted into the digestive system, controlled by ultrasound, is a small, hollow, flexible tube called an endoscope. Threaded through the endoscope is a device with a tiny, deflated balloon at the end. The balloon is inflated when it reaches the duct, thus widening the canal. A stent is placed to prevent the duct from narrowing backwards.

Pancreas resection

The pancreatic head is surgically removed. This not only relieves the pain caused by the painful swelling of the nerve endings but also reduces the pressure on the ducts. For resection of the pancreas three primary methods are used:

  • The Beger procedure: This involves resection of the inflamed pancreatic head with careful sparing of the duodenum, the rest of the pancreas is reconnected to the intestines.
  • The Frey procedure: This is used when the doctor believes pain is being caused by both inflammation of the head of the pancreas as well as the blocked ducts. The Frey procedure adds a longitudinal duct decompression to the pancreatic head resection – the head of the pancreas is surgically removed, and the ducts are decompressed by connecting them directly to the intestines.
  • Pylorus-sparing pancreaticoduodenectomy (PPPD): The gallbladder, ducts, and the head of the pancreas are all surgically removed. This is only done in very severe cases of intense chronic pain where the head of the pancreas is inflamed, and the ducts are also blocked. This is the most effective procedure for reducing pain and conserving pancreas function. However, it has the highest risk of infection and internal bleeding.

Total pancreatectomy

This includes whole pancreas being surgically removed. It handles the pain very effectively. However, for some of the vital functions of the pancreatic, such as insulin release, a person who has had total pancreatectomy will be dependent on treatment.

Autologous pancreatic islet cell transplantation (APICT)

A suspension of separated islet cells from the surgically removed pancreas is produced during the complete pancreatectomy procedure and is injected into the liver’s portal vein. The cells of the islets can act as a free grease in the liver, releasing insulin.

Diet

It is vital that dietary measures are taken to reduce the pancreatitis effects.

Digestion involves the pancreas but this function may be impaired by pancreatitis. That means that many foods will be difficult for people with the disease to digest.

Instead of three big meals per day, people with pancreatitis are advised to eat six small meals instead. Taking a low-fat diet is also better.

The aim of the diet management during pancreatitis is to achieve four outcomes:

  • reducing the risk of malnutrition and shortages of certain nutrients
  • avoiding high or low blood sugar
  • managing or preventing diabetes, kidney disease, and other complications
  • decreasing the likelihood of an acute flare-up of pancreatitis

A diet plan must either be drafted by a doctor, or a qualified dietitian may be referred to the patient. The program is based on the current nutrient levels in the blood as shown in diagnostic testing.

Meal plans will generally involve high protein food sources and have rich nutritional content. These are likely to include whole grains, beans, fruits, low-fat dairy products and lean sources of protein, such as boneless chicken and fish.

Fatty, oily, or greasy foods should be avoided, as they can activate more enzymes than normal in the pancreas. Alcohol is also best avoided as a primary cause of chronic pancreatitis while following a pancreatitis-friendly diet.

Patients may also have to take artificial versions of some enzymes to aid digestion, depending on the extent of the damage. These will relieve bloating, make their feces less greasy and foul-smelling and help with any cramps on the abdomen.

Symptoms

Abdominal pain in man
A person with chronic pancreatitis may experience abdominal pain that travels along the back.

Common signs and symptoms of chronic pancreatitis include:

  • severe upper abdominal pain that can sometimes travel along the back and is more intense following a meal
  • nausea and vomiting, more commonly experienced during episodes of pain

The symptoms of pain become more frequent and severe as the disease progresses. Several patients end up suffering severe abdominal pain.

As chronic pancreatitis progresses, and the pancreas ‘ ability to produce digestive juices worsens, the following symptoms can appear:

  • smelly and greasy stools
  • bloating
  • abdominal cramps
  • flatulence

The pancreas can ultimately not be able to produce insulin at all, leading to type 1 diabetes, which can cause the following symptoms:

  • thirst
  • frequent urination
  • intense hunger
  • weight loss
  • tiredness
  • blurred vision

Causes

Complication of chronic, acute pancreatitis episodes. These can cause permanent pancreatic damage.

Acute pancreatitis occurs when trypsin is activated inside the pancreas. Trypsin is an enzyme formed in the pancreas and released into the gut, where it breaks down proteins as part of the digestive system.

Trypsin is inactive until it reaches the intestines. If trypsin is activated inside the pancreas, the pancreas itself will begin to digest, leading to pain and pancreatic inflammation. This translates into acute pancreatitis.

Alcohol misuse

As can gallstones, alcohol can cause a mechanism that causes trypsin activation inside the pancreas.

People who misuse alcohol and develop acute pancreatitis appear to have frequent episodes, and chronic pancreatitis eventually develop.

Eventually, the recurrent bouts of acute pancreatitis take their toll on the pancreas, causing permanent damage, which then becomes chronic pancreatitis.

That is also called chronic alcoholic pancreatitis.

Idiopathic chronic pancreatitis

If a illness is idiopathic it has no known explanation or cause. For most of the remaining cases, idiopathic chronic pancreatitis reflects.

Most cases of chronic idiopathic pancreatitis occur for people between the ages of 10 and 20, and those over 50 years.

No-one is sure why other age groups are barely affected. In about 50 percent of patients with idiopathic chronic pancreatitis, the SPINK-1 and CFTR genes, forms of mutated genes, occur. These genetic mutations can compromise pancreatic functions.

Other much rarer causes include:

  • autoimmune chronic pancreatitis, in which the person’s own immune system attacks the pancreas
  • heredity pancreatitis, where patients have a genetic condition and are born with a faulty pancreas
  • cystic fibrosis, another genetic condition that damages organs including the pancreas

Diagnosis

Reliable approaches for diagnosing chronic pancreatitis do not exist. According to the patient’s symptoms, history of repeated acute pancreatitis flare-ups or alcohol abuse, a doctor may assume the disease.

Blood testing may be useful in monitoring blood glucose levels, which may be high.

At this stage, blood tests for elevated amylase and lipase levels are unreliable. Blood levels of amylase and lipase rise during the first few days of pancreatitis, and then settle back to normal after 5 to 7 days. A patient suffering from chronic pancreatitis would have had the disease a lot longer.

Physicians need to have a good look at the pancreas for proper diagnosis of the disorder. Most definitely, that will include:

  • An ultrasound scan: High frequency sound waves create an image on a monitor of the pancreas and its surroundings.
  • A CT scan: X-rays are used to take many pictures of the same area from several angles, which are then placed together to produce a 3-D image. The scan will reveal changes of chronic pancreatitis.
  • Magnetic resonance cholangiopancreatography (MRCP) scan: This scan shows the bile and pancreatic ducts more clearly than a CT scan.
  • An endoscopic retrograde cholangio-pancreatography (ERCP) scan: An endoscope is inserted into the digestive system. The doctor uses ultrasound to guide the endoscope through.

Chronic pancreatitis patients face an increased risk of developing pancreatic cancer. If symptoms worsen, particularly pancreatic duct narrowing, doctors may be suspicious of cancer. They’ll order a CT scan, MRI scan, or endoscopic analysis if they do.

Complications

There are several ways in which chronic pancreatitis can develop and become harmer to the well-being of a person.

Stress, anxiety, and depression

The disease can affect the psychological and emotional well-being of the patient. Constant or recurring, sometimes serious, pain may cause distress, anxiety, irritability, stress and depression.

Patients need to inform their doctors if they are affected mentally or psychologically. If there is a support group in your region, it may help you feel less alone and more able to cope with being able to talk to people who have the same condition.

Pseudocyst

This is a mixture of tissue, fat, waste, pancreatic enzymes, and blood in the abdomen that is caused by digestive fluid leakage from a faulty pancreatic duct.

Pseudocysts usually do not cause any health issues. Occasionally, however, they may become infected, cause partial blockage of the intestine, or burst and cause internal bleeding. If this occurs, then the cyst must be removed surgically.

Pancreatic cancer

Even though pancreatic cancer is more common in chronic pancreatitis patients, incidence is only 1 in 500.

Prevention

Acute pancreatitis patients significantly lower their risk of developing chronic pancreatitis if they give up drinking alcohol. This is particularly true of patients who drink regularly and heavily.

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