Acute and chronic pancreatitis – symptoms, treatment

Proven content

Although they affect the same gland, the pancreas, they are different diseases. Acute inflammation has symptoms and treatments that differ from chronic inflammation. Chronic inflammation, however, is not an acute consequence.

The pancreas almost acts as a double agent. On the one hand, it is an endocrine gland that produces the hormones insulin and glucagon. On the other hand, it produces pancreatic juice containing digestive enzymes and secretes it into the duodenum. Then it acts as an exocrine gland. Disruptions in its work lead to serious digestive disorders and / or disturbances in carbohydrate metabolism.

Acute pancreatitis

The most common cause of the disease are diseases of the bile ducts, especially gallstones. Long-term alcohol consumption can also cause them.

Acute pancreatitis – Symptoms

It starts abruptly after major dietary mistakes or after drinking a lot of alcohol. The main signals are recurring pains, often paroxysmal. Patients describe them as squeezing, girdling, burning, located in the epigastric region, radiating to the spine. Unfortunately, they do not go away after painkillers. There are also other ailments: anxiety, vomiting, nausea, abdominal distension, fever, chills, diarrhea (results of incomplete digestion of food due to a deficiency of pancreatic enzymes), jaundice.

Course of illness

It can be mild and then symptoms disappear after a few days. In more severe cases, they can join, among others disorders of breathing, blood clotting and circulatory system disorders. Sometimes the symptoms are very serious and the prognosis is unfavorable.

RESEARCH

One of the basic tests for the diagnosis of inflammation is the measurement of amylase (one of the pancreatic enzymes) in blood serum and urine. Its increased concentration usually indicates pancreatic disease. The activity of lipase, the level of glucose, calcium and leukocytosis in the blood is also measured.

Acute pancreatitis – Treatment

Acute pancreatitis requires hospital treatment. If you experience severe abdominal pain, vomiting, chills, progressive weakness – you need to call an ambulance! The therapy consists in the use of an appropriate diet, administration of painkillers, antibiotics (in the case of infection of the damaged pancreas), drugs that inhibit the secretion of gastric acid, insulin (in the case of diabetes). Sometimes surgery is necessary to remove necrotic and infected pancreatic tissue or gallbladder or stones from the bile duct.

Acute pancreatitis – Diet

During the acute phase of the disease, fasting is required for the first few days, patients are nourished intravenously or enterally. At the beginning of convalescence – for about a month – the diet is restrictive. It consists of 5 low-volume, easily digestible, cooked meals a day (also boiled vegetables and fruits). Do not fry or stew dishes in fat. It is forbidden to use hot spices, but you can use mild ones – cinnamon, vanilla, dill, basil. You also need to limit salting. In addition, the diet should not contain too much dietary fiber, and exclude products that have a bloating effect – cruciferous and legume vegetables. You can drink fruit and vegetable juices (prepared at home), weak tea. Lean meats, meat and skimmed milk are recommended. As the recovery progresses, the menu may be similar to that of a healthy person. Of course, certain rules must be constantly followed – avoid fatty and fried foods and do not drink alcohol.

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Chronic pancreatitis

It is not a consequence of prolonged acute pancreatitis, as may be mistakenly believed. The disease most often manifests itself in people who abuse alcohol for a long time. It seems that high consumption of protein and fats is also important in the development of this disease. Patients with hyperparathyroidism, post-traumatic or postoperative damage to the pancreatic duct, and pancreatic cancer are also predisposed to it.

Course of illness

It lasts for many years and the symptoms are non-specific, which makes diagnosis difficult. The disease is a gradual and progressive necrosis and fibrosis of the pancreas, leading years later to exocrine and endocrine insufficiency – disorders of digestion, absorption and diabetes.

Chronic pancreatitis – Symptoms

Failure can develop secretly. The pains – initially slight – are usually long-lasting, appear in the epigastrium and radiate to the spine. Over time, they become more intense, often girdling, and last for hours. They require the use of strong painkillers. Other symptoms include nausea and vomiting. Recurrent pains, intensifying after eating, lead to avoidance of food, which, along with the emergence of diarrhea, leads to weight loss. Odorous fatty diarrhea is caused by a lack of sufficient food-digesting enzymes. About 20-30 percent patients develop diabetes.

RESEARCH

Diagnosis in the initial stage of the disease is quite difficult due to the lack of characteristic symptoms. The basic examination is an ultrasound of the abdominal cavity. It allows to observe changes in the pancreas (fibrosis, calcifications), as well as to recognize comorbidities, e.g. gallstones. A good diagnostic method is also computed tomography and magnetic resonance imaging. In advanced forms of the disease, endoscopic retrograde cholangiopancreatography (EPCW) is useful, allowing the assessment of the pancreatic and biliary tract. Sometimes an X-ray examination of the abdominal cavity is helpful (it shows possible calcifications in the pancreas).

Chronic pancreatitis – Treatment

Sometimes a low-fat diet and alcohol withdrawal will suffice. Most patients are given pancreatic enzymes (in tablets), which the diseased organ cannot produce in sufficient quantity. Painkillers, antispasmodics, and drugs that reduce gastric and pancreatic secretions are also used. If diabetes develops during pancreatitis, treatment is also started. Sometimes an operation is necessary – to remove a part of the damaged pancreas. It is important to treat early-stage gallstone disease or cholangitis.

Chronic pancreatitis – Diet

Easily digestible meals are recommended, in small portions (at the same time, preparations with pancreatic enzymes must be taken). Recommended products are: stale bread (rolls, rusks), groats, skim milk, lean white cheese, lean meat (poultry, veal, beef) and lean sausage and fish, vegetable fats (olive oil, sunflower oil). You can drink fruit and vegetable juices (from fresh products), weak coffee and tea. Soups are cooked without bones and meat, and meat dishes are prepared without fat or baked in foil.

Worth knowing

How does alcohol affect the pancreas?

One of the main causes of chronic pancreatitis is long-term alcohol abuse. Steady doses of alcohol cause an overproduction of pancreatic enzymes (protein molecules) that clog the small ducts of the pancreas. This leads to impaired outflow of pancreatic juice from individual follicles and, consequently, to their disappearance and development of connective tissue. In this way, with time and constant drinking of alcohol, there is a progressive loss of the secretory part (both exocrine and endocrine) and organ fibrosis. These are irreversible changes. Thus, the amount of active pancreatic parenchyma continues to decline, resulting in pancreatic insufficiency. It manifests itself – in addition to epigastric pain – severe diarrhea, diabetes and progressive weight loss.

Text: Anna Romaszkan

Consultation: Ewa Czernicka-Cierpisz, MD, PhD, specialist in internal diseases, Dental and Medical Treatment DEMETER, Warsaw

Source: Let’s live longer

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