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Gastroenterology in Critical Care
Pancreatitis
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The Pancreas
The pancreas is an abdominal organ that manufacturers insulin and certain digestive enzymes.
Causes of Pancreatitis
Pancreatitis is an inflammation of the pancreas. It is often, but not always, the result of alcohol abuse. It can also be due to gallstones that migrate and block the pancreatic duct, high fat levels in the blood, hyperthyroidism, pancreatic tumors, abdominal injury, infection and drug allergies. Often the exact cause of acute pancreatitis cannot be diagnosed.
Symptoms
Symptoms include fever, nausea, vomiting, dehydration, severe abdominal pain and delirium. These can progress to shock and death. Pancreatitis is especially serious because the information may release digestive enzymes that cause additional, widespread damage.
Pancreatitis is a true diagnostic challenge because it mimics other serious abdominal diseases, such as perforated peptic ulcer and intestinal obstruction. Blood test and CT scan usually diagnose the disorder.
Treatment
Treatment depends on the underlying causes (for example, gallstones are other infection). Immediate IV fluid replacement is always required, and patients usually benefit from a nasogastric tube and maintaining NPO status.
With acute pancreatitis, a pseudocyst can form. This round, fluid filled cavity in the pancreas, results from the effects of the errant enzymes which can literally self digest the organ. A pseudocyst can be seen on CT scan or by ultrasound exam. If it causes pain or hemorrhage (or rapidly enlarges), it must be surgically drained.
Chronic pancreatitis often follows repeated attacks of acute inflammation. It can cause chronic abdominal pain, and usually leads to diabetes and poor digestion, because of the organ malfunctions.
Treatment of this disorder is complex; involving medicine, intravenous fluids and sometimes surgery to remove inflamed tissue. The long-term, postoperative prognosis is guarded, depending on the cause of the pancreatitis.
REFERENCE:
Gott, Peter H, MD, “Pancreatitis Not Always Due to Alcohol”, The Benton Courier, p 3, Dec 14, 00
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