Pancreatitis

Pancreatitis symptoms vary depending on the type. The main symptom is generally pain in the upper left side or middle of the stomach that may radiate to the back. Symptoms based on the type include:

1. Symptoms of Acute Pancreatitis

In acute pancreatitis, pain begins slowly or suddenly in the upper abdomen and usually spreads to the back. This pain can be mild or severe and may last for several days. Other symptoms include:

• Fever
• Nausea and vomiting
• Jaundice (yellowing of the skin and the whites of the eyes)
• Tenderness or swelling of the abdomen
• Rapid heartbeats

2. Symptoms of Chronic Pancreatitis

In chronic pancreatitis, pain is constant and severe in the upper abdomen, which may radiate to the back. The intensity of pain may worsen after eating. Other symptoms include:

• Diarrhea
• Nausea
• Greasy, foul-smelling stools
• Vomiting
• Weight loss
• Back pain

The pancreas is a gland that plays two important roles:

• Helps in making enzymes and sends them into your small intestine. These enzymes help break down food.
• Makes the hormones insulin and glucagon and releases them into your bloodstream. These hormones control your body’s blood sugar level.

Most of the time, the enzymes are active only after they reach the small intestine. These enzymes can degrade pancreatic tissue if they start to function inside the organ. This can harm the organ's blood vessels and produce swelling, bleeding, and damage.

In acute pancreatitis, the pancreas's digestive enzymes are not effectively secreted, which causes auto-digestion and pancreatic inflammation (swelling). Certain diseases, surgeries, and habits increase the likelihood of developing this condition.

The most common causes of both acute and chronic pancreatitis are:

• Gallstones: Gallstones are the most common cause of pancreatitis. They obstruct the bile and enzyme drain when exiting the gallbladder and entering the bile ducts, causing bile and enzymes to "back up" into the pancreas and lead to swelling.
• Heavy alcohol use: Alcohol is the second most common factor associated with acute pancreatitis after gallstones. Excessive alcohol consumption can initiate an episode of acute pancreatitis and increase susceptibility to chronic pancreatitis.
• Genetic disorders of your pancreas: Some individuals may have a genetic susceptibility to pancreatitis. Mutations in certain genes can disrupt the normal function of the pancreas, making it more vulnerable to the harmful effects of alcohol.
• Infections: Infections such as mumps, hepatitis A or B, and certain bacteria or viruses (e.g., varicella-zoster virus, herpes simplex virus, salmonella, aspergillus) can also cause pancreatitis.
• Injury to your pancreas: Accidental damage to the pancreas or stomach, such as during a procedure to remove gallstones or examine the pancreas, can lead to pancreatitis.
• Pancreatic cancer: Cancerous tumors in the pancreas can block the pancreatic duct, hindering the entry of pancreatic enzymes into the gut for digestion, potentially leading to chronic pancreatitis.
• Certain diagnostic procedures: Some procedures used to diagnose gallbladder and pancreatic issues, like endoscopic retrograde cholangiopancreatography (ERCP) or ultrasound-guided biopsy, can damage the pancreas and lead to chronic pancreatitis.
• Pancreas divisum: This congenital defect, where parts of the pancreas do not join together, has been associated with chronic pancreatitis.
• Medications: Certain medications, including some antibiotics and chemotherapy drugs (especially estrogens, corticosteroids, sulfonamides, thiazides, and azathioprine), have been linked to acute pancreatitis as side effects.
• Blockage in pancreatic duct: Blockage of the bile ducts or pancreatic ducts can cause pain and may lead to chronic pancreatitis.
• High levels of lipids: Elevated lipid levels in the blood can harm pancreatic cells due to continuous inflammation, ultimately leading to pancreatitis. Check your lipid levels with a simple test called the lipid profile test.
• High calcium levels: High levels of calcium can cause deposits in the pancreatic duct, leading to pancreatitis. Understand the serum calcium test and its importance.
• Autoimmunity: Individuals with other autoimmune conditions are at higher risk for autoimmune pancreatitis, a rare disorder where the immune system attacks healthy cells in the pancreas.
• Smoking: The number of cigarettes smoked and the duration of smoking can increase the risk of pancreatitis. Smoking accelerates disease progression, and quitting smoking at any age can reduce this risk.

Here are a few practical ways to quit smoking.

The detailed evaluation of a patient is required to diagnose pancreatitis. It includes:

1. History
   The doctor in charge of your care will ask you about the history of your symptoms and may carry out a physical examination. If you have acute pancreatitis, certain areas of your abdomen will be very tender to touch. The doctor may inquire about a detailed history of medical conditions such as:
   • Gallbladder stones
   • Alcohol abuse
   • Medication use
   • History of weight loss
   • History of diabetes
   • Previous surgery or trauma
   • Hypertriglyceridemia or hypercalcemia (high levels of lipids and calcium)
   • Autoimmune disease
   • Genetic causes
2. Laboratory evaluation
   Blood tests will be carried out to detect signs of acute pancreatitis, which involves the release of pancreatic enzymes. These include:
   • Elevated amylase level in the blood
   • Elevated serum lipase level (a more specific indicator of pancreatitis than amylase levels)
   • Increased urine amylase level
   Other tests include complete blood count, serum lactate, serum triglycerides, C-reactive protein (CRP), and blood urea nitrogen (BUN).

   Additional tests include:

   • Pancreatic function test (PFT): This test measures how your pancreas responds to secretin, a hormone made by the small intestine.
   • Stool test: This test is done to determine if a person has a problem with the absorption of fats.
   • HbA1c level: This blood test measures your average blood sugar levels over the past three months.
   • Genetic testing: This is done to assess genetic history or identify any genetic disorders.
3. Imaging Tests
   The following imaging tests that can show swelling of the pancreas may be performed:
   • Ultrasound: This test uses high-frequency sound waves to visualize the organs and structures within the pancreas.
   • Computed tomography (CT) scan: These are standard non-invasive imaging techniques used to assess individuals who may have chronic pancreatitis.
   • Magnetic resonance imaging (MRI) scan: MRI and MR cholangiopancreatography (MRCP) are recommended, especially in patients without specific changes detected on CT scans.
   • Endoscopic retrograde cholangiopancreatography (ERCP): This is performed to look for fibrosis (thickened and stiff tissues) in patients with chronic pancreatitis.
   • Magnetic resonance cholangiopancreatography (MRCP): This involves injecting a contrast agent that makes your pancreas and surrounding organs appear clearly on an MRI scan.
4. Biopsy
   A biopsy involves taking a small sample of cells from the pancreas and sending it to a laboratory for examination under a microscope to check for the presence of cancerous cells.

A healthy lifestyle can reduce your chances of developing this medical condition. Acute pancreatitis is often caused by gallstones or excessive alcohol consumption. You may lower your risk of new or repeat episodes of pancreatitis by taking the following steps:

1. Eat right: The most effective way of preventing gallstones is by eating a healthy balanced diet that includes fresh fruits and vegetables. Include whole grains to lower bad cholesterol levels in the blood and avoid excessive consumption of fatty foods high in cholesterol.
2. Focus on your weight: Maintain a healthy weight, as being overweight may increase the risk of forming gallstones. Regular exercise is advised to help prevent this condition.
3. Cut down on alcohol: Limit your alcohol intake to reduce the risk of developing acute pancreatitis. This helps prevent damage to the pancreas and other medical conditions, such as liver cancer.
4. Get necessary treatment: High cholesterol levels are associated with the development of pancreatitis. Treat medical issues that lead to high blood levels of triglycerides to help prevent the condition.
5. Do not neglect vaccinations: Ensure children receive vaccines to protect against mumps and other childhood illnesses, which can reduce the chances of developing pancreatitis.
6. Say no to smoking: Studies indicate that smoking increases the risk of developing gallstones, which can lead to pancreatitis.

Acute pancreatitis is treated in hospital, where you'll be closely monitored for signs of serious problems and given supportive treatment, such as fluids and oxygen. The treatment consists of:

1. Medications
   The doctor may prescribe medications such as steroids (like corticosteroids) and mild to strong painkillers (like paracetamol, morphine, etc.) to relieve severe abdominal pain.
   Note: You may also need pancreatic enzyme supplements to help digest your food.
2. Management of Alcoholism and Tobacco Abuse
   After recovering from acute pancreatitis, you should completely avoid alcohol if it was the cause of the condition. For this, you can have one-to-one counseling with a doctor or take medication such as acamprosate to help reduce alcohol cravings.
   For smokers, anti-smoking treatment, such as nicotine replacement therapy (NRT) or bupropion (a medication used to reduce cravings for cigarettes), is recommended.
3. Surgery
   Depending on the exact cause of your pain, various surgical techniques may be used to treat chronic pancreatitis, such as:
   • For gallstone-associated pancreatitis: You may need a procedure called endoscopic retrograde cholangiopancreatography (ERCP) or gallbladder removal surgery.
   • Endoscopic surgery: This is performed for patients with stones in the pancreatic duct and is called lithotripsy (involves using shock waves to break the stone into smaller pieces).
   • Pancreatic resection: In this procedure, specific parts of the pancreas that are inflamed and causing severe pain are surgically removed. It is used if endoscopic treatment is ineffective.
   • Total pancreatectomy: In serious cases of chronic pancreatitis, if the entire pancreas is damaged, the whole pancreas may be removed.
4. Supportive Care
   
   • Fluid Resuscitation: Fluid resuscitation or fluid replacement is the medical practice of replenishing bodily fluid lost through sweating, bleeding, or other pathological processes.
   • NG Tube (Nasogastric Tube): It can be used to remove fluid and air, giving your pancreas more time to heal. It can also be used to deliver liquid food into your stomach as you heal.
   • Oxygen Administration: To ensure your vital organs have enough oxygen, it will usually be supplied through tubes into your nose. The tubes can be removed after a few days, once your condition is improving.

If you are suffering from pancreatitis pain, natural methods along with your medical treatment can bring you greater comfort and relief. Home care remedies for pancreatitis relief include:

• Turmeric (Haldi): A powerful antioxidant that reduces inflammation and provides relief from the symptoms of an inflamed pancreas.
• Ginger (Adrak): Contains antioxidants that help control swelling and boost the enzymes needed for proper digestion.
• Coconut oil (Nariyal ka tel): Rich in omega-3 fatty acids, it reduces swelling, repairs damaged tissue, and boosts nutrient absorption.
• Spinach (Palak): Rich in antioxidants and contains vitamins A, B, C, and E, iron, and selenium, which are essential for pancreas health.
• Mushrooms: Have anti-inflammatory and analgesic effects that help relieve the symptoms of pancreatitis.

Pancreatitis, if left untreated, may lead to various complications, such as:

• Pseudocysts: Fluid that can develop on the surface of the pancreas.
• Infected pancreatic necrosis: Interruption of the blood supply to the pancreas.
• Systemic inflammatory response syndrome (SIRS): Inflammation affecting the pancreas that spreads throughout the body.
• Chronic pancreatitis.
• Diabetes.
• Pseudoaneurysms: Injury to a blood vessel wall.
• Splenic vein thrombosis: Blood clotting within the splenic vein.
• Recurrent acute pancreatitis.
• Risk of progression to pancreatic cancer.
• Acute respiratory distress syndrome (ARDS): Fluid collects in the air sacs of the lungs.
• Compartment syndrome: Pressure builds up within the muscles.
• Acute kidney injury (AKI).
• Disseminated intravascular coagulation (DIC): The blood's inability to clot and stop bleeding.

It is suggested that no one should begin an alternative therapy without speaking with their physician. Alternative therapies that can help manage symptoms of chronic pancreatitis include:

• Yoga: Studies show that practicing yoga at least three times a week improves pain, reduces the need for pain medication, and enhances quality of life.
• Therapeutic touch: This process involves energy exchange, where the practitioner uses their hands to facilitate healing. It promotes relaxation, provides comfort, and effectively decreases anxiety while altering the perception of pain.
• Massage therapy: This therapy includes partial or full body massage using various techniques such as stroking or kneading the muscles. It improves blood circulation, reduces swelling, and helps manage pain.
• Physical exercise: Engaging in physical exercise enhances overall body functioning and quality of life. It reduces stress, pain, nausea, fatigue, and depression, while positively affecting hormonal balance.
• Acupuncture: This technique involves stimulating specific points on the body through various methods to relieve pain associated with pancreatitis and pancreatic cancer.

Pancreatitis symptoms can appear unexpectedly and be painful, uncomfortable, inconvenient, and embarrassing. Eating healthy, exercising regularly, reducing weight, limiting alcohol intake, and quitting smoking can significantly aid in managing the condition. Patients with pancreatitis may experience a wide range of emotions as a result of their condition. Effective management can include:

• Talking to loved ones
• Joining support groups
• Understanding physical limitations
• Starting palliative care to alleviate other symptoms
• Coping with practical issues such as financial expenses, childcare, and work-related challenges

Role of caregivers

Caregivers play a crucial role in the overall disease outcome for patients diagnosed with pancreatitis. Their important responsibilities include:

• Making decisions about disease management options
• Participating in doctor appointments and maintaining regular follow-ups
• If surgery has been performed, administering medications on time, changing dressings, assisting with bathing, and monitoring surgical sites
• Helping with meal preparation