Acute and chronic pancreatitis

Pancreatitis (acute and chronic) is an inflammation of the pancreas (pancreas) caused by the active enzymes in this organ.

The pancreas is a large gland located behind the stomach and near the duodenum, the initial part of the small intestine.
In the normal digestive process, the pancreatic enzymes are released in inactive form through the pancreatic duct into the small intestine.
They become active in the small intestine.
With pancreatitis, the enzymes inside the pancreas are activated and begin to digest the pancreatic tissue.
This process is known as self-digestion and can lead to irritation of the pancreatic cells, resulting in inflammation of the pancreas.
Through the pancreatic duct, enzymes such as lipase are transported to the duodenum, where the breakdown of lipids that have already been mixed with other enzymes found in bile takes place.
The pancreas also produces other hormones such as insulin and glucagon, which enter the bloodstream.
Normally, the enzymes are activated on the way from the pancreas to the duodenum. However, if the pancreas is inflamed due to gallstones (gallstone pancreatitis) or alcohol abuse, the enzymes already become active in the pancreatic tissue.

Instead of decomposing the lipids in the duodenum, lipase attacks the pancreatic tissue.


Classification of pancreatitis

Pancreatitis can be divided into 2 types: acute and chronic.

In acute pancreatitis, inflammation of the pancreas occurs suddenly with the consequence of pain, while in the chronic form, recurrent (recurrent) inflammation is observed.

Autoimmune chronic pancreatitis (AIP) is an inflammatory disease that occurs because the immune system mistakenly attacks the pancreas, causing inflammation that can also affect the kidneys, liver, lungs, salivary glands, and lymph nodes.

Acute pancreatitis can be divided into two types:

  • Edematous pancreatitis
    This is the mildest and most common type, characterized by inflammation and a small area of lipid necrosis (focal).
  • Acute hemorrhagic-necrotizing pancreatitis Acute hemorrhagic-necrotizing pancreatitis
    arises from inflammation of the pancreas.
    It is a serious and fatal disease, especially in fulminant pancreatitis.
    Signs of acute hemorrhagic pancreatitis are:
    – vomiting;
    – heart disease such as cardiovascular shock;
    – acute pancreatic necrosis or destruction of the islets of Langerhans in the pancreas.

Causes of pancreatitis

The two main causes of pancreatitis, the formation of gallstones and alcoholism, represent about 80% of cases. Alcohol-related pancreatitis occurs due to the long-term consumption of alcoholic beverages.
The formation of gallstones in the gallbladder can lead to the closure of the pancreatic duct and the accumulation of digestive juices inside the pancreas. This causes irritation and inflammation.
One of the risk factors is smoking. Therefore, you should stop smoking.
Other causes:

  • Vascular diseases with low blood pressure
  • Kidney transplantation
  • Trauma
  • Hyperparathyroidism with hypercalcemia
  • Postoperatively after cholecystectomy or other operations, for example on the stomach and pancreas, or after coronary artery bypass

Pancreatitis can develop for various reasons, depending on whether it is acute or chronic.

Acute pancreatitis The main causes of acute pancreatitis
are gallstones, diseases of the gallbladder and alcoholism.
It is also caused by operations on the bile duct, traumatic lesions, abnormal structures of the pancreas, genetic factors, hypertriglyceridemia (increased fat levels in the blood), etc.
Some medications, such as corticosteroids, thiazide diuretics, and estrogens, can cause pancreatitis.
Some bacterial or viral infections such as parotitis, pneumonia (pneumonia) caused by mycoplasma, and Coxsackie B virus can contribute to acute pancreatitis.
As a rule, acute pancreatitis in children occurs together with cystic fibrosis, parotitis, abdominal trauma, Reye’s syndrome, Kawasaki disease and hemolytic-uremic syndrome.

Chronic pancreatitis
Most often, chronic pancreatitis is caused by long-term alcohol abuse.
Some other diseases can lead to chronic pancreatitis, for example, narrowing or occlusion of the pancreatic duct due to trauma, the formation of pseudocysts, hyperparathyroidism, hypercalcemia (may promote the formation of calcium deposits) and hyperlipidemia.
There may be a genetic (hereditary) disease, but in some cases it is idiopathic (no known cause).

Symptoms of pancreatitis

Acute pancreatitis The most common symptoms of acute pancreatitis

  • Abdominal pain that can extend to the back
  • Vomit
  • Nausea
  • Fever

Chronic pancreatitis
Many symptoms of chronic pancreatitis are similar to those of acute pancreatitis, but others may also occur if inflammation of the pancreas persists and worsens over time.
Symptoms of chronic pancreatitis include:

  • Stomach ache
  • Backache
  • Anorexia
  • Swelling
  • Weight loss
  • Malabsorption

The long-term complications of chronic pancreatitis also include the pancreatic tumor.

Diagnosis of pancreatitis

Acute pancreatitis
The responsible doctor is the gastroenterologist.
During the physical examination, the doctor checks whether there is a fever, low blood pressure, rapid breathing and an accelerated heartbeat.
Blood tests are carried out to determine the levels of amylase and lipase in serum and the examination of amylase in the urine
Amylase and lipase are digestive enzymes produced in the pancreas.
Amylase and lipase levels are elevated in acute pancreatitis

Lipase levels in pancreatitis

The lipase level indicates the severity of pancreatitis.

What is lipase and what role does it play?
Lipase is an enzyme produced by the pancreas and released into the small intestine, where it contributes to the conversion of lipids into fatty acids.
It converts lipids such as glycerides into glycerol and free fatty acids.

In addition, other laboratory tests such as a complete blood count, determination of blood sugar and calcaemia are carried out.
Apparatus examinations such as CT, magnetic resonance imaging and echography are used to detect abnormalities in the pancreatic cells and gallstones that close the bile ducts and can also cause jaundice (jaundice).

Ranson Score

When recording:

  • Age over 55 years
  • Number of white blood cells above 16 000/mm3
  • Blood sugar above 200 mg/dl
  • Lactate dehydrogenase > 350 U/l
  • Aspartate aminotransferase > 250 U/l

After 48 hours:

  • Reduction of haematocrit by at least 10%
  • Blood azotemia levels > 5 mg/dl
  • Calcium < 8 mg/dl (reference values are 8.9-10.1 mg/dl)
  • Partial oxygen pressure < 60 mm Hg (may be caused by pleural effusion or pulmonary edema)
  • Base deficit > 4 mmol/l
  • Fluid accumulation > 6 l

Each positive point has the value of 1 point, up to a total score of 3 you can assume an uncomplicated course.

  • From 3 to 4 points, mortality is 15%
  • From 5 to 6 points, mortality is 40%
  • Over 6 points, mortality is 100%

Chronic pancreatitis
The diagnosis of chronic pancreatitis requires some research such as measuring fat content in the stool and blood tests such as amount of amylase, lipase and trypsinogen in the blood.
Abdominal CT, ultrasound and endoscopic retrograde cholangiopancreatography (ERCP) can be performed to verify inflammation or calcium deposits in the pancreas.

Possible complications of untreated pancreatitis

If acute and chronic pancreatitis is not treated, it can lead to serious complications.
Acute pancreatitis can cause breathing problems due to some chemical changes in the body.
This can affect lung function.
Due to acute pancreatitis, the risk of bacterial infection in the pancreas increases.
Acute pancreatitis can lead to accumulation of fluids and waste products inside the pancreas, causing the formation of a large pseudocyst.
If this pseudocyst bursts, infections and internal bleeding can occur.
Chronic pancreatitis can cause damage to the cells that produce insulin in the pancreas.
This can cause blood sugar levels to rise, leading to diabetes.
Chronic pancreatitis is considered a risk factor for pancreatic cancer.
Acute and chronic pancreatitis can lead to malnutrition and weight loss due to inadequate digestion of food and impaired nutrient utilization (malabsorption).

Therapy of pancreatitis

At the initial stage, the patient is not allowed to eat anything to promote the recovery of the pancreas. After that, the patient must follow a diet consisting of low-fat foods.
Drug therapy includes painkillers, for example, paracetamol (ben-u-ron).

Treatment of pancreatitis depends on the underlying cause. Treatment of inflammation of the pancreas due to gallstones consists in surgery to remove the gallbladder. If a bile duct is obstructed or occluded, endoscopic retrograde cholangiopancreatography (ERCP) may be performed to widen the duct.
If pancreatitis is provoked by alcohol abuse, the person must rigorously refrain from drinking.

Diet and nutrition in pancreatitis

Diet is the best remedy for this condition.
It is important to follow a diet that contains a lot of carbohydrates and proteins to promote the functioning of the pancreas.
On the other hand, in pancreatitis, one should completely refrain from eating fatty foods or reduce them.
Daily fat intake should be 30-40 grams.

On the other hand, foods rich in protein and carbohydrates can reduce the workload of the pancreas and lead to a rapid cure of the disease.
When dieting against pancreatitis, one should regularly eat vegetable soups and salads with fresh vegetables or fruits.
In case of hyperglycemia, one should avoid desserts.
Pancreatitis can lead to dehydration and it is therefore important to drink plenty of water throughout the day.

Safe food
The safest foods for pancreatitis are:

  • Salad
  • Oatmeal
  • Rice
  • Potatoes
  • Yams
  • Turkey
  • Tofu
  • Fresh fruit juice
  • Vegetable soups and vegetable broth
  • Lean fish
  • Pumpkin
  • Soy milk

to avoid 
In the diet for acute and chronic pancreatitis, one should completely avoid all spicy, fried and processed foods. You should also avoid fatty foods.
Foods and beverages to avoid include:

  • Eggs
  • Cheese
  • Bacon
  • Beans
  • Bratwurst
  • Butter
  • Black tea
  • Sugar
  • Coffee
  • Caffeine
  • Energy drinks
  • Wine
  • Beer
  • Pizza

How long does pancreatitis last? Prognosis

Recovery times for acute edematous pancreatitis range from one to two weeks, and mortality is less than 2%.
Acute necrotizing hemorrhagic pancreatitis has a mortality rate between 30 and 50%.