Do you have a stomach ache too? Maybe it's pancreatitis!

Do you sometimes experience a strange pain that starts in the lower abdomen and travels to the back? Or do you feel full or uncomfortable after eating? Perhaps behind these things is a problem with a very important organ that we don't talk about much, but may be. Today, let's talk about the pancreas and its inflammation, `(Pancreatitis)`.

What is this pancreas? What happens to it?

Simply put, your pancreas is a small, but very important organ in your abdomen. If you put your right hand across your abdomen, that's how big your pancreas is, behind your stomach and slightly in front of your spine. This little organ does two big things: 1. Helping with digestion: It makes special enzymes (such as amylase) that help your body absorb the nutrients in the food you eat. These enzymes travel down a pancreatic duct into the small intestine, where the food you eat is stored. 2. Controlling blood sugar levels: You've probably heard of insulin. The pancreas makes hormones that help keep blood sugar levels in check.

So, what is pancreatitis?

Pancreatitis is an inflammation or swelling of your pancreas. It's like when we get an injury somewhere in our body, it swells and hurts. This inflammation is what causes the stomach pain we mentioned earlier. Think about it, when our body's defense system (immune system) tries to heal an injured area, inflammation occurs. This inflammation occurs when the pancreas is injured or damaged. Most of the time, this is caused by gallstones blocking the pancreatic duct or excessive alcohol consumption.

Are there types of this?

Yes, there are mainly two types of pancreatitis:

1. Acute Pancreatitis

This is the temporary type. It occurs when the pancreas is trying to heal after a small, short-term injury. Most people recover completely within a few days. However, it requires proper treatment , such as rest, drinking plenty of fluids, and taking painkillers . However, sometimes this ``Acute pancreatitis'' condition can become very severe and can lead to life-threatening complications .

2. Chronic Pancreatitis

This is the long-term, progressive type. It doesn't just get better, it gets worse over time. This condition occurs when damage to the pancreas continues. This causes scarring (`(Fibrosis)`) of the pancreatic tissue, which begins to produce less of the enzymes and hormones it needs to make. This can take years to happen.

How common is this disease?

In a country like America, more than 200,000 people are hospitalized each year due to acute pancreatitis. Of these, about 20% are said to be in a serious condition. Chronic pancreatitis is a little less common, but it still causes about 86,000 hospitalizations each year. This condition is also increasingly seen in Sri Lanka.

What are the symptoms? How do you feel?

The main symptom of pancreatitis is stomach pain , but other symptoms may also occur.

Acute symptoms:

• Nausea and vomiting may occur.
• Heart rate is increasing.
• Breathing becomes rapid and shallow.
• You may get a fever .

Symptoms of a chronic condition:

• Indigestion and pain after eating.
• Loss of appetite and weight loss .
• Oily stool (looks like a film of oil on the toilet).
• Feeling dizzy (due to low blood pressure ).

These mean that your pancreas is gradually failing.

How does this pain feel?

The pain of pancreatitis can range from moderate to severe . It often feels like it's radiating from the abdomen to the outside . Acute pancreatitis is usually more severe, and can feel like a stabbing pain . The abdomen may also hurt when touched. Chronic pancreatitis is a long-term condition that can vary in severity. Sometimes it comes and goes, but it never goes away completely. It's most common after eating. For some people, the pain is constant. When the pain is worse:

• When you lean back.
• When coughing.
• When exercising.
• When you eat too much.

Pain may be reduced when:

• When you sit up straight.
• When you bend forward.
• When you curl up like a ball.
• When you eat less.

How do you know if the pancreas is not working properly?

When the pancreas stops working properly due to chronic pancreatitis, you may first notice changes in your digestive system. When the pancreas can't produce enough digestive enzymes and send them to the intestines, the body can't properly absorb the nutrients in food, especially fats. This can cause discomfort after eating, and undigested fats can pass through your stool. Over time, you may also start to lose weight.

What are the main reasons?

The two main causes of pancreatitis are: 1. Gallstones (Gallstones) 2. Excessive alcohol consumption. When these two causes are combined, they account for about 80% of pancreatitis patients.

1. Gallstone pancreatitis

The bile in your gallbladder enters your intestines through the common bile duct. This duct and the pancreatic duct both open into your intestines at the same point. Imagine what happens if a gallstone gets stuck in that junction? The pancreatic juices can't get out, they get stuck inside the pancreas. Then the pressure increases, and those enzymes start working inside the pancreas, and they start digesting the pancreas itself. That's what causes this inflammation.

2. Excessive alcohol use

Excessive alcohol consumption is also a clear cause of pancreatitis. Although scientists are still not sure exactly how it happens, it is thought that the toxic components in alcohol cause inflammation of the pancreas, or that the digestive enzymes are chemically activated. About half of all cases of acute and chronic pancreatitis are said to be caused by excessive alcohol consumption.

Other reasons

In addition to these two main reasons, there are other reasons, but they are a little less common.

• Various infections, for example viruses.
• The body's own immune system attacks the pancreas (`(Autoimmune pancreatitis)`).
• Genetic mutations that are passed down through generations (`(Hereditary pancreatitis)`).
• Complications of conditions such as cystic fibrosis.
• High levels of fat (triglycerides) in the blood (`(Hypertriglyceridemia)`).
• High blood calcium levels (Hypercalcemia).
• Reduced blood supply to the pancreas (`(Ischemia)`).
• Cancer status.
• Injuries to the pancreas.
• Some medications are harmful to the pancreas.

All these reasons add up to about 20%. Sometimes, no reason can be found.

Are acute and chronic inflammations the same?

Most often, pancreatitis occurs suddenly and goes away temporarily (`(Acute)`). However, if there are ongoing causes, such as hereditary diseases, pancreatitis can occur over a period of time (`(Chronic pancreatitis)`). Similarly, if acute pancreatitis occurs repeatedly, it can also become a long-term condition.Imagine, when the pancreas is continuously subjected to pressure and damage, the body becomes accustomed to it and may continue to have inflammation even after the damage stops.

Can this lead to death?

Yes, if acute pancreatitis becomes very severe, complications can even lead to death. In a small number of people, severe acute pancreatitis can cause a reaction that affects the whole body. This can lead to shock and multiple organ failure. If not treated quickly, it can be life-threatening. It is best to go to the hospital as it is difficult to understand how serious the condition is when you have symptoms.

What are the possible complications?

Most cases of acute pancreatitis do not cause complications. But about 1 in 5 cases can become severe. It is not yet clear why some people get this severe. Severe cases can even lead to death. Chronic pancreatitis can also cause complications, but they develop gradually and are not immediately life-threatening. Most complications can be managed with treatment.

Complications of Acute Pancreatitis:

• Tissue death (`(Necrosis)`) and infection: In about 1 in 3 cases of severe acute pancreatitis, the pancreas becomes so swollen that the blood supply to it is cut off. Then, tissue in some parts of the pancreas dies. This dead tissue is a good place for bacteria. If the bacteria get infected, they can spread quickly and get into the blood. An infection in the blood (`(Septicemia)`) is an emergency. The body responds to this with a condition called `(Systemic Inflammatory Response Syndrome)`. This causes the blood vessels to become enlarged, blood pressure to drop (`(Septic shock)`) and blood to vital organs to decrease, which can lead to `(Multiple organ failure)`.
• Pancreatic pseudocysts: Inflammation of the pancreas can block the duct that carries pancreatic juice to the intestine. The juice then leaks around the pancreas, causing inflammation in the surrounding tissues. Over time, a hard sac with fluid forms around the inflamed area, which is called a pseudocyst. Most of the time, these cysts don't cause symptoms or require treatment. However, they can sometimes become infected or grow large and cause problems. Rarely, a blood vessel can enter the cyst and bleed. In this case, doctors may need to drain the fluid or stop the bleeding.
• Chronic pancreatitis: When acute pancreatitis occurs repeatedly, it can become chronic. When the pancreas is continuously inflamed, scarring (fibrosis) develops in the tissue. This prevents the pancreas from functioning as a gland. Over time, the body's ability to produce enzymes and hormones gradually decreases, leading to further complications.

Complications of chronic pancreatitis:

These occur gradually:

• Exocrine pancreatic insufficiency (EPI), malabsorption, and malnutrition: As the pancreas becomes scarred, it produces less of the enzymes needed to digest food. This makes it difficult for the body to absorb nutrients , especially fats and fat-soluble vitamins. Excess fat is excreted in the stool, leading to oily stools and, later, diarrhea. When you don't get enough nutrition from your diet, you become thin and begin to feel the effects of nutritional deficiencies.
• Low blood sugar (`(Hypoglycemia)`), high blood sugar (`(Hyperglycemia)`), and type 1 diabetes (`(Type 1 diabetes)`): Long-term inflammation of the pancreas also reduces the production of hormones that control blood sugar. Depending on which hormone is affected first, the loss of glucagon can cause low blood sugar (`(Hypoglycemia)`) or the loss of insulin can cause high blood sugar (`(Hyperglycemia)`). Eventually, both hormones are lost and diabetes develops.
• Persistent pain: While some people experience relief from their pain, others find that the pain becomes more severe and persistent. This can be difficult to control, even with medication, and can also affect your mental health.
• Increased risk of pancreatic cancer: Any persistent inflammation anywhere increases the risk of cancer. People who have had pancreatitis for a long time have a 1% to 2% risk of developing pancreatic cancer (pancreatic adenocarcinoma). Because the symptoms are similar to those of chronic inflammation, it can sometimes go unnoticed. Doctors recommend that people with this condition get screened regularly for cancer.

How to diagnose the disease?

If you have symptoms of pancreatitis, your doctor will examine your pancreas with blood tests and imaging tests. A blood test looks for elevated levels of pancreatic enzymes in your blood. If they are more than three times higher than normal, pancreatitis is suspected. A CT scan or MRI may then be done to confirm the diagnosis. These scans can show signs of swelling and fluid buildup in the pancreas. If they suspect you have chronic pancreatitis, other tests may be done:

• Glucose test (to check if the pancreas is producing insulin properly).
• Stool elastase test (to check if the pancreas is producing enough digestive enzymes).
• Fecal fat analysis (see if there is a lot of fat in the stool, which is a sign of poor fat absorption).
• Blood tests (to check your nutritional status and whether you have enough fat-soluble vitamins in your blood).

How is it treated?

Treatment depends on the cause, whether it is acute or chronic, and how severe it is. In general, if you have symptoms of pancreatitis, you should see a doctor. Some acute conditions can be managed on their own, but this depends on the cause and severity. In the meantime, many people need painkillers to help manage the pain. Some people need emergency treatment. Others may need intensive care because of complications.

Treatment for Acute Pancreatitis:

Supportive Care

If the cause is resolved and the condition is not serious, the best course of action is to help the body heal on its own. This usually includes:

• Giving saline (IV fluids): Pancreatitis causes dehydration, and hydration is very important for recovery.
• Tube feeding: If you are unable to eat by mouth, you are given food through a tube that is placed through your nose or into your stomach.
• Parenteral nutrition: In very severe cases, nutrition can be given directly through a vein.
• Painkillers: Painkillers are given either intravenously or orally.

Gallstone Removal

If you have pancreatitis due to gallstones, you may need to have a stone removed from your bile duct. You may also be recommended to have your gallbladder removed (Gallbladder removal surgery) to prevent this problem from happening again. Here's what you can do:

• Endoscopic retrograde cholangiopancreatography (ERCP): This involves passing an endoscope (a thin, flexible tube with a camera attached) into the bile ducts. Many stones can be removed this way. The tube is inserted down the throat and passed through the stomach into the bile ducts.
• Gallbladder removal surgery: Once you've been hospitalized for gallstones, you're more likely to have problems again. So the gallbladder is often removed. This is usually done laparoscopically (`(Laparoscopic cholecystectomy)`), which means it can be done through a few small incisions.

Additional Support

If there are complications, these may also be needed:

• Antibiotics.
• Surgery to remove fluid or dead tissue.
• Intensive care.

Treatment for chronic pancreatitis:

If you have this condition, your general practitioner will refer you to a specialist (a gastroenterologist). Treatment begins with pain management and lifestyle changes to prevent the condition from getting worse. Over time, you may need to take external medications to replace the enzymes and insulin that your pancreas is not producing.

Lifestyle Changes

This is very important. You definitely need to stop drinking alcohol and smoking.Both of these have a big impact on pancreatitis, and the disease can quickly get worse. Your doctor will tell you where you can get help to stop these. It is also very important to get used to a diet low in fat, high in vegetables and fruits, and to drink enough water throughout the day .

Pain Management

Managing chronic pain can be complicated. You may need to try different medications and methods to find what works for you. Be sure to talk to your doctor about your pain and what you can do if things don't help. He or she may refer you to a pain management specialist (a chronic pain specialist). In some cases, endoscopic removal of scar tissue or pancreatic stones can help reduce symptoms. Injecting anesthesia into the nerves in the pancreas (a celiac plexus block) is another option for selected patients.

Nutritional supplements

Over time, many people develop exocrine pancreatic insufficiency (EPI). They must take pancreatic enzymes from outside sources. They also need to take nutritional supplements to get enough calories and nutrients (vitamins and minerals). Some people become unable to tolerate glucose, eventually developing diabetes and becoming insulin-dependent.

Surgery

If severe inflammation is limited to a specific part of the pancreas, and that part is causing unbearable pain or complications, your doctor may recommend removing that part (`(Resection)`). In very advanced cases, if the pancreas is severely damaged and there is still severe pain, the entire pancreas may be removed (`(Total pancreatectomy)`).

What kind of situation can be expected in the long term?

Most people recover completely from acute pancreatitis. If it is not severe, it will usually resolve in 5-10 days. In severe cases or with complications, you may need to stay in the hospital for several weeks. If you can treat the cause, it is possible to prevent a recurrence. In the small number of people who develop organ failure, the mortality rate is about 20%. Chronic pancreatitis is a slowly progressive disease. By seeking regular medical attention and monitoring its progress, you can prevent complications before they occur. Pain management can be a challenge for some people, and it can also affect mental health and quality of life. Surgery may be considered. It is possible to live without a pancreas, but you may need to rely on insulin.

Can this be prevented?

Not all causes can be prevented. But you can reduce your risk by limiting your alcohol consumption . The other major cause of gallstones is by lowering your cholesterol . If you have had acute pancreatitis, quitting alcohol and smoking can help.It helps prevent recurrence. If it is caused by gallstones, removing the gallbladder can prevent recurrence.

You probably don't think much about your pancreas until one day it hurts. This can be a really scary, stressful way to get your attention.

Finally, things to remember

If you have symptoms of pancreatitis, please don't ignore it. See a doctor right away. Most cases of acute pancreatitis will get better in a few days. If you can figure out what's causing it, don't hesitate to treat it. Chronic pancreatitis can start slowly and be undetected by the time you know it. While some causes, like alcohol, are predictable, others can be more unusual and unexpected. You may never have thought you were at risk for developing this long-term condition. However, learning to live with it can be a challenge. You'll need a doctor you trust to help you manage it for the rest of your life. Your health is your responsibility, so take care of it. Pancreatitis, Pancreatitis, Abdominal Pain, Gallstones, Alcohol, Digestion