The pancreas is a thin, flat, long organ placed horizontally deep in the abdomen, a little above the level of the umbilicus. In shape it resembles the wooden spatula often used in the kitchen for use on non-stick pans. The pancreas has two functions. Firstly, it produces pancreatic juice which contains enzymes that digest food. The enzymes are poured by the pancreatic tissue into the duct of the pancreas, and from there they are discharged into the intestines. In the absence of these enzymes, digestion is adversely affected. Secondly, the pancreas produces insulin, which regulates blood sugar levels. If the pancreas is not working properly, the patient can develop diabetes.
Pancreatitis is an inflammation of the pancreas. Pancreatitis occurs because some of its digestive enzymes leak between the pancreatic cells instead of flowing into the pancreatic duct. Here they begin to digest the cells themselves, and can cause immense harm. Inflammation continues unchecked, and the toxins of inflammation can generate oxidants, which further damage the pancreatic tissue. When pancreatitis develops, the pancreas initially enlarges in size and fills with water and other fluids. With time the damaged pancreas either heals or develops a collection of water around it (pseudocyst) or a collection of pus around it (abscess).
The pancreas also contains protective enzymes called antiproteases. With the help of these antiproteases, the pancreas may regress to normal. Sometimes, unfortunately, the damage may continue till much of the pancreas is destroyed.
Pancreatitis can be caused by many factors.
One of the major causes of pancreatitis is alcohol
intake. Another common cause of pancreatitis is stones in
the gall bladder. Some drugs and some viral infections
can also cause pancreatitis.
Pancreatitis presents with abdominal pain.
The pain is in the mid-abdomen and can spread to the rest
of the abdomen and the back. Pain is typically very
severe and lasts for days. It is often confused with the
pain of an ulcer, kidney stones or appendicitis. The
patient can become very ill, with a fall in the blood
pressure and life-threatening changes in the blood.
Vomiting, fall in blood pressure and a rise in the pulse
rate usually occur. Fever may be present.
The best method of treatment is by giving rest to the pancreas. This is done by restricting food intake, and often a tube is passed from the nose into the stomach to suck out the contents of the stomach and intestines. Symptomatic control is by adequate doses of painkillers. Intravenous fluids are administered, and in most cases antibiotics are needed as well to prevent or minimize infection. Newer drugs such as somatostatin have shown promise in decreasing pancreatic enzyme production, thus allowing rest and healing.
If the damage to the pancreas has been
marked, and the patient is not recovering, surgery may be
needed. An operation is needed in the following cases:
The main aim of treatment in acute pancreatitis is provide rest to the pancreas. This is effective only when the pancreas does not need to digest food. Initially the patient is not allowed any food by mouth. After 2 days or more, depending on the severitiy of the attack, the patient is allowed oral fluids, and then solids. Of the nutrients, water stimulates the pancreas the least, and fats the most. Therefore the sequence of nutrients is as follows: first water, then carbohydrates (sugars, starch), then proteins, and lastly fats. Fat-containing foods are allowed after 2-6 weeks. In the early days the patient will be allowed glucose water. 2-3 days later fat-free milk, boiled vegetables, some cereals and pulses can be give. Fried foods, butter, cream etc are fat-containing foods and are allowed only much later.
Intravenous fluids: dextrose, saline,
Ringer's lactate and others
Severe pain in the abdomen is always in indication for visiting your doctor. Pancreatitis is not a condition one can diagnose on ones own, unless the setting is very classical (such as severe upper abdominal pain in the presence of known gall stones or after an alcoholic binge)
Sood, MBBS (AIIMS), MS (AIIMS), MAMS, is a
practising surgeon attached to Dharamshila Cancer
Hospital, Sir Ganga Ram Hospital and to Noida Medicare
Center. Formerly Professor of Surgery, Himalayan
Institute of Medical Sciences, Dehradun, Dr Sood has a
special interest in gastrointestinal surgery. He has had
an active academic career, has published several papers
in national and international journals, and is the Editor
(with Dr Anurag Krishna) of a widely acclaimed book
titled Surgical Diseases in Tropical Countries.
Last revised: May 12, 2000