Pancreatitis or inflammation of the pancreas can cause upper left abdominal pain during a flare-up. Pancreatitis can be either acute or chronic in nature:
- Acute pancreatitis: An episode can range from mild to severe, lasting usually for 48 hours but not exceeding more than a week. It is treated as a medical emergency.
- Chronic pancreatitis: May cause intermittent attacks of severe pain or chronic mild to moderate pain and other symptoms such as vomiting, shock, and sometimes jaundice. Flare-ups are typically triggered by certain foods, alcohol consumption, dislodging of gallstone blocking the pancreatic duct, or an infection in adjacent organs reaching the pancreas.
What are the symptoms of pancreatitis?
Acute pancreatitis symptoms
- Abdominal pain:
- Sudden onset of dull, aching pain that gradually intensifies in severity
- Felt in the upper abdomen and may radiate to the back
- Nausea and vomiting, which is sometimes presented along with anorexia
Chronic pancreatitis symptoms
- Abdominal pain
- Similar to acute pancreatitis
- May present as both intermittent unpredictable attacks of severe pain or chronic mild to moderate pain
- May or may not be preceded by meals
- Tends to last for several hours
- Diarrhea due to pancreatic exocrine insufficiency and steatorrhea (fatty stool)
- Weight loss (may be caused by fear of eating)
What are the complications of pancreatitis?
Acute pancreatitis complications
People with mild acute pancreatitis can recover without experiencing any complications. However, severe cases can lead to serious complications such as:
- Pancreatic pseudocysts, which are sacs of fluid that develop on the surface of the pancreas and can cause:
- Dull abdominal pain
- Infection that needs drainage
- Pancreatic necrosis, which occurs when the pancreas loses its blood supply, which can cause some of the tissue of the pancreas to die
- Sepsis, which occurs if the necrosed pancreas becomes infected
- Multi-organ failure
Chronic pancreatitis complications
Repeated attacks of acute pancreatitis may eventually permanently damage your pancreas and cause:
- Chronic abdominal pain
- Diabetes mellitus
- Kidney failure
- Weight loss
- Pancreatic pseudocysts
- Pancreatic cancer
- Acute flare-ups that keep coming back
- Osteopenia and osteoporosis
- Biliary obstruction
- Duodenal obstruction
How is pancreatitis diagnosed?
In addition to your symptoms, medical history, and physical examination, diagnosis of pancreatitis involves:
- Blood tests: Ordered to evaluate your:
- Complete blood count
- Erythrocyte sedimentation rate
- C-reactive protein
- Liver function tests
- Imaging tests: An ultrasound or CT scan of your pancreas, gallbladder, and bile duct may reveal abnormalities.
- Secretin pancreatic function test: Checks your response to a hormone (secretin) released by the small intestine. Secretin usually triggers the pancreas to release digestive juices insufficient in lipolytic juices.
- Oral glucose tolerance test: Checks for diabetes that may be caused by endocrine insufficiency.
- Stool test: Checks the fat content in stool.
- Endoscopic ultrasound (endosonography): Takes detailed pictures of the pancreas, part of the liver, gallbladder, and bile duct
- Endoscopic retrograde cholangiopancreatography: Allows your doctor to see and remove anything blocking the pancreas or bile duct such as a gallstone or pancreas stone.
How is pancreatitis treated during a flare-up?
Acute pancreatitis is treated in the hospital and involves supportive treatment such as fluids and oxygen along with monitoring vitals.
- Mild acute pancreatitis usually resolves within 48 hours. Many people can leave the hospital after a few days.
- Severe acute pancreatitis, however, can cause complications that may require intensive care unit care.
Treatment may include:
- Fluids: Acute pancreatitis can leave you dehydrated, so fluids are given through your vein to prevent dehydration.
- Oxygen: Acute pancreatitis can affect normal respiration and leave you without sufficient oxygenated blood. To make sure your body gets enough oxygen, you may be given oxygen through nasal tubes. Artificial ventilation equipment may be used in severe cases.
- Painkillers: Acute pancreatitis often causes severe abdominal pain that requires painkillers.
- Antibiotics: If you have an infection with pancreatitis, antibiotic therapy is initiated depending on the type of infection.
- Nutritional support: Abdominal pain can reduce your appetite and you may be advised not to eat solid foods for a few days. You may be given a special liquid food mixture that contains essential nutrients.
- Avoiding alcohol: Because alcohol is one of the triggers for pancreatitis, giving it up completely reduces symptoms and slows the progression of the condition.
- Smoking cessation: Tobacco smoking increases the risk of pancreatitis and pancreatic cancer. It also increases the risk of pancreatic calcification, which is one of the complications of pancreatitis.
- Dietary changes: A low-fat, high-protein, high-calorie diet with fat-soluble vitamin-rich diet may be recommended.
- Surgery: Surgery can be used to treat severe pain in chronic pancreatitis:
- Endoscopic surgery: Lithotripsy involves using shock waves to break the stones into smaller pieces, which are then removed using an endoscope through the pancreatic duct.
- Pancreatic resection: If you have partial infection and necrosis, part of the pancreas is surgically removed.
- Total pancreatectomy: If you have profound and comprehensive damage to the pancreas, leading to life-threatening complications such as sepsis, total removal of the pancreas may be the treatment of choice.
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Acute Pancreatitis. https://emedicine.medscape.com/article/181364-overview
Chronic pancreatitis. https://emedicine.medscape.com/article/181554-overview
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