Pancreatitis-pancreatitis

The pancreas is a large gland in the upper abdomen at about the level of the duodenum. It has two main tasks:

• The production of digestive juices and enzymes that break down proteins, carbohydrates, and fats in food into their component parts in the intestines. These digestive juices flow out via the duodenum and flow with the bile duct into the small intestine (exocrine function).

• Production of important hormones such as insulin and glucagon, which regulate the blood sugar concentration (endocrine function).

A distinction is made between acute and chronic pancreatitis:

Acute pancreatitis

A very painful and potentially life-threatening condition.

Causes

The most common are gallstones, as well as alcohol abuse. The gallstones obstruct the excretory ducts and the digestive juices are backed up into the pancreas. This begins to digest itself. Rarely mumps disease in children

Symptoms

There is severe colicky pain in the upper abdomen, radiating like a belt to the back. Usually also nausea and vomiting, possibly fever and intestinal paralysis. In Central Europe, 10 - 50 per 100,000 inhabitants fall ill each year, women somewhat more frequently than men. Chronic pancreatitis If the pancreas is repeatedly inflamed, this is called chronic pancreatitis.

The most common is chronic alcohol abuse, rarely metabolic disorders and drug side effects.

Alcohol abuse destroys the glandular cells. The scar tissue that forms cannot produce sufficient digestive enzymes and insulin. The body no longer breaks down food optimally, leading to malnutrition and undersupply of vitamins. The blood sugar level is no longer lowered sufficiently, diabetes mellitus (diabetes) can develop.

Repeated upper abdominal discomfort, often radiating to the back. Digestive problems. People with chronic pancreatitis lose weight over time.

In our latitudes, chronic pancreatitis affects about 8 per 100,000 inhabitants each year, men more often than women, especially in the fourth and fifth decades of life.

Complications

In severe cases, acute pancreatitis can lead to circulatory failure (shock) and thus to death. Rarely, infections or abscesses can also occur.

As a consequence of chronic pancreatitis, diabetes mellitus develops in about 30 percent of patients. Cyst formation further worsens the prognosis. Pancreatic carcinomas occur more frequently in patients with chronic pancreatitis.

Elevated blood levels of amylase and lipase (produced increasingly during the breakdown of pancreatic tissue).

Ultrasound examination: change in the shape of the organ and possibly gallstones visible.

Computer tomography: assessment of the extent of tissue destruction and possible involvement of neighbouring organs.

In the stool: the fat content and enzymes such as chymotrypsin and alpha-1-elastase can be determined in chronic pancreatitis.

Acute pancreatitis must be treated in hospital. Patients are not allowed to eat anything, they are exclusively fed parenterally = by infusion. Digestion should be immobilised as far as possible. Gastric juice formation is reduced by medication and gastric juice can be aspirated. For pain, patients are given painkilling drugs such as NSAIDs, butyscopolamine, tramadol or other opiods.

When the patient is symptom free and the blood counts have also normalized, a slow diet can be started. The diet must be extremely low in fat, and alcohol, coffee and cigarettes must be strictly avoided.

Gallstones can be removed endoscopically.

The same dietary recommendations apply to chronic pancreatitis; vitamins and digestive enzymes must be monitored over the long term and possibly replaced. Painkillers, antispasmodic drugs. One tries to avoid complications, such as diabetes mellitus.

Surgery is only necessary in the case of acute pancreatitis, where necrotic tissue must be removed, or some complications, such as carcinoma or duct obstruction.