What if the Patient Has Gallstones?
Ultrasound is used to detect gallstones and sometimes can provide the doctor with an idea of how severe the pancreatitis is. When gallstones are found, surgery is usually needed to remove them. When they are removed depends on how severe the pancreatitis is. If it is mild, the gallstones often can be removed within a week or so. In more severe cases, the patient may wait a month or more, until he improves, before the stones are removed. The CAT (computer axial tomography) scan may also be used to find out what is happening in and around the pancreas and how severe the problem is. This is important information that the doctor needs to determine when to remove the gallstones.After the gallstones are removed and inflammation subsides, the pancreas usually returns to normal. Before patients leave the hospital, they are advised not to drink alcohol and not to eat large meals.
What Is Chronic Pancreatitis?
Chronic pancreatitis has many causes but 70 to 80 percent of cases are due to chronic alcohol abuse. It may develop after only one acute attack, especially if the ducts of the pancreas become damaged. Damage to the pancreas from drinking alcohol may cause no symptoms for many years, and then the patient suddenly has an attack of pancreatitis. It is more common in men than women and often develops between 30 and 40 years of age. In other cases, pancreatitis may be inherited. Inherited forms appear to be due to abnormalities of the pancreas enzymes that cause the enzymes to autodigest the pancreas.In the early stages, the doctor cannot always tell whether the patient has acute or chronic disease. The symptoms may be the same. Patients with chronic pancreatitis tend to have three kinds of problems: pain, malabsorption of food leading to weight loss, or diabetes.
Some patients do not have any pain but most do. Pain may be constant in the back and abdomen, and for some patients, the pain attacks are disabling. In some cases, the abdominal pain goes away as the condition advances. Doctors think this happens because pancreatic enzymes are no longer being made by the pancreas.
Patients with this disease often lose weight, even when their appetite and eating habits are normal. This occurs because the body does not secrete enough pancreatic enzymes to break down food, so nutrients are not absorbed normally. Poor digestion leads to loss of fat, protein, and sugar into the stool. Diabetes may also develop at this stage if the insulin-producing cells of the pancreas (islet cells) have been damaged.
How Is Chronic Pancreatitis Diagnosed?
Diagnosis may be difficult but is aided by a number of new techniques. Pancreatic function tests help the physician decide if the pancreas still can make enough digestive enzymes. The doctor can see abnormalities in the pancreas using several techniques (ultrasonic imaging, endoscopic retrograde cholangiopancreatography (ERCP), and the CAT scan). In more advanced stages of the disease, when diabetes and malabsorption (a problem due to lack of enzymes) occur, the doctor can use a number of blood, urine, and stool tests to help in the diagnosis of chronic pancreatitis and to monitor the progression of the disorder.How Is Chronic Pancreatitis Treated?
The doctor treats chronic pancreatitis by relieving pain and managing the nutritional and metabolic problems. The patient can reduce the amount of fat and protein lost in stools by cutting back on dietary fat and taking pills containing pancreatic enzymes. This will result in better nutrition and weight gain. Sometimes insulin or other drugs must be given to control the patient's blood sugar.In some cases, surgery is needed to relieve pain by draining an enlarged pancreatic duct. Sometimes, part or most of the pancreas is removed in an attempt to relieve chronic pain.
Patients must stop drinking, adhere to their prescribed diets, and take the proper medications in order to have fewer and milder attacks. Reprinted from the National Digestive Diseases Clearinghouse
