NIS

Gallstone Pancreatitis

  • What is the pancreas
  • Types of pancreatitis
  • Causes of pancreatitis
  • Symptoms of pancreatitis
  • Diagnosis of pancreatitis
  • Treatment of pancreatitis
     
  • What is the pancreas
    The pancreas is a solid organ about the size of a cucumber which produces enzymes essential for digestion and hormones such as insulin that help the body regulate blood levels of glucose(sugar). The pancreas is connected to the intestine just below the stomach and is also connected to the bile ducts draining bile from the liver and gallbladder into the intestine.
  • Types of pancreatitis
    In broad categories there are two types of pancreatitis, acute and chronic. Acute pancreatitis is the most common and is an isolated illness that has onset of less than one day and usually resolves within two weeks. Chronic pancreatitis is an ongoing illness which is the result of irreversible damage to the pancreas. The severity of pancreatitis ranges from mild to life threatening with pain ranging from 1 to 11 on a scale of 1 to 10.
  • Causes of pancreatitis
    The causes of pancreatitis in decreasing order of incidence are 1)gallstone pancreatitis, 2) alcohol abuse, 3) hyperlipidemia, 4) familial, 5) drug related, 6)idiopathic, 7) pancreatic divisum and 8) scorpion stings. Gallstone pancreatitis is very important because it is the most common and because it is the most easily cured. Gallstone pancreatitis is also very commonly misdiagnosed and attributed to alcohol abuse incorrectly. Chronic pancreatitis is the consequence of repeated injury to the pancreas over time.
  • Symptoms of pancreatitis
    The primary symptom of pancreatitis is pain in the pit of the stomach commonly radiating to the middle of the back. The pain can be so severe that the patient needs high doses of narcotic pain medications and must be hospitalized.
  • Diagnosis of pancreatitis
    A simple blood test will very quickly and accurately diagnose acute pancreatitis. Amylase and lipase are two enzymes normally produced by the pancreas which get into the blood during an episode of acute pancreatitis and are detectable by blood tests. Chronic pancreatitis is clinically diagnosed by a doctor and can occur when many tests are normal. An endoscopic test called ERCP (endoscopic retrograde cholangiopancreatography) is the gold standard for diagnosing chronic pancreatitis but it is invasive and has risks.
  • Treatment of pancreatitis
    To treat pancreatitis it is mandatory to treat or eliminate the cause. Recurrent pancreatitis caused by gallbladder disease is cured by removing the gallbladder. Failure to diagnose and treat gallstone pancreatitis may result in worsening episodes of pancreatitis which can be life threatening. A common misconception that can lead to errors is that you cannot have gallstone pancreatitis if you do not have gallstones. In fact patients can have undetectably small gallstones causing pancreatitis.

Acute episodes of pancreatitis are treated with hospitalization and supportive care, that is, giving the patient IV fluids and pain medications. The pancreas recovers from acute pancreatitis in its own time as long it is not reinjured by the original cause.

Chronic pancreatitis is much harder to treat and patients frequently live the rest of their lives in pain once they develop this condition. The most severe cases may require removal of the pancreas or a complicated surgical procedure to correct the blockages that occur in the pancreatic duct in chronic pancreatitis. This procedure is knows as a lateral pancreatico-jejunostomy or the Peustow- Gelisby procedure. Removal of the pancreas results in a severe form of diabetes because the body’s source of insulin and glucagon is removed. Digestive enzymes normally produced by the pancreas can be replaced by medications.

Bottom line is that if you have gallstone pancreatitis you need to get your gallbladder removed. If you are uninsured you cannot let that stop you.

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