Pancreatitis and treatment

Pancreatitis-

Pancreatitis is the inflammation of pancreas. In pancreas there are number of cells that produces enzymes , hormones and when inflammation occur it leads to digestion of the pancreas by it's own enzymes or cause irreversible structural damage to the organ.

Pancreatitis is of two types-

1. Acute pancreatitis

2. Chronic pancreatitis.

What are the functions of pancreas and how they get affected with pancreatitis-

Pancreas have two types of functions-

1. Exocrine by Acinar cells-

It secret inactive enzymes into pancreatic duct these enzymes are-

• Amylase - breakdown carbohydrates to glucose
• Protease -  breakdown protiens.
• Lipase    - breakdown fats

Pancreas have epithelial cells which release bicarbonate.

2.  Endocrine Islets of Langerhans-

It release insulin , glucagon , somatostatin , pancretic polypeptide into blood stream.

These all enzymes are not activated and they become activated when enter into the duodenum which is part of small intestine. These enzymes reach to duodenum via pancreatic duct.

When pancreatitis occur  which cause inflammation and pancreas get swell up. Enzymes become unable to release due to obstruction in path and these enzymes starts to leak surrounding the pancreatic tissues and also in surrounding organs which leads many complications.

Complications included-

1. Chronic pancreatitis leads to damage to isletI of Langerhans and cause low production of insulin which cause diabetes mellitus.

2. Malabsorption   occur due inadequate secretion of enzymes and their release into small intestine. Which leads to improper digestion of food and cause malabsorption.

3. GI pain due to inflammation of tissues.

4. Internal bleeding due to the inflamation 

of blood vessels.

5. Ascitis occur due to leaking of pancreatic secretions into peritoneum.

6. Fibrosis

7. Cyst formation.

8. Respiratory distress.

What Is difference between acute and chronic pancreatitis? -

Acute pancreatitis-

1. Sudden inflammation due to something that triggers the digestive enzymes to activate inside the pancreas.

2. These activated enzymes inside the pancreas starts to digest cells of pancreas. Which leads to swell up of pancreas and inflamed tissues died cause fibrosis , cyst formation  and abscess formation.

3. Due to location of pancreas it leads to inflammation of other organs. E.g respiratory distress etc.

Chronic pancreatitis-

1. Chronic pancreatitis is repeated episode of acute pancreatitis but most common cause is years of alcohol abuse.

2. It is irreversible change to pancreas.

3. There is complete Loss of endocrine and exocrine cells functions.

4. Complete damage to pancreatic ducts functions.

What are causes of acute and chronic pancreatitis? -

Acute pancreatitis- 

Mainly two causes are dominant-

1. Gallstones- hardened deposit of undissolved cholesterol salt or bilirubin that can block common bile duct cause reverse transport of enzymes. These enzymes get activated and start to digest it's own cells in pancreas.

2. Alcohal - leads to damage of the cells of pancreas (Acinar cells) , pancretic ducts and lead to the activation of enzymes.

Other-

• Abdominal trauma.
• Medications.
• Infections.
• Tumors.
• Genetics.
• High triglycerides level.
• High calcium level.

Chronic pancreatitis -

1. Long term alcohal abuse- recurrent inflammation and damage to the structure of pancreas occur which leads to the chronic pancreatitis.

2. Cystic fibrosis- there is lack of CFTR proteins. This protein play important role in the movement of chloride ions and maintain balance of water and salt in epithelial cells that lining the pancretic ducts. When cystic fibrosis occur it leads to low production of bicarbonate and leads to thick mucous in pancreatic duct. This thick mucous starts blockage and leads to activate digestive enzymes inside pancreas leads to fibrosis of pancreatic tissues.

 Other - 

1. Increased calcium .

2. Increased  cholesterol.

Diagnosis-

1. Blood test for serum amylase and lipase. Also to find out increase electrolytes.

2. CT scan and Ultrasound.

3. ERCP - use to diagnose and treatment purposes. It assess pancreas , bile ducts and gall bladder.

What are sign and symptoms of acute pancreatitis?-

1. There is sudden and very painful mid epigastric pain and radiate to back. It hurts worst when lying in supine position. Pain becomes after drink alcohol or eating fatty meal.

2. Patient may have fever due to infection , increased heart rate and decreased BP.

3. Increase in glucose level and also amylase and lipase level.

4. Cullen's sign- there is bluish discoloration around umbilicus due to leaking of enzymes into umbilicus area.

5. Grey turner's - it is bluish discoloration of the flank area.

Treatment-

Care of patient with pancreatitis-

 Goal should be rest to pancreas , control pain , monitor for complications , administer medications as per ordered. Assessment of pancreatic enzymes and therapeutic diet.

1. Maintain NPO status of patient. Let pancreas rest and when sign symptoms get slow than provide liquid without fats.

2. Maintain IV hydration as prescribed.

3. Insertion of NG tube may prescribed by doctor which help to remove gastric contents , gas and help to Decrease vomiting.

4. Monitor glucose level and administer insulin as per ordered.

5. Monitor stool for greasy appearance which indicates steatorrhoea.

6. Monitor urine output and colour.

7. Administer pain medication as per ordered.

Morphine is contraindicated because it results spasms of sphinctor of Oddi.

8. Advise to patient to lean forward or sit up and not have to take supine position.

9. Administer pancreatic enzymes as per ordered which help to break protein and fat to prevent steatorrhoea.

10. Administer these enzymes with acidic foods and not administer with alkaline e.g milk, pudding and ice-cream.

Diet- 

1. Avoid alcohol or greasy fatty foods.

2. Low fats.

3. High proteins.

4. Limited sugar + refined carbs and complex carbs.