Gary S Sy, MD
IN this infrequent disease, the pancreas suddenly becomes inflamed. The pancreas is a cone-shaped gland about 5 inches long that lies crosswise just behind your stomach. The pancreas has two major functions: To secrete fluid containing digestive enzymes into the duodenum (the first portion of the small intestine) and to secrete the hormones insulin and glucagon, which are needed in regulating the level of glucose in your blood.
Normally, the pancreas secretes pancreatic juices through the pancreatic duct to the duodenum. This pancreatic juice contains digestive enzymes. Once there’s a blockage in the pancreatic duct, for example, a gallstone, it stops the flow of the pancreatic juices, and it accumulates in the pancreas and begins to digest the cells of the pancreas, causing severe inflammation.
About half the people who develop acute pancreatitis already have gallstones. Other causes are excessive use of alcohol, and, less commonly, certain drugs; high blood levels of lipids, especially triglycerides; damage to the pancreas from trauma; cancer of the pancreas; reduced blood supply to the pancreas, for example, from low blood pressure; hereditary pancreatitis; a penetrating duodenal ulcer; or hyperparathyroidism. It can also be a complication of mumps.
What are the symptoms?
The main symptom is agonizing pain the center of your upper abdomen. It often begins 12 to 24 hours after a large meal or a heavy bout of drinking. The pain seems to radiate to the back and is accompanied by vomiting. Rarely, the pain is felt first in the lower abdomen. Usually starting suddenly and reaching its maximum intensity in minutes, the pain is steady and severe, has a penetrating quality, and persists for days. Even large doses of pain-reliever don’t give a complete relief. Coughing, vigorous movement, and deep breathing may make it worse, sitting upright and leaning forward may provide some comfort.
In severe cases you become very ill and feverish, have bruise marks on your abdomen from internal bleeding around the pancreas, and may even have the symptoms of shock. The main danger of acute pancreatitis is that shock, which cause death, will develop.
What is the treatment?
If you have the symptoms mentioned, you must be admitted to a hospital as soon as possible. You might undergo a series of laboratory examinations to establish the diagnosis. Analysis of the blood samples for certain levels of pancreatic enzymes and other body chemicals often reveal the presence of the disease.
You will probably take painkillers and injections of drugs to reduce some of the pancreatic juices. Shock is treated with intravenous fluids. Antibiotics may be necessary. As you recover, you will gradually be able to eat and drink, but should never drink alcohol again. This is to prevent chronic pancreatitis. After further convalescence, an ultrasound scan is performed to look for gallstones, which your physician may then want to remove.
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