Pancreatitis – Symptoms and causes

Overview The pancreas diseases are a long, level organ that sits tucked behind the stomach in the upper midsection. Also, the pancreas produces proteins that help assimilation and hormones that help control the manner in which your body forms its sugar (glucose). Pancreatitis can occur as acute pancreatitis that means it can appear suddenly and […]

Overview

The pancreas diseases are a long, level organ that sits tucked behind the stomach in the upper midsection. Also, the pancreas produces proteins that help assimilation and hormones that help control the manner in which your body forms its sugar (glucose).

Pancreatitis can occur as acute pancreatitis that means it can appear suddenly and lasts for days. Besides pancreatitis can result in chronic pancreatitis, which is pancreatitis that happens over many years.

With some mild cases of pancreatitis, it may go off untreated, but in serious cases can cause life-threatening problems.

The pancreas contains exocrine glands that produce enzymes vital for digestion. These enzymes include trypsin and chymotrypsin to digest proteins; amylase for the digestion of carbohydrates; and lipase to break down fats. When food enters the stomach, these pancreatic juices are released into a system of ducts that culminate in the main pancreatic duct. The pancreas duct joins the common bile duct to form the ampulla of Vater which is located at the first portion of the small intestine, called the duodenum.

There are two groups of pancreatic cysts, nonneoplastic or neoplastic cysts. Each group includes many different subtypes of cysts, such as pseudocysts, serous cystadenomas, and mucinous cystic neoplasms. Most aren’t cancerous, and many don’t cause symptoms. But some pancreatic cysts can be or can become dangerous.

Pancreatitis is inflammation in the pancreas. The pancreas is a long, flat gland that sits tucked behind the stomach in the upper abdomen. The pancreas produces enzymes that help digestion and hormones that help regulate the way your body processes sugar (glucose).

Cyst on pancreas

They are saclike pockets of fluid on or in your pancreas. The pancreas is a large organ behind the stomach that produces hormones and enzymes that help digest food. Pancreatic cysts are typically found during imaging testing for another problem.

The main categories of pancreatic cysts can be divided into two groups, nonneoplastic or neoplastic cysts. Each group includes many different subtypes of cysts, such as pseudocysts, serous cystadenomas, and mucinous cystic neoplasms. Most aren’t cancerous, and many don’t cause symptoms. But some pancreatic cysts can be or can become cancerous.

Pancreas Duct System

There is a main pancreatic duct that collects juices from all the branches of the pancreatic stream, and exits at the main papilla of Vater. The pattern of these branches varies considerably, but this does not matter.

Further more, there is often another important duct (named after Santorini) that connects the main pancreatic duct to another small papilla (the minor or accessory papilla) which is found about 2 cm (3/4 inch) above the main papilla of Vater in the duodenum.

In addition to this, (normal) arrangement comes about as a result of complex reorganization during fetal development. Early in the development of the embryo, the pancreas is in two parts (dorsal and ventral elements).

Altogether, these parts usually join together to form one pancreas between six and eight weeks of pregnancy. Even after joining, the santorini stays open or “patent,” and drains into the minor papilla in over half of patients. Thus, the patient who develops a problem at the main papilla (like a stone or tumor) may not develop any symptoms of pancreatic obstruction if Santorini’s duct and the minor papilla are open, and can take over the drainage function.

There are other rarer variations of pancreatic anatomy. Annular pancreas describes a congenital condition in which one of the branches of the pancreas swings all around the duodenum; this can narrow the duodenum sufficiently to cause an obstruction and require an operation.

Enzymes in pancreas

Pancreatic enzymes help break down fats, proteins and carbohydrates. A normally functioning pancreas secretes about 8 cups of pancreatic juice into the duodenum, daily. This fluid contains pancreatic enzymes to help with digestion and bicarbonate to neutralize stomach acid as it enters the small intestine.

Enzymes in pancreas and Their Effects

Lipase

Effects:
Lipase works with bile from the liver to break down fat molecules so they can be absorbed and used by the body.

Shortage may cause:
  • Lack of needed fats and fat-soluble vitamins.
  • Diarrhea and/or fatty stools.
Protease

Effects:
Proteases break down proteins. They help keep the intestine free of parasites such as bacteria, yeast and protozoa.

Shortage may cause:
  • Allergies or the formation of toxic substances due to incomplete digestion of proteins.
  • Increased risk for intestinal infections.
Amylase

Effects:
Amylase breaks down carbohydrates (starch) into sugars which are more easily absorbed by the body. This enzyme is also found in saliva.

Shortage may cause:
  • Diarrhea due to the effects of undigested starch in the colon.

Types of Pancreas diseases

  • Neuroendocrine tumors (NET) of the pancreas/duodenum

These are rare tumors. They are most often sporadic (not inherited), but some may be part of inherited syndromes such as MEN or Von Hippel-Lindau.

  • Nonfunctioning NETs of the pancreas

These tumors do not produce hormones that cause symptoms. Therefore they are usually discovered late. If the disease has not spread outside of the pancreas, the best treatment is usually surgery.

  • Gastrinoma

These tumors produce gastrin, which can lead to ulcers and diarrhea, known as Zollinger-Ellison syndrome. The tumors are found in the “gastrinoma triangle”, which encompasses the duodenum and the head of the pancreas.

  • Insulinoma

These tumors produce insulin, which leads to profound hypoglycemia and symptoms of mental status changes, and loss of consciousness. The symptoms disappear with eating sugary foods. Most (90%) are benign. They are often difficult to diagnose and localize. Insulinomas may be part of the MEN1 syndrome.

  • Endocrine pancreas surgery

Many pancreatic neuroendocrine tumors may be removed with enucleation, which essentially shells out the tumor from the pancreas gland. However, the removal of part of the gland is sometimes required. A pancreaticoduodenectomy or Whipple procedure removes the head of the pancreas, and a distal pancreatectomy removes the body and tail of the pancreas.

  • Preoperative preparation for pancreas surgery

Patients with functional neuroendocrine tumors of the pancreas will need to have the effects of hormone excess controlled prior to surgery. Patients with insulinomas will need to be admitted overnight to the hospital for IV glucose infusions and frequent glucose determinations while they are NPO (nothing by mouth) prior to surgery.

Pancreas pain location

The location of the pain in the pancreas affects the types of symptoms and how soon they might start to show. For example, jaundice symptoms may appear when the pain obstructs the head of the pancreas.

If the pain is in the body or tail of the pancreas, pain and weight loss might be more likely. Pancreatic cancer in the body or tail can also take longer to present with symptoms, allowing the pain more time to grow or metastasize before it’s found.

Location of cyst on pancreas

The characteristics and location of the pancreatic cyst, along with your age and sex, can sometimes help doctors determine the type of cyst you have:

  • Pseudocysts are not cancerous (benign) and are usually caused by pancreatitis. Pancreatic pseudocysts can also be caused by trauma.
  • Serous cystadenomas can become large enough to displace nearby organs, causing abdominal pain and a feeling of fullness. Serous cystadenomas occur most frequently in women older than 60 and only rarely become cancerous.
  • Mucinous cystic neoplasms are usually situated in the body or tail of the pancreas and nearly always occurs in women, most often in middle-aged women. Mucinous cystadenoma is precancerous, which means it might become cancer if left untreated. Larger cysts might already be cancerous when found.
  • An intraductal papillary mucinous neoplasm (IPMN) is a growth in the main pancreatic duct or one of its side branches. IPMN may be precancerous or cancerous. It can occur in both men and women older than 50. Depending on its location and other factors, IPMN may require surgical removal.
  • A cystic neuroendocrine tumor is mostly solid but can have cystlike components. They can be confused with other pancreatic cysts and may be precancerous or cancerous.

Pancreatitis Symptoms & Signs of pancreatitis

Mainly signs of pancreatitis and symptoms vary, depending on which type you experience.

Pancreatitis signs and symptoms include:

  • Pain in Upper abdominal
  • Abdominal pain that spreads to your back
  • Abdominal pain that feels worse after eating
  • Fever
  • High pulse
  • Nausea
  • Vomiting
  • Tenderness when touching the abdomen
Chronic pancreatitis signs and symptoms include:
  • Upper abdominal pain
  • Losing weight without even trying
  • Oily, smelly stools (steatorrhea)

Pancreas problems in Animals

Pancreatitis in Dogs

When your family dog doesn’t feel to eat and is spitting out, you hope it gets better. It could be a condition of pancreatitis. The state happens when there is an inflamed pancreas. There is an organ near the stomach that helps digest food and maintain blood sugar levels.

Pancreatitis in Cats

The pancreas is a small organ tucked between your cat’s stomach and intestines.  This organ plays a critical role in producing hormones called insulin and glucagon that controls blood sugar. The pancreas also makes digestive enzymes that help to break down fat, protein, and carbohydrates. This range of variety means that the signs of a pancreatic problem often linked to other medical conditions.

Symptoms

 

Often, a dog:

  • Loses appetite
  • Vomits
  • Has belly pain

Other symptoms are:

  • Fever or low body temperature
  •  Diarrhea
  • No energy
  • Difficulty in breathing
  •  Dehydration

Your doctor might take a sample of the pancreatic cyst fluid to determine if cancer cells are present. Or your doctor might recommend monitoring a cyst over time for changes that indicate cancer.

What are the Symptoms of Acute Pancreatitis?

Almost everyone with acute pancreatitis has severe abdominal pain in the upper abdomen. The pain penetrates to the back in about 50% of people. When acute pancreatitis is caused by gallstones, the pain usually starts suddenly and reaches its maximum intensity in minutes. When pancreatitis is caused by alcohol, pain typically develops over a few days.

Coughing, vigorous movement, and deep breathing may worsen the pain. Sitting upright and leaning forward may provide some relief. Most people feel nauseated and have to vomit, sometimes to the point of dry heaves (retching without producing any vomit). Often, even large doses of an injected opioid analgesic do not relieve pain completely.

In acute pancreatitis, a person may develop some swelling in the upper abdomen. This swelling may occur because the intestinal contents have stopped moving, causing the intestines to swell (a condition called ileus).

Some people, especially those who develop acute pancreatitis because of alcohol use, may never develop any symptoms other than moderate to severe pain.  These conditions may decrease the amount of lung tissue available to transfer oxygen from the air to the blood and can lower the oxygen levels in the blood.

Pancreatitis Diagnosis with doctor consultation

Not to mention, try to make an appointment with your doctor if you have to feel abdominal pain. Therefore, seeking immediate help. If your abdominal pain super serious that you can’t sit, walk or find a position that makes you comfortable that means a serious problem is here.

Acute Pancreatitis Diagnoses

  • Blood tests
  • Imaging tests

Characteristic abdominal pain leads a doctor to suspect acute pancreatitis, especially in a person who has gallbladder disease or who drinks a lot of alcohol. During the examination, a doctor often notes that the abdomen is tender and the abdominal wall muscles may be rigid. When listening to the abdomen with a stethoscope, a doctor may hear few or no bowel (intestinal) sounds.

  • Blood tests

No single blood test proves the diagnosis of acute pancreatitis, but certain tests suggest it. Blood levels of two enzymes produced by the pancreas—amylase and lipase—usually increase on the first day of the illness but return to normal in 3 to 7 days.

  • Imaging tests
  1. X-rays of the abdomen may show dilated loops of intestine or, rarely, one or more gallstones. Chest x-rays may reveal areas of collapsed lung tissue or an accumulation of fluid in the chest cavity.
  2. An ultrasound of the abdomen may show gallstones in the gallbladder or sometimes in the common bile duct and also may detect swelling of the pancreas.
  3. A computed tomography (CT) scan is particularly useful in detecting inflammation of the pancreas and is used in people with severe acute pancreatitis. For this scan, people are also injected with a contrast agent. The agent is a substance that can be seen on x-rays. Because the images are so clear, a CT scan helps a doctor make a precise diagnosis and identify complications of pancreatitis.
  4. Magnetic resonance cholangiopancreatography (MRCP), a special magnetic resonance imaging (MRI) test, may also be done to show the pancreatic duct and bile duct and to determine if there is any dilation, blockage, or narrowing of the ducts.
  5. Endoscopic retrograde cholangiopancreatography allows doctors to view the bile duct and pancreatic duct. During this test, doctors are able to remove from the bile duct gallstones that are causing a blockage.

Whipple procedure

A Whipple procedure — also known as a pancreaticoduodenectomy — is a complex operation to remove the head of the pancreas, the first part of the small intestine (duodenum), the gallbladder and the bile duct.

The Whipple procedure is used to treat tumors and other disorders of the pancreas, intestine and bile duct. It is the most often used surgery to treat pancreatic cancer that’s confined to the head of the pancreas. After performing the Whipple procedure, your surgeon reconnects the remaining organs to allow you to digest food normally after surgery.

The Whipple procedure is a difficult and demanding operation and can have serious risks. However, this surgery is often lifesaving, particularly for people with cancer.

Inflamed pancreas / Pancreatitis Causes

Additionally,pancreatitis can happen when digestive enzymes in  pancreas become activated while still in the pancreas, irritating the cells of your pancreas and causing harmful inflammation.

Moreover, repeated bouts of acute pancreatitis, harm to the pancreas can result and lead to chronic pancreatitis. Scar tissue may form in the pancreas, causing a lack of function. Further, A badly functioning pancreas can cause digestion problems and diabetes. Moreover, the most common symptom of acute pancreatitis is upper abdominal pain. It can range from bearable to severe. The pancreas pain location usually occurs in the middle of the body, just under the ribs.

Conditions that can lead to pancreatitis include:
  • Abdominal surgery
  • Alcoholism
  • Certain medications
  • Cystic fibrosis
  • Gallstones
  • High calcium levels in the blood (hypercalcemia), which may be resulted by an overactive parathyroid gland (hyperparathyroidism)
  • High triglyceride levels in the blood (hypertriglyceridemia)
  • Infection
  • Injury to the abdomen
  • Obesity
  • Pancreatic cancer

The most common causes (more than 70% of cases) of acute pancreatitis are

  • Gallstones
  • Alcohol use
  • Gallstones

It cause about 40% of cases of acute pancreatitis. They are collections of solid material in the gallbladder. These stones sometimes pass into and block the duct that the gallbladder shares with the pancreas (called the common bile duct).

Normally, the pancreas secretes pancreatic fluid through the pancreatic duct into the first part of the small intestine (duodenum). This pancreatic fluid contains digestive enzymes that help digest food. If a gallstone becomes stuck in the sphincter of Oddi (the opening where the pancreatic duct empties into the duodenum), pancreatic fluid stops flowing. But if the blockage remains, the enzymes collect in the pancreas and begin to digest the cells of the pancreas, causing severe inflammation.

  • Alcohol

Alcohol use causes about 30% of cases of acute pancreatitis. The risk of developing pancreatitis increases with increasing amounts of alcohol (4 to 7 drinks per day in men and 3 or more drinks per day in women).

. Another theory is that alcohol may cause the small ductules in the pancreas that drain into the pancreatic duct to clog, eventually causing acute pancreatitis.

  • Other causes

For some people, acute pancreatitis is hereditary. Gene mutations that predispose people to develop acute pancreatitis have been identified. People who have cystic fibrosis or carry the cystic fibrosis genes have an increased risk of developing acute as well as chronic pancreatitis. Many drugs can irritate the pancreas.

Risk factors

Factors that accelerate your risk of pancreatitis include:

  • Excessive alcohol consumption. Research states that heavy alcohol users (people who consume four to five drinks a day) are highly vulnerable to pancreatitis.
  • Cigarette smoking. Smokers are on average three times more likely to develop chronic pancreatitis, compared with nonsmokers. However, the good news is leaving smoking lessens your risk by about half.
  • Obesity. You’re more likely to have pancreatitis if you’re overweight.
  • Family history of pancreatitis. The part of genetics is becoming increasingly important in chronic pancreatitis.

Complications

As well, Pancreatitis can lead to severe complications, including:

    • Pseudocyst. Acute pancreatitis can occur from fluid and debris to collect in cystlike pockets in your pancreas. However, a large pseudocyst that ruptures can cause difficulties such as internal bleeding and infection.
    • Infection. Acute pancreatitis can make your pancreas vulnerable to bacteria and infection. Therefore, pancreatic infections are serious and require intensive treatment, such as surgery to remove the infected tissue.
    • Kidney failure. It causes kidney failure, which can be treated with dialysis if kidney failure is serious and persistent.
    • Breathing problems. In fact, acute pancreatitis can result from chemical changes in your body that affect your lung function, causing the level of oxygen in your blood to drop to dangerously low levels.
    • Diabetes. Damage to insulin-producing cells in your pancreas from chronic pancreatitis can result in diabetes, a disease that influences the way your body takes blood sugar.

Pancreas cancer Staging

Long-standing inflammation in your pancreas results in chronic pancreatitis which is a risk for cancer pancreas cause.

 

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