Acute and Chronic Pancreatitis Difference and Treatment

What is the difference between acute pancreatitis and chronic pancreatitis?

Acute pancreatitis is an isolated episode of abdominal pain accompanied by elevations
in blood enzyme levels. Essentially, it describes active inflammation of the pancreas.
More than 80 percent of the cases of acute pancreatitis are related to biliary stones or
alcohol use. Acute pancreatitis may lead to chronic pancreatitis.

Chronic pancreatitis is a painful disease of the pancreas in which inflammation has resolved, but with resultant damage to the gland characterized by fibrosis, calcification and ductal inflammation. It is possible for patients with chronic pancreatitis to have episodes of acute pancreatitis.

What causes chronic pancreatitis?

The most common cause of chronic pancreatitis are

  1. Alcohol consumption.
  2. Hyperparathyroidism (increased secretion from the parathyroid glands)
  3. Trauma to the pancreas.
  4. Tropical pancreatitis, a variant of chronic pancreatitis, is seen in tropical parts of
    Asia and Africa, and can affect children between 12 and 15 years of age.
  5. Recurrent acute pancreatitis..

What are the symptoms of chronic pancreatitis?

Symptoms of chronic pancreatitis range widely

  • Acute abdominal pain ranging from severe to mild radiating to back. The pain of chronic pancreatitis often radiates to the back, although it may radiate to both upper and lower quadrants. Sitting up and leaning forward may relieve or reduce discomfort
  • Vomiting
  • Epigastric tenderness
  • Weight loss
  • Steatorrhea( passing of undigested fat in stools)
  • Glucose intolerance/ Diabetes
  • Diarrhea which may be chronic (six or more bowel movements per day). The diarrhea is a result of fat malabsorption, which results in bulky, foul-smelling stools that may appear oily and float (steatorrhea).

How is chronic pancreatitis diagnosed?

Chronic pancreatitis is best diagnosed using historical information, serum enzymes,
exocrine function and radiographic studies (X-rays), ultrasound abdomen, CT/MRI scan.
Tests of exocrine function (fat absorption) are helpful.

Are there any particular complications that result from chronic pancreatitis?

Yes. Nutrient malabsorption, diabetes mellitus are main complications of chronic pancreatitis. Patients with chronic pancreatitis are also at increased risk of chronic pancreatitis.

Malabsorption is faulty absorption of nutrients from the digestive tract. In chronic pancreatitis, malabsorption occurs after the capacity for enzyme secretion is reduced by more than 90 percent. Fat absorption suffers to maximum extent in case of chronic pancreatitis.

Chronic pancreatitis affects the endocrine function of the pancreas, responsible for insulin and glucagon production.

Diabetes is common in patients with chronic pancreatitis, and the incidence increases over time with the progression of the disease. Approximately 45 percent of patients with chronic pancreatitis will develop diabetes. Fortunately, the pancreatic form of diabetes is usually mild and the usual complications (retinopathy, nephropathy and vasculopathy) are uncommon. Neuropathic complications may occur with continued alcohol abuse or malnutrition.

How is chronic pancreatitis treated?

Treatment for chronic pancreatitis includes medical, endoscopic and surgical therapy.

Can patients expect long-term relief of pain after surgery?

Surgical intervention provides long-term relief of pain in 90 percent of patients. When
patients have exhausted other avenues of treatment for pain relief, surgery should be
considered.

If I have chronic pancreatitis and am being treated, can I expect a full recovery from this disease?

The changes of chronic pancreatitis are not reversible. However, it is possible to have
control of pain and steatorrhea with medical, endoscopic, percutaneous or surgical
treatment. Surgery provides the best relief of pain in short as well as long term. In
addition to pain relief , surgery can slow down destruction of pancreas thus delaying
onset of diabetes mellitus and malabsoption.

Jaundice ( Peelia) – Symptoms Causes Treatment

Jaundice-Myths-And-Facts

Jaundice (peelia)- It’s yellowness of eyes and skin due to disturbance in metabolism of bilirubin.

Liver produces bile and then put it into intestine through a tract called biliary tract.

Any disturbance from making of bile and obstruction to its outflow will cause jaundice.

If one has this idea then one can really negate the myths prevalent in society about jaundice.

Myths and facts

  1. Jaundice will subside on its own.  Majority of jaundice do subside on its own as majority are due to infection but it’s for doctor to decide by testing as which type will subside on its own and which type require further treatment.
  2. We should not eat turmeric in jaundice.  It’s untrue. Turmeric does not do any harm to liver and does not increase jaundice.
  3. We should not eat certain foodstuffs in jaundice. – Untrue . One can eat all types of foodstuffs during jaundice. One should have good healthy diet during an episode of jaundice.
  4. Jaundice can be cured some spiritual leader by some herbal medicine. Majority of jaundice are self limiting so will cure even if you don’t take any medicine. So these types of jaundice get cured by any means and credit goes to spiritual leader.
  5. Jaundice can be transmitted from one person to another. Some type viral infection can be transmitted by sexual contact or sharing needle with infected person as seen with AIDS while another can spread by consuming food contaminated by infected person so infected person should maintain good hygiene to prevent further spread to its family members and friends.
  6. How can one prevent jaundice ?
    • Maintain good hygiene and have well cooked food.
    • Drink clean water.
    • Do not have unsafe sex.
    • Do not share syringes or needle.

What is treatment for jaundice?

Treatment of jaundice depends upon type of jaundice. For treatment purposes jaundice is divided into

  1. Medical jaundice- this type is primarily treated with medicines
  2. Surgical jaundice- It requires surgical intervention for its cure.

Medical jaundice arises usually due damage to cells of liver while surgical jaundice is caused by obstruction to flow of bile from liver to intestine. Liver function tests, Ultrasound abdomen, MRCP helps in classifying the jaundice. Your general physician/gastroenterologist/gastrosurgeon can help in diagnosing the type of jaundice based on these tests.

Causes of medical jaundice –

  1. Hepatitis – infectious or toxic
  2. Drug toxicity
  3. Damage to liver by abnormal deposition
  4. Defect in bilirubin metabolism
  5. Alcohol hepatitis
  6. Autoimmune hepatitis

Causes of surgical jaundice

  1. Stone in bile duct
  2. Gall bladder stone
  3. Tumor of gall bladder or bile duct
  4. Tumor of liver
  5. Liver cysts
  6. Liver abscesses

Except for stone in bile duct that is treated with ERCP, all other causes of surgical jaundice require surgical treatment. These cases are best treated by surgeon with knowledge and expertise in liver and biliary tract surgery.

Acute Pancreatitis Causes, Symptoms & Treatment

What does pancreas do?

The pancreas is a long, flat gland that sits tucked behind the stomach in the upper abdomen. The pancreas produces enzymes that help digestion and hormones that help regulate the way your body processes sugar (glucose). What does pancreas do?

What is acute pancreatitis?

Acute pancreatitis is an inflammation of the pancreas that occurs suddenly. It differs from chronic pancreatitis in that there is a discrete episode.

Acute pancreatitis which may be classified as mild, moderate or severe, depending on the amount of damage and organ dysfunction caused by the pancreatitis.

What are causes or risk factor of acute pancreatitis?

Causes of acute pancreatitis are :

  1. Biliary stones are the cause of 35 to 50 percent of the cases of acute pancreatitis.
  2. Alcohol intake is the second leading cause of acute pancreatitis.
  3. Several drugs may cause pancreatitis e.g, immunosuppressants, estrogens, acetaminophen, sulindac. tetracycline, salicylates, erythromycin, pentamidine, thiazide diuretics, furosemide and valproic acid.
  4. Viral causes include hepatitis A, B, and non-A/non-B; cytomegalovirus; mumps; and coxsackievirus.
  5. Bacterial causes may include Legionella, mycoplasma and mycobacterium tuberculosis.
  6. Parasitic infections may also cause acute pancreatitis.
  7. Pancreas divisum (a congenital defect of the pancreatic ducts).
  8. Metabolic imbalances (hyperlipidemia and hypercalcemia).
  9. Sphincter of Oddi dysfunction.
  10. Scorpion stings.
  11. Trauma to pancreas may also cause acute pancreatitis.

What are symptoms of acute pancreatitis?

  1. Upper abdominal pain is main symptom. Usually it is severe and radiates to back.
  2. Nausea and vomiting are the other most frequent symptoms of acute pancreatitis.
  3. Fever
  4. High pulse rate.
  5. Few patients may have jaundice.
  6. Patient may have low blood pressure and confusion or coma may occur.

Can acute pancreatitis become chronic pancreatitis?

Yes. Chronic pancreatitis results when inflammation in the pancreas has caused damage and resulted in fibrosis, calcifications and ductal inflammation. It is also possible for patients with chronic pancreatitis to have episodes of acute pancreatitis. Chronic pancreatitis is slow self propagating disease that results in slow destruction of pancreas.

How is acute pancreatitis diagnosed?

Diagnosis of acute pancreatitis is usually made clinically when patient presents with typical pain of pancreatic origin that is pain upper abdomen radiating to back. Further tests helps in confirming diagnosis e.g,

  1. Increased serum amylase and/or lipase (pancreatic enzymes).
  2. Ultrasound abdomen
  3. CT Scan abdomen

Can I prevent acute pancreatitis?

Avoidance of known causes of pancreatitis (i.e., alcohol consumption) may help prevent the onset of the disease. Lifestyle factors such as obesity, alcoholism, hepatitis and others that contribute to a poor state of overall health lead to complications of acute pancreatitis and to a poorer prognosis for recovery.

What is treatment of acute pancreatitis?

The treatment of acute pancreatitis depends on its severity.

  1. If the disease is considered mild, the patient is usually treated supportively with intravenous fluids, pain control medication, keeping close watch on patient’s general condition so that it does not deteriorates.
  2. Severe pancreatitis requires close monitoring of the patient to detect possible systemic complications. The patient may be admitted to an intensive care unit. Organisms may reach the pancreas and infect it by crossing the colonic wall. Antibiotics may be used to prevent sepsis. These patients may have some organ failure thus require support for these failed systems.
  3. Surgical debridement and drainage may be necessary if infected pancreatic necrosis (cell death) arises. CT scan-guided aspiration of necrotic areas may be done to identify the infecting organism so that it may be treated effectively. Surgical intervention is usually done 4 weeks after onset of pancreatitis.
  4. Therapeutic endoscopic retrograde cholangiopancreatography (ERCP) may be performed in the early stages of acute pancreatitis to remove gallstones and may require sphincterotomy (cutting the sphincter muscle to allow drainage from the biliary/pancreatic tract).

What are possible complications of acute pancreatitis?

Complications can be localized or systemic.

  1. Systemic complications are usually seen in severe acute pancreatitis. These include
    1. Low  blood pressure
    2. Lung failure
    3. Kidney failure
    4. Inflammation may extend to surrounding organs such as the  colon and stomach, gastrointestinal bleeding.
  2. Localized complications include
    1. Fluid collections
    2. Pancreatic pseudocysts
    3. Pancreatic necrosis
    4. Pancreatic abscess

Is there hereditary link with acute pancreatitis?

No. There may, however, be genetic influence in chronic pancreatitis.