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| Pancreatitis |
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| Also Listed As: |
Pancreas, Inflammation of |
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Pancreatitis is inflammation of the pancreas,
a glandular 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; a duct
connects it to the duodenum, the first part of the small intestine.
Pancreatic enzymes and bile produced by the liver enter the
duodenum at the same location.
Pancreatitis may be either acute (sudden
and severe) or chronic. Both acute and chronic pancreatitis
can cause bleeding and tissue death in or around the pancreas.
In a single episode of acute pancreatitis, the gland usually
heals without causing functional or structural changes, but
in the case of recurring pancreatitis, long-term damage is
common. In chronic pancreatitis, smoldering attacks result
in a slow deterioration of the structure of the pancreas and
loss of pancreatic function.
Necrotizing pancreatitis (which involves
death of pancreatic tissue) 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 lining of the
abdomen. This can damage blood vessels and lead to internal
bleeding, which may be life threatening.
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| Signs and Symptoms |
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Common signs and symptoms of pancreatitis
include the following:
- Severe, ongoing, sharp abdominal pain,
often radiating to the back
- Nausea and vomiting
- Fever
- Sweating
- Abdominal tenderness
- Rapid heart rate
- Rapid breathing
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| What Causes It? |
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There are several possible causes of
pancreatitis:
- Disease of the biliary tract. The
biliary tract is the system of organs and ducts (including
the liver, gallbladder, and bile ducts) that creates, transports,
stores, and releases bile into the duodenum for digestion.
The formation of stones in the biliary tract can block the
main duct of the pancreas as it enters the duodenum.
- Heavy alcohol use over a long period
of time, which can raise protein levels in pancreatic juices.
Over time, the protein can form plugs, blocking small pancreatic
ducts. Alcohol also allows enzymes to pass more easily through
duct walls and damage the pancreas. Biliary tract stones
and alcoholism are the most common causes of pancreatitis.
- The drugs azathioprine, sulfonamides,
corticosteroids, nonsteroidal anti-inflammatories (NSAIDs),
and tetracyclines
- 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
- Injury resulting in compression of
the pancreas against the spine
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| Who's Most At Risk? |
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These conditions or characteristics increase
the risk for pancreatitis:
- Biliary tract disease
- Binge alcohol use and chronic alcoholism
- Recent surgery
- Family history of high triglycerides
- Age (most common between ages 35 and
64)
African-Americans are at higher risk
than Caucasians and Native Americans.
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| What to Expect at Your
Provider's Office |
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Your healthcare provider will examine
you for signs and symptoms of pancreatitis. He or she may
also perform blood tests, take X rays, and use ultrasound,
computed tomography (CT) scans, and other procedures to determine
the severity of your condition and decide which treatment
options are most appropriate.
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| Treatment Options |
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| Treatment Plan |
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Mild edematous pancreatitis (marked by
buildup of fluid in the pancreas) can usually be treated with
intravenous fluids and by fasting, along with careful monitoring
by the healthcare provider. Nasogastric suction (suction of
the stomach using a tube inserted through the nose) reduces
stomach secretions and prevents stomach contents from reaching
the small intestine. This procedure is sometimes used although
there is no proven benefit. Parenteral nutrition (nutrients
given through the veins, muscles, or skin rather than orally)
may be needed if the patient does not adequately recover within
several days. For those with low blood pressure, low urine
output, low levels of oxygen in the blood, or increased levels
of red blood cells, more aggressive therapy may be required.
For pancreatitis from high triglycerides, treatment includes
weight loss, exercise, fat-restricted diet, control of blood
sugar for diabetics, and avoidance of alcohol and medications
that can raise triglycerides, such as thiazide diuretics and
beta-blockers.
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| Drug Therapies |
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Painkillers such as meperidine may be
prescribed. Antibiotics, such as ampicillin, ceftriaxone,
and imipenem, may be given to treat or prevent infection in
some cases.
Enzyme Replacement: Oral intake of exocrine pancreatic
enzymes are of key importance in the treatment of mal-digestion
in chronic pancreatitis with pancreatic insufficiency. It
has been studied for the therapeutic effectiveness of a conventional
and an acid-protected enzyme preparation, and an acid-stable
fungal enzyme preparation in the treatment of severe pancreatogenic
steatorrhea. The results showed that a supplemental enzyme
preparation is best for patients with chronic pancreatitis
and those who underwent Whipple's procedure (a surgical procedure
performed on pancreatic cancer patients), while patients with
an intact upper gastrointestinal tract fare best with an acid-protected
porcine pancreatic enzyme preparation.
Pancreatin is secreted from the pancreas and provides potent
concentrations of the digestive enzymes protease, amylase,
and lipase. Pancreatin is sold as a drug to treat those with
pancreatic insufficiency. Pancreatin efficacy was demonstrated
in a study conducted on patients who took pancreatin to maintain
postoperative digestion. The effects of supplementation were
determined by measuring the postoperative intestinal absorption
and nutritional status in a randomized trial with patients
receiving pancreatin or placebo. Before the trial, patients
showed abnormal digestion of fats and protein, and total energy
was low at baseline and 3 weeks after surgery. Pancreatin
supplementation improved fat and protein absorption as well
as improving nitrogen balance. However, those patients taking
a placebo had worsened absorption after the surgery. The data
suggest that long-term postoperative pancreatic enzyme supplementation
is both efficacious and necessary in surgery patients who
suffered from pancreatitis.
There are many forms of Pancreatic Enzymes on the Market.
Consult your Doctor for which one is best for you and which
dosage you should be taking before meals. For more information
on types and dosages of Pancreatic Enzymes, Click
Here
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| Surgical and
Other Procedures |
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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 hemorrhagic (bleeding) pancreatitis, surgery will stop
the bleeding and help restore pancreatic function. 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 where he or she can gain access
to the pancreatic and biliary ducts.
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| Complementary and
Alternative Therapies |
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A number of 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. Several
ways to neutralize these deleterious effects have evolved
over time. Antioxidants, for example, help rid the body of
free radicals. Insufficient antioxidant levels in the blood
(including reduced amounts of vitamin A, vitamin E, selenium,
and carotenoids), though, may lead to chronic pancreatitis
due to the destructive effects of increased free radical activity.
Antioxidant deficiency and the risk of developing pancreatitis
may be particularly relevant in areas of the world with low
soil concentrations or 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.
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| Nutrition |
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As explained, low levels of antioxidants
in the blood may make an individual more prone to develop
pancreatitis; at the same time, someone who already has pancreatitis
is more likely to develop deficiencies of the following nutrients:
- Magnesium – particularly in
the case of chronic alcoholism
- Methionine
- Selenium
- Vitamin A
- Vitamin C
- Vitamin E
Some studies do suggest that taking these
nutrients mentioned, particularly the latter five each of
which has antioxidant properties, can reduce the pain from
which people with pancreatitis suffer and recover more readily
from the condition. Other potentially valuable supplements
to take include:
- Vitamin B12; levels may be low with
pancreatitis; works best in this case if given by injection.
- Soybeans; extracts of soybeans known
as polyunsaturated phosphatidylcholines (PCs) work as antioxidants
and have demonstrated prevention of damage to the pancreas
in animal studies.
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| Herbs |
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- Emblica officinalis (Indian
gooseberry) is a traditional Ayurvedic medicinal plant used
to treat pancreatic disorders. It is the richest natural
source of vitamin C. Animal studies further suggest that
this herb can be used to prevent development of pancreatitis.
Individual case reports suggest that
traditional Chinese medicines are effective for the prevention
and treatment of pancreatitis including the following which
are also used commonly as both Western and Ayurvedic treatments
of gastrointestinal disorders:
- Licorice root (Glycyrrhiza glabra)
- Ginger root (Zingiber officinale)
- Asian ginseng (Panax ginseng),
- Peony root(Paeonia officinalis)
- Cinnamon Chinese bark (Cinnamomum
verum)
Animal studies further suggest the value
of using these herbs in combination along with the following
herbs:
- Bupleurum (Bupleri falcatum L)
- Pinelliae tuber (Pinelliae ternata)
- Chinese skullcap (Scutellariae
baicalensis)
- Jujube (Zizyphi jujuba)
To determine the regimen for each individual,
it is best to see a skilled herbalist or licensed and certified
practitioner of traditional Chinese medicine, particularly
because these herbs often work best in combination.
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| Reflexology or
Massage Therapy |
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Reflexology is based on a system of points on the
hands and feet thought to correspond or "reflex" to other
areas of the body. The technique is thus specific to particular
body parts (most often the feet), but is intended to assist
the entire body
Massage Therapy has been described as "the healing
touch." Often referred to as bodywork or somatic therapy,
massage therapy refers to the application of various techniques
to the muscular structure and soft tissues of the body. It
consists of a group of manual techniques that include applying
fixed or movable pressure, holding, and/or causing movement
of or to the body, using primarily the hands. The massage
therapist can also use other areas of the body, such as the
forearms, elbows or feet. These techniques affect the musculoskeletal,
circulatory-lymphatic, nervous, and other systems of the body.
The goal of massage therapy is fairly straightforward: to
positively affect the health and well being of the client.
Numerous physical and mental health benefits have been attributed
to massage, including reducing stress and aiding in relaxation;
reducing the heart rate; lowering blood pressure; increasing
blood circulation and lymph flow; relaxing the muscles; reducing
chronic pain and improving joint range of motion. Specifically,
people have found that therapeutic massage can help manage
a variety of conditions:
For more information on Refexology, Massage Therapy and other
forms of Alternative Healing Click
Here
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| Acupuncture |
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The value of acupuncture for treating
pancreatitis is controversial. There are case reports stating
that acupuncture has helped relieve pain from pancreatitis
and pancreatic cancer. But a review of several studies finds
that results of acupuncture and electroacupuncture (small
electrical currents applied through acupuncture needles) for
pancreatitis are mixed with some concluding that there is
no benefit with the addition of either of these modalities
for people with pancreatitis.
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| Prognosis/Possible
Complications |
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Possible complications of pancreatitis
include infection of the pancreas; cyst-like pockets that
can become infected, bleed, or rupture; the failure of several
organs (heart, kidney, lungs) and shock due to toxins in the
blood; and diabetes. In mild edematous pancreatitis, with
inflammation in the pancreas alone, the prognosis is excellent.
Fewer than 5% of people with this form die. With severe tissue
death and bleeding, or where inflammation is not confined
to the pancreas, the death rate is 10 to 50% or higher, due
to infection and other serious complications. In chronic pancreatitis,
recurring attacks tend to become more severe.
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| Following Up |
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Patients with chronic pancreatitis should
eat a low-fat diet, abstain from alcohol, and avoid abdominal
trauma to prevent acute attacks and further damage. Those
with high triglyceride levels should lose weight, exercise,
and avoid medications, such as thiazide diuretics and beta-blockers,
that increase triglyceride levels. Given the recent reports
suggesting that oxidative stress may contribute to the development
of pancreatitis and that antioxidant supplementation may be
of some benefit, healthcare providers may begin recommending
antioxidant nutrients to their patients with pancreatitis.
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