Pancreatic Inflammation: How do you treat an inflamed pancreas?

Pancreatic Inflammation

The pacreas, the largest gland in the body, is an important regulator of sugar in the blood and of digestion. It cannot nomally be felt by examination of the abdomen, nor can it be seen externally. It has a duct, like a hose, that pours its secretion into the intestine. The pancreas is part of the intestinal tract. Its position is on a line from the navel to a point high underneath the left ribs. Pain due to disease of the pancreas can be very severe and acute, and chronic inflammations of the pancreas are among the most difficult to endure. The bravest individual is soon reduced to the need for drugs to control the pain.

What is the pancreas and what does it do?

The pancreas is a gland that is situated on the back part of the abdomen behind the stomach and overlays the spine. It has a fishlike shape with a head, neck and tail. It produces insulin, the lack of which results in diabetes. The pancreas also puts certain enzymes into the intestine which help in digestion, especially of fats and proteins. You may know of it under the name of stomach sweetbread.

What causes it to become acutely inflamed? 

In the majority of instances it is associated with excessive use of alcohol, and the disease is often seen in alcoholics. However, the inflammation is also related to gallbladder disease and ulcers. Sometimes the cause is not clear.

How can you be sure that I have acute inflammation of the pancreas? 

This can be a difficult diagnosis. It is usually made with a knowledge of the possible causative factor, examination of the abdomen, and certain blood tests. The blood often contains an increased amount of the enzyme called amylase, but this finding is not 100 percent accurate.

Is it a serious condition? 

It is almost always serious. The type caused by alcoholism can be fatal, sometimes even with the first attack. When the acute inflammation is due to gallstone or ulcer disease, it can usually be arrested when the other disease is corrected.

What constitutes a severe acute case? 

Acute pancreatitis is of varying severity. It may be so mild as to go unrecognized and be passed off as a dietary indiscretion or indigestion. The very sick patient is admitted in a coma, in shock, or with evidence of severe infection or blood loss.

Why is the acute attack so serious? 

The acute attack of pancreatitis may be dangerous for several reasons, any one of which is serious in itself. In acute pancreatitis the glandular structure is destroyed and the limiting capsule is violated. The gland will look like a bad black eye instead of smooth pink fish flesh. When this bruising of the gland takes place, pancreatic enzymes are released to the body lining and cavity instead of into the intestine. The enzymes will act the same on the body's own tissues as they do on ingested food. That is, they digest part of the body wall and the lining (peritoneum) of the abdominal cavity. The inflammation of the abdominal cavity and lining is called peritonitis. This infection can then extend into the bloodstream as a septicemia ("blood poisoning"). The loss of body fluid by vomiting, peritonitis and infection causes some degree of kidney malfunction and kidney failure. Inflammation of the lungs (pneumonia) and the lung lining (pleurisy) are common chest complications of pancreatitis.

When is surgery advised in the treatment of acute pancreatitis? 

Only rarely, when there is an abscess that has to be drained or a gangrenous area that can be removed.

Why don't you remove the inflamed pancreas, just as you do the inflamed appendix? 

It is a completely different affair. The appendix is relatively easy to remove, and one gets along well thereafter. The pancreas is much more difficult to remove, and its absence can result in diabetes and nutritional abnormalities. The removal of the pancreas is very major surgery.

What is the treatment if you don't operate? 

The treatment method allows the inflamed area to heal by rest. A broken bone, for example, heals by resting it in a cast so it doesn't move. We try to cast or splint the pancreas in the same way by not allowing it to function. Thus, we don't allow the patient food by mouth so that the pancreas won't have to secrete its enzymes. This is one reason why we feed intravenously. Another tube in the stomach is used to suck out all the acid which stimulates pancreatic secretion; the tube also prevents the patient from vomiting. Antibiotics are employed to kill the bacteria, while other drugs are used to modify pancreatic and intestinal activity. Blood and fluids are given to keep the circulation normal.

Can the disease be prevented? 

The disease is uncommon in teetotalers; this speaks for itself and for its single commonest cause. When pancreatitis is associated with a diseased gallbladder or a peptic ulcer, the correction of these primary factors usually prevents recurrent pancreatitis. There are other causes for pancreatic inflammation, but they are relatively uncommon.

You mean that if I recover from this attack and stop drinking, I'll be OK? 

In the sense that you won't further damage the part of the pancreas that is still functioning. Of course, the part already destroyed cannot be restored. It will, at best, remain as a scar. If the pancreatic abuse continues, it can go on to chronic pancreatitis or recurrent pancreatitis.

Why don't you just X-ray my pancreas? 

No direct, simple way of X-raying the pancreas is available. This would be good if we could do it.

What constitutes severe chronic pancreatitis?

If the pancreas contains cysts, the cysts can bleed or get infected. If the gland has stones in it, these can be associated with severe narcotic addicting pain. The gland is so scarred that it can no longer supply the required enzymes, resulting in a marked weight loss and malnutrition. Chronic inflammation of the pancreas can be a totally disabling disease.

I didn't know the pancreas could get stones in it. 

You must understand that pancreas stones result from inflammation. These are unlike gallstones, which cause inflammation. The first come from inflammation, the second cause it.

When is surgery advisable for chronic inflammation of the pancreas? 

Surgery is undertaken to drain inflamed cysts. In other instances, part or even all of the pancreas is removed to alleviate intractable pain and malnutrition. All surgeons agree that the past ten years have brought about great advances in the diagnostic investigation and operative management of pancreatic disease. With regard to pancreatitis all surgeons would agree that the best approach is to prevent it. No treatment is as effective as the advice interdicting the use of alcohol in susceptible individuals.

How long a hospital stay is required for the uncomplicated case? 

The simpler cases can be managed well and controlled in about two weeks. If surgery is required, the stay may be considerably longer, depending on the operative procedure chosen.

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