When pancreatic enzymes such as trypsin (a serine protease that hydrolyses proteins) that helps in the digestion of food are activated in the pancreas instead of the small intestines, it will result to the inflammation of the pancreas called pancreatitis.
Similar to other disorders and internal conditions, pancreatitis acts in stages. It will begin as an acute condition, an abrupt occurrence that will last for a few days and will turn chronic as years pass by. It has three specific types: acute, chronic, pancreatic abscess and pancreatic pseudocyst.
What usually causes pancreatitis?
Based on clinical reports, approximately eighty percent of patients diagnosed with this disease are caused by alcohol that affects the liver, gall bladder and pancreas. The collection of bile and pancreatic juices that are consequently trapped in the pancreas causes the formation of crystalline concretions called gall stones, which are considered to be the primary cause of acute pancreatitis. These concretions are mostly composed of cholesterol, which wasn’t secreted from the biliary tract along with stool.
Dyskinesia, a dysfunction of the sphincter of ampulla or sphincter of Oddi (a muscular valve named after its discoverer Ruggero Oddi) can also hinder the pancreatic juices and bile from flowing freely through the biliary tract. It is a rare condition, but when this happens, the fluids will solidify and form gall stones, too.
There are also rare cases of genetic transference due to the activation of the trypsinogen enzyme in the pancreas. Trypsinogen is a precursor form of Trypsin 1, a pancreatic enzyme found in the pancreatic juice together with lipase, amylase and chymotrypsinogen.
There are some prescribed medication like cholesterol reduction statins, corticosteroids, HIV drugs, diuretics, anticonvulsant valproic acid, chemotherapy agents such as estrogen, L-asparaginase and azathioprince that can cause pacreatitis. This disease can also be an aftereffect of hypothermia, scorpion stings, trauma, mumps, high blood calcium, high blood triglycerides and autoimmune disease and ERCP (endoscopic retrograde cholangiopancreatography.
Pancreas divisum (a congenital anomaly or malformation where one pancreatic duct is not formed), elevated blood triglycerides during pregnancy, vasculitis (the inflammation of the small blood vessels found in the pancreas) and porphyria (a skin problem or neurological complication acquired or inherited disorder of certain enzymes) can also cause pancreatitis.
Other less common infectious causes of pancreatitis are from infections. Certain pathogens like viruses (varicella-zoster virus, Coxsackie virus, cytomegalovirus, herpes simplex virus, mumps and hepatitis B), fungus (aspergillus), bacteria (salmonella, leptospira, legionella and mycoplasma) and parasites (ascaris, toxoplasma and cryptosporidium) can affect the body and the biliary tract.
A person suffering from pancreatitis will manifest signs and symptoms like vomiting, nausea, severe upper abdominal pain, chills, fever, internal bleeding, elevated blood pressure, dehydration, elevated heart rate, elevated respiratory rate, sweating, clammy skin, fatigue or weakness, weight loss and jaundice (yellowish pigment of the skin). Like with any other abdominal disease or disorder, bowel movements are affected and can worsen into bowel paralysis. Because of this, there is sudden weight loss due to the lack of pancreatic enzymes that helps in the digestion process.
Taking abdominal x-rays, blood tests, urinalysis and abdominal ultrasound and CT scans can determine the specific type of the disease the patient is suffering from. Blood tests and urinalysis will help determine the levels of amylase and lipase. If the results are four to six times higher than normal, diagnosis will learn towards pancreatitis. However, because of the initial abdominal pain, an abdominal ultrasound is needed be performed to see the real cause of the pain. This test can detect any possible formation of gall stones and can clearly see if the pancreas is inflamed or not.
The severity of the symptoms defines what type of pancreatitis the patient has and the kind of treatment he or she will undergo. To relieve the pain, administering morphine is usually done. However, there are those that suggest that morphine constricts the sphincter of ampulla although there isn’t any proof to this claim. Proper nutrition (excluding fats), fluids and electrolytes are intravenously given to a patient.
If remained untreated or undetected for years, pancreatitis may produce several complications such as infection, shock, systemic inflammatory response syndrome, high blood glucose, dehydration, and low blood calcium and eventually kidney failure. Chronic pancreatitis can lead to pancreatic cancer and diabetes. It can also lead to respiratory related complications that are can be quite severe and painful. Because of pleural effusion (excess of fluids), pancreatic enzymes will attack the lungs and cause inflammation that will eventually lead to lung collapse. Renal complications can also occur as well as abdominal compartmental syndrome and intra-abdominal hypertension.