A Family Doctor's Tale - PANCREATITIS

DOC I HAVE PANCREATITIS

Pancreatitis is a rare condition which is related to alcoholism. It typically produces pain in the epigastrium area which shoots right through to the back of the abdomen. It is often mistaken for acute gastritis. So far in my practice I have only experience 1 case of pancreatitis . The best way to test for pancreatitis is to do a serum amylase while the patient is having the pain. A high concentration of serum amylase usually confirm the diagnosis. Treatment is usually quite effective but more importantly is prevention by avoiding alcohol.

Pancreatitis is an acute or chronic inflammation of the pancreas.



Pancreatitis is usually caused by the following:

1. Alcoholism and diseases of the biliary tract


2. bacterial infections from salmonella typhi and streptococcus


3. viral infection especially mumps, coxsackie virus, cytomegalovirus


4. trauma


Chronic disease follows attacks of acute infection.


Persons who has Acute Pancreatitis has the following symptoms:

1.acute onset of abdominal pain starting from the epigastrium, radiating to the back in 50% of cases.


2.Pain usually very severe occurring a large meal or drinking bout


3.Pain is worse lying supine, therefore patients sit or lean forward


4.mild fever and bodyaches


5.nausea and vomiting


6.hypotension followed by clinical shock


Signs:

1.Tenderness at the epigastrium with muscle spasm


2.Distension and diminished bowel sounds


3.Pleural effusion  10%,abdominal mass 20%,  ascites 20%


4. Acute renal failure, respiratory failure following shock.


Chronic Pancreatitis
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Symptoms:

1.repeated attacks of epigastric abdominal pain


2.Pain worse after eating, radiates to the back


3.weight loss


4.Fever


Signs:

1.abdominal tenderness


2.abdominal mass may suggest swelling and pseudocysts


3.tender subcutaneous masses seen indicating fat necrosis



Diagnosis can usually be made by :

1.Physical examination with tenderness in the epigastrium


2.Serum and urine amylase very high after 6 hours 


3.White blood cell count high


4.Serum lipase high in 50% patients


5.Blood calcium may be low


6.Blood glucose tolerance test for diabetes


7.Ultrasound may show up the presence of pseudocyst in pancreas


8.CAT scan and MRI may show swelling and pseudocysts in pancreas

Complications are:
1.Pseudocysts from damage to pancreatic tissues


2.Hemorrhage - bleeding due to damage to the blood vessels in pancreas


3.peritonitis from rupture of pseudocysts and bleeding


4.diabetes mellitus from damage to the glands in the pancreas producing insulin


Acute Pancreatitis is treated by:

Admission to hospital


Gastric suction and fluid replacement


Analgesic or antispasmodic medicine usually by injection


Antibiotics for infections


Treat biliary tract diseases and alcoholism


Surgical drainage of pseudocysts after acute episode.


Chronic Pancreatitisis treated by:

Pancreatic extracts and enzymes together with meals


Sodium bicarbonate and cimetidine to prevent enzymes breakdown


Analgesic or antispasmodic medicine usually by injection


Surgical procedures usually unsuccessful


Prognosis is usually good after treatment of acute pancreatitis with recovery in 5-7 days.


Hemorrhagic Pancreatitis has high mortality of 50-90%


Most trauma cases has complete resolution


Some alcoholic pancreatitis may go on to chronic pancreatitis.


Chronic pancreatitis relapses frequently


Rupture of pseudocysts may result in death