Pancreatitis

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1- Introduction

2- Pathophysiology

3- Symptoms

4- Treatment

Introduction

Pancreatitis is inflammation of the pancreas, an organ that plays a crucial role in digestion and blood sugar regulation. Pancreatitis can be acute or chronic, each with distinct characteristics, causes, and clinical courses.

Pathophysiology

  • Acute Pancreatitis:

    • Autodigestion: Inflammation occurs when digestive enzymes (trypsin, amylase, and lipase) are prematurely activated within the pancreas, leading to autodigestion of pancreatic tissue.
    • Inflammatory Response: Activated enzymes damage pancreatic cells, triggering an inflammatory response. This can cause edema, hemorrhage, and necrosis of pancreatic tissue.
    • Systemic Inflammatory Response: Severe cases can lead to systemic inflammatory response syndrome (SIRS), multi-organ failure, and complications such as acute respiratory distress syndrome (ARDS) and sepsis.

  • Chronic Pancreatitis:

    • Recurrent Inflammation: Repeated episodes of inflammation cause progressive and irreversible damage to the pancreas, leading to fibrosis, atrophy, and calcification.
    • Loss of Function: Chronic inflammation results in the loss of both exocrine (digestive enzymes) and endocrine (insulin and glucagon) functions of the pancreas, leading to malabsorption, steatorrhea, and diabetes mellitus.

Symptoms

  • Acute Pancreatitis:

    • Severe, sudden onset of upper abdominal pain that may radiate to the back.
    • Nausea and vomiting.
    • Fever.
    • Rapid pulse.
    • Abdominal tenderness.

  • Chronic Pancreatitis:

    • Persistent or recurrent upper abdominal pain.
    • Weight loss due to malabsorption.
    • Fatty, foul-smelling stools (steatorrhea).
    • Diabetes mellitus due to loss of insulin-producing cells.

Treatment

  • Acute Pancreatitis:

    • Hospitalization: Most patients require hospital care for intravenous fluids, pain management, and nutritional support.
    • Fasting: Resting the pancreas by avoiding oral intake of food and fluids initially.
    • Nutritional Support: Gradual reintroduction of food; in severe cases, enteral or parenteral nutrition.
    • Address Underlying Causes: Gallstone removal, cessation of alcohol use, treatment of hypertriglyceridemia.
    • Complications Management: Treatment of complications like infected necrosis, abscesses, and pseudocysts.

  • Chronic Pancreatitis:

    • Pain Management: Medications for pain relief, including analgesics and sometimes opioids.
    • Nutritional Support: Pancreatic enzyme supplements to aid digestion, dietary modifications, and vitamin supplementation.
    • Diabetes Management: Insulin therapy for diabetes mellitus secondary to chronic pancreatitis.
    • Alcohol Abstinence: Complete avoidance of alcohol.
    • Endoscopic or Surgical Interventions: Procedures to relieve ductal obstructions, drain pseudocysts, or resect damaged tissue.
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