Re: Acute pancreatitis vs. Chronic pancreatitis

[Guest guest]

Acute Pancreatitis.

This is a medical emergency marked by acute abdominal stress. Symptoms are

caused by spillage of pancreatic fluids into the abdominal cavity. These

fluids contain enzymes which begin to digest and destroy the lining of the

intestine and the intestinal wall itself as well as any internal organs it

encounters.

Pain typically radiates from the pit of the abdomen through to the back with

nausea, vomiting, low-grade fever, and shock. Some patients exhibit none of

these save shock. There may be evidence of intra-abdominal bleeding.

Causes include direct trauma, overindulgence in alcoholic beverages, viral

and bacterial infections, duodenal ulcer perforation into the pancreas,

certain metabolic insults, and toxicity from some pharmacological drugs.

The diagnosis is made by ultrasound with supporting evidence from elevated

pancreatic enzyme levels (amylase and lipase). These people usually have

elevated white cell counts.

Acute pancreatitis is a medical emergency and must be treated in a hospital

setting. In addition to the usual management doctors in nutritional medicine

have noted that intramuscular selenium followed by repeat doses 24 hours

later, then daily doses are useful in the management of this disorder. Only

doctors who practice nutritional medicine have a clue about the use of

selenium for this indication.

In the acute stage of acute pancreatitis the patient should have nothing by

mouth, intravenous feeding should be instituted, calcium and magnesium

levels maintained, pain managed, and the cause of the disorder treated. This

may involve surgery.

Chronic pancreatitis may result from one or more bouts of acute pancreatitis

and this condition is marked by radiologic evidence of calcification of the

pancreas, passage of undigested fat in the stool, diabetes, vitamin B12

deficiency, and poor digestion due to loss of pancreatic enzymes. Also a

cyst-like condition may develop requiring surgery.

The most important aspect in the treatment of acute pancreatitis is

supportive care. This includes replacement of fluid and electrolytes,

correction of metabolic abnormalities such as symptomatic hypercalcemiaand

nutritional support. Other measures such as the use of nasogastric suction

and antibiotics should be decided on a case-by-case basis.

Agents that have been used to inhibit pancreatic secretion have not been

found to be useful in altering the course in acute pancreatitis. These

include somatostatin and glucagon. Protease inhibitors, which are effective

in laboratory studies, have not been shown to be useful in clinical

pancreatitis.

Emergency surgery is not indicated in mild acute pancreatitis. Some surgical

procedures such as resection of necrotictissue and peritoneal lavagemay have

a role in select patients with severe, progressive necrotizing pancreatitis

or pancreatic abscess. Cholecystectomy has been demonstrated to be effective

in patients with recurrent acute pancreatitis and microlithiasis (Figure

17).

Surgical sphincteroplasty of the pancreatic sphincter is an alternative

approach to endoscopic pancreatic sphincterotomy in patients with pancreatic

sphincter dysfunction. Although the patient outcome is the same as for the

endoscopic approach, it is more invasive, requiring laparotomy and .

duodenotomy

Sphincteroplasty of the minor papilla is indicated for unsuccessful or

failed endoscopic minor papilla sphincterotomy in patients with . pancreas

divisum

Endoscopic therapy has a therapeutic role in three specific areas in the

management of acute pancreatitis: 1) acute gallstone pancreatitis, 2)

recurrent pancreatitis due to pancreatic sphincter dysfunction, and 3)

recurrent pancreatitis due to . pancreas divisum The rationale for

endoscopic therapy in each area is the relief of obstruction to flow of

pancreatic juice.

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Although it would seem logical that removal of the gallstones from the

common bile duct early in acute gallstone pancreatitis would improve the

clinical course, there is a lack of a " predictable " good outcome as

suggested by propective clinical trials. It appears, however, that the

patients with suspected stones who benefit from early ERCP are those with

evidence of biliary obstruction such as jaundice or dilation of the bile

duct and severe pancreatitis. Further clinical trials are needed before more

definitive recommendations can be made. In a subgroup of patients with acute

recurrent pancreatitis and ,microlithiasis endoscopic sphincterotomy has

been shown to significantly reduce the frequency of attacks (Figure 18).

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With the advent of manometric studies of the pancreatic sphincter, many

cases of so-called idiopathic recurrent pancreatitis are now known to be a

result of pancreatic sphincter dysfunction. Endoscopic pancreatic

sphincterotomy may be expected to have a good outcome in up to 90% of these

patients. There are two techniques for endoscopic pancreatic sphincterotomy;

one is with a pull-type sphincterotome followed by stenting of the

pancreatic duct and the second is with a needle-knife sphincterotome

performed over a pancreatic stent. Following pancreatic sphincterotomy there

may be tissue swelling that could result in obstruction to pancreatic

outflow. Therefore, short-term pancreatic stenting is indicated when

pancreatic sphincterotomy is performed to maintain patency of pancreatic

outflow (Figure 19).

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Endoscopic minor papilla sphincterotomy is effective treatment for patients

with recurrent pancreatitis and pancreas divisum (Figure 20). Good long-term

results are found in about 70% of patients but may be significantly less if

there are changes of chronic pancreatitis.

There are two techniques for endoscopic minor papilla sphincterotomy; one is

with a pull-type sphincterotome followed by stenting of the pancreatic duct

and the second is with a needle-knife sphincterotome performed over a

pancreatic stent (Figure 21). Following pancreatic sphincterotomy there may

be tissue swelling that could result in obstruction to pancreatic outflow.

Therefore short-term pancreatic stenting is indicated when pancreatic

sphincterotomy is performed to maintain patency of pancreatic outflow.

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Acute pancreatitis vs. Chronic pancreatitis

> Can someone help me understand the difference between multiple

> episodes of acute pancreatitis and chronic pancreatitis. I do not

> understand how a person is classified into each category.

> Meghan

> Age 22

> Diagnosed with mastocytosis, interstitial cystitis, GERD, bile

> gastritis

> have had about 6 episodes of pancreatitis

>

>

>

>

>

>

> Too many emails!

> Change your mail delivery status not your membership status!!

> send an e-mail to:KarynWms@...

>

> To change your mail delivery status, send an email to:KarynWms@...

>

>

>

[Guest guest]

Chronic Pancreatitis

Chronic pancreatitis is an inflammatory disease in which progressive and

irreversible structural changes to the pancreas result in a permanent

impairment of both the exocrine and endocrine functions.

As the pancreas become progressively more scarred, some persons develop

diabetes and/or the inability to digest foods, especially fats. Because of

the lack of normal pancreatic enzymes, digestion of food and the production

of wastes are adversely affected. Abdominal pain is common, especially after

eating. Stools become bulky, greasy, foul smelling and tend to float in the

water because of their high fat content - a condition known as steatorrhea.

The formation of stones in the pancreas is also common.

The treatment of chronic pancreatitis depends on 4 factors: the cause of the

pancreatitis, the portion of the pancreas involved, the presence or absence

os symptoms, and the size of the pancreatic duct.

When symptoms are mild or absent ( " silent pancreatitis " ) no treatment is

indicated. For persons with disabling symptoms, however, treatment is

indicated. Treatment may consist of medications and possibly surgery.

The pancreas is a long, slender organ in the upper abdomen. The exocrine

area of the pancreas produces digestive juices and the endocrine area makes

hormones, such as insulin, that regulate how the body stores and uses food.

Both functions are impaired by chronic pancreatitis, an inflammatory disease

that causes progressive, irreversible structural changes. Some persons

develop diabetes and/or become unable to digest foods, especially fats. The

lack of normal pancreatic enzymes adversely affects digestion and waste

production. Abdominal pain is common, especially after eating. This illness

can make stool bulky, fatty and odiferous (that's " steatorrhea " ), and can

cause stones to form in the pancreas.

In some 70% to 80% of cases, alcoholism is a factor, but other causes can

include duct obstruction, nutritional factors and genetic abnormalities.

About 30% of cases have no known cause. Symptoms include severe abdominal

pain, weight loss and steatorrhea. When symptoms are mild, no treatment is

indicated. When needed, treatment focuses on pain control, relieving duct

obstruction, correcting digestive problems, and detecting and managing

complications.

The choice of treatment for you or for the patient you care about, depends

on the cause, the portion of the organ involved, symptoms and duct size.

This illness requires individual diagnosis and treatment. Not all patients

respond to the same therapy. Treatment may consist of medications and,

possibly, surgery. The Journal of Gastrointestinal Surgery reports that

surgery for chronic pancreatitis " can be performed safely with minimal

morbidity and excellent long-term survival. "

Acute pancreatitis vs. Chronic pancreatitis

> Can someone help me understand the difference between multiple

> episodes of acute pancreatitis and chronic pancreatitis. I do not

> understand how a person is classified into each category.

> Meghan

> Age 22

> Diagnosed with mastocytosis, interstitial cystitis, GERD, bile

> gastritis

> have had about 6 episodes of pancreatitis

>

>

>

>

>

>

> Too many emails!

> Change your mail delivery status not your membership status!!

> send an e-mail to:KarynWms@...

>

> To change your mail delivery status, send an email to:KarynWms@...

>

>

>

[Guest guest]

So in a nutshell Meghan. Chronic pancreatitis is an inflammatory disease in

which progressive and irreversible structural changes to the pancreas result

in a permanent impairment of both the exocrine and endocrine functions.

Acute Pancreatitis is marked by acute abdominal stress. Symptoms are caused

by spillage of pancreatic fluids into the abdominal cavity. These fluids

contain enzymes which begin to digest and destroy the lining of the

intestine and the intestinal wall itself as well as any internal organs it

encounters.

I hope this finds you and yours well

Mark

Acute pancreatitis vs. Chronic pancreatitis

> Can someone help me understand the difference between multiple

> episodes of acute pancreatitis and chronic pancreatitis. I do not

> understand how a person is classified into each category.

> Meghan

> Age 22

> Diagnosed with mastocytosis, interstitial cystitis, GERD, bile

> gastritis

> have had about 6 episodes of pancreatitis

>

>

>

>

>

>

> Too many emails!

> Change your mail delivery status not your membership status!!

> send an e-mail to:KarynWms@...

>

> To change your mail delivery status, send an email to:KarynWms@...

>

>

>

[Guest guest]

Hi Mark! What a great way to explain pancreatitis! I might add one more cause

though, which is structural abnormality (like my pancreas divisum). I notice

you mentioned it later. I've had the endoscopic sphincteroplasty, not to

mention having 5 ERCPs where they cut my common bile duct for my SOD. Now my

pain is coming back and I'm worried about the other type of sphincteroplasty.

What exactly do they do in that surgery? I know it's way more invasive. And

afterwards, what are some of the problems one may encounter? If you have this

info, I would really appreciate it. And thanks again for the great explanation.

Anita

Acute pancreatitis vs. Chronic pancreatitis

> Can someone help me understand the difference between multiple

> episodes of acute pancreatitis and chronic pancreatitis. I do not

> understand how a person is classified into each category.

> Meghan

> Age 22

> Diagnosed with mastocytosis, interstitial cystitis, GERD, bile

> gastritis

> have had about 6 episodes of pancreatitis

>

>

>

>

>

>

> Too many emails!

> Change your mail delivery status not your membership status!!

> send an e-mail to:KarynWms@...

>

> To change your mail delivery status, send an email to:KarynWms@...

>

>

>