Pancreatitis Health Article

Definition

Pancreatitis is an inflammation of the pancreas, an organ that is important in digestion. In pancreatitis, normal digestive enzymes act abnormally to break down the pancreas itself.

Description

The pancreas is a complex organ with many critical functions for normal digestion and regulation of blood sugar. When inflamed, as in pancreatitis, several potent enzymes are inappropriately activated within the organ itself. In acute pancreatitis, inflammation is sudden and causes symptoms. In almost 90% of acute cases, the symptoms disappear within one week after treatment, and the pancreas returns to its normal function. With chronic pancreatitis, damage to the pancreas occurs over longer periods of time. Symptoms may be persistent or sporadic, as the pancreas is slowly but permanently impaired. More than 90% of pancreatic tissue will be destroyed before serious symptoms begin. Late signs of chronic pancreatitis include diabetes mellitus and mal-absorption syndromes in which nutrients are poorly absorbed from the digestive tract.

Causes and symptoms

There are a number of causes of acute pancreatitis, the most common of which are gallstones and alcoholism. These two diseases are responsible for more than 80% of all hospitalizations for acute pancreatitis. Gallstones may obstruct normal drainage from the pancreas into the small intestine, resulting in a backup of normal pancreatic secretions and inflammation of the pancreas until the obstruction is relieved.

The mechanism by which alcohol inflames the pancreas is not so well understood. It is thought that alcohol causes proteins to collect and result in obstruction and calcification of the pancreas.

Other factors in the development of acute pancreatitis include:

• certain drugs, including estrogens, sulfonamides, and diuretics
• infections
• structural problems of the pancreatic duct and common bile duct
• injury to the abdomen
• abnormally high levels of circulating fats in the bloodstream
• high blood levels of calcium
• complications from kidney failure or transplant
• a hereditary tendency toward pancreatitis
• various forms of vasculitis (inflamed blood vessels)

In pancreatitis, enzymes become prematurely activated so that they actually begin their digestive functions within the pancreas. The pancreas, in essence, begins digesting itself. Digestion of the blood vessels in the pancreas results in bleeding. Other active pancreatic chemicals cause blood vessels to become leaky, and fluid begins seeping into the abdominal cavity. The activated enzymes also gain access to the bloodstream through leaky, eroded blood vessels, and begin circulating throughout the body.

Pain is a major symptom in acute pancreatitis, and it is usually quite intense and steady, located in the upper abdomen, and radiating to the patient's back. Nausea and vomiting and abdominal swelling are also common symptoms. A patient will often have a slight fever, with an increased heart rate and low blood pressure.

Patients with acute pancreatitis are at risk of complications related to shock, a very serious syndrome that occurs when the blood pressure is too low to get adequate circulation to critical organs. Without adequate blood pressure, organs are deprived of oxygen, nutrients, and waste removal and may not function well. Kidney, respiratory, and heart failure are serious possible outcomes of shock.

Even if shock does not occur, circulating pancreatic enzymes and related toxins can cause damage to the heart, lungs, kidneys, lining of the gastrointestinal tract, liver, eyes, bones, and skin. As the pancreatic enzymes affect blood vessels, the risk of blood clots increases. When blood flow is blocked by clotting, the supply of oxygen is further decreased to various organs and additional damage done.

Other serious complications of acute pancreatitis include pancreatic necrosis, abcess, and pseudocyst formation. Pancreatic necrosis occurs when a significant portion of the pancreas is permanently damaged during an acute attack. Pancreatic necrosis has an increased risk of death and an increased chance of pancreatic infection. A pancreatic abscess is a local collection of pus that may develop several weeks after the illness subsides. Another late complication of pancreatitis, occurring several weeks after the illness begins, is called a pancreatic pseudocyst, which occurs when dead pancreatic tissue, blood, white blood cells, enzymes, and fluid leaked from the circulatory system accumulate. Pseudocysts cause recurrent abdominal pain and also press on other nearby structures in the gastrointestinal tract, causing disruption of function. Pseudocysts are life threatening when they become infected (abscess) and rupture. Simple rupture of a pseudocyst causes death 14% of the time, but rupture complicated by bleeding causes death 60% of the time.

In very severe cases of pancreatitis, called necrotizing pancreatitis, the pancreatic tissue begins to die, and bleeding increases. Due to the bleeding into the abdomen, two distinctive signs may be noted in patients with necrotizing pancreatitis. Turner's sign is a reddish-purple or greenish-brown color to the area between the ribs and the hip (flank). Cullen's sign is a bluish color around the navel.

Alcohol abuse is the cause of tissue damage in 80% of cases of chronic pancreatitis. Tissue damage occurs more slowly, and many digestive functions become disturbed. The quantity of hormones and enzymes normally produced by the pancreas begins to decrease, resulting in the inability to appropriately digest food. Fat digestion, in particular, is impaired. A patient's stools become greasy as fats are passed out of the body. The inability to digest and use proteins results in smaller muscles (wasting)