Pancreatitis

Pancreatitis is inflammation of the pancreas, an organ that produces several enzymes to aid in the digestion of food, as well as the hormone insulin, which controls the level of sugar (glucose) in the blood. The pancreas is located in the upper abdomen, behind the stomach. When the pancreas is inflamed, the body is not able to absorb all the nutrients it needs.

Pancreatitis may be either acute (sudden and severe) or chronic. Both types of pancreatitis can cause bleeding and tissue death in or around the pancreas. Mild attacks of acute pancreatitis can get better on their own, or by changing your diet. In the case of recurring pancreatitis, however, long-term damage to the pancreas is common, sometimes leading to malnutrition and diabetes.

Necrotizing pancreatitis (in which pancreatic tissue dies) can lead to cyst-like pockets and abscesses. Because of the location of the pancreas, inflammation spreads easily. In severe cases, fluid containing toxins and enzymes leaks from the pancreas through the abdomen. This can damage blood vessels and lead to internal bleeding, which may be life threatening.

 

Signs and Symptoms:

Common signs and symptoms of pancreatitis include the following:

• Mild-to-severe, ongoing, sharp pain in the upper abdomen that may radiate to back or chest
• Nausea and vomiting
• Fever
• Sweating
• Abdominal tenderness
• Rapid heart rate
• Rapid breathing
• Oily stools (chronic pancreatitis)

 

Causes

There are several possible causes of pancreatitis. The most common are gallstones, which block the duct of the pancreas (for acute pancreatitis), and excessive alcohol consumption (for chronic pancreatitis).

• Certain drugs, including azathioprine, sulfonamides, corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), and antibiotics such as tetracycline
• Infection with mumps, hepatitis virus, rubella, Epstein-Barr virus (the cause of mononucleosis), and cytomegalovirus
• Abnormalities in the structure of the pancreas or the pancreatic or bile ducts, including pancreatic cancer
• High levels of triglycerides (fats) in the blood
• Surgery to the abdomen, heart, or lungs that temporarily cuts off blood supply to the pancreas, damaging tissue
• Hereditary diseases, such as cystic fibrosis
• Injury to the abdomen

 

Risk

People with these conditions or characteristics have a higher risk for pancreatitis:

• Biliary tract disease
• Binge alcohol use and chronic alcoholism
• Recent surgery
• Family history of high triglycerides
• Age (most common ages 35 - 64)

African-Americans are at higher risk than Caucasians and Native Americans.

 

 

Treatment Plan

Acute pancreatitis may require you to be admitted to the hospital, where you will receive medication for pain. You will also fast, to allow the pancreas to rest and stabilize. You will receive intravenous fluids and nutrition (parenteral nutrition). If you have gallstones, your doctor may recommend surgery or other procedures to remove them.

People with chronic pancreatitis may require treatment for alcohol addiction, if that is the cause. Treatment also includes pain management, enzyme supplements, and dietary changes. Treatment for patients who have pancreatitis due to high triglyceride levels includes weight loss, exercise, eating a low-fat diet, controlling blood sugar (if you have diabetes), and avoiding alcohol and medications that can raise triglycerides, such as thiazide diuretics and beta-blockers.

 

Drug Therapies

You may be given painkillers. Antibiotics may be given to treat or prevent infection in some cases. Enzyme supplements, such as pancrelipase (Lipram, Pancrease, Viokase), may be prescribed to help your body absorb food better.

 

Surgical and Other Procedures

Different types of surgical procedures may be necessary, depending on the cause of the pancreatitis. With infected pancreatic necrosis (tissue death), surgery is virtually always required to remove damaged and infected tissue. Surgery may also be required to drain an abscess. For chronic pancreatitis with pain that won't respond to treatment, a section of the pancreas may need to be removed. If the pancreatitis is a result of gallstones, a procedure called endoscopic retrograde cholangiopancreatography (ERCP) may be necessary. In ERCP, a specialist inserts a tube-like instrument through the mouth and down into the duodenum to access the pancreatic and biliary ducts.

 

Complementary and Alternative Therapies

It is important to get conventional medical treatment for pancreatitis as soon as possible. A severe attack can be life-threatening if left untreated. Most alternative therapies have not yet been studied for use specifically in pancreatitis, although some evidence indicates that antioxidants may have beneficial effects. Several therapies, though, may reduce the risk of developing pancreatitis or ease some of the symptoms when used in conjunction with conventional care. You should never treat pancreatitis without your doctor's supervision.

Numerous studies have explored the role of oxidative stress in pancreatitis. Oxidative stress results from the production of free radicals, which are by-products of metabolism that are harmful to cells in the body. Antioxidants help rid the body of harmful free radicals. Low antioxidant levels in the blood (including reduced amounts of vitamins A, C, and E; selenium; and carotenoids) may lead to chronic pancreatitis due to the destructive effects of increased free radicals. Antioxidant deficiency and the risk of developing pancreatitis may be particularly linked in areas of the world with low dietary intake of antioxidants. In addition, the cooking and processing of foods may destroy antioxidants. Alcohol-induced pancreatitis is linked to low levels of antioxidants as well. There is also some evidence that antioxidant supplements may eliminate or minimize oxidative stress and help alleviate pain from chronic pancreatitis.

 

Nutrition and Supplements

People who are susceptible to pancreatitis should avoid any alcohol consumption.

Some evidence suggests that increasing your intake of antioxidants (found in fruits and green vegetables) may help protect against pancreatitis or alleviate symptoms of the condition. Several studies have explored the role of free radicals, which are by-products of metabolism that are harmful to cells in the body, in pancreatitis. Antioxidants are often recommended to help rid the body of free radicals, and low levels of antioxidants in the blood may make someone more likely to develop pancreatitis. Alcohol-induced pancreatitis is linked to low levels of antioxidants as well.

Following these nutritional tips may help reduce risks and symptoms:

• Eliminate all suspected food allergens, including dairy (milk, cheese, eggs, and ice cream), wheat (gluten), soy, corn, preservatives, and chemical food additives. Your health care provider may want to test you for food allergies.
• Eat foods high in B-vitamins and iron, such as whole grains (if no allergy), dark leafy greens (such as spinach and kale), and sea vegetables.
• Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell pepper).
• Avoid refined foods, such as white breads, pastas, and sugar.
• Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy) or beans for protein.
• Use healthy oils for cooking, such as olive oil or vegetable oil.
• Reduce significantly or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Avoid coffee and other stimulants, alcohol, and tobacco.
• Drink 6 - 8 glasses of filtered water daily.
• Exercise moderately for 30 minutes daily, 5 days a week.

Technorati Tags: management,nursing,careplan. diagnosis,pancreatitis