Pancreatitis: Symptoms, Diagnosis, Treatment and Prevention

The pancreas is an elongated gland, located in the upper part of the abdominal cavity, behind the stomach and under the liver. This small organ belongs to both the digestive system and the endocrine system; the pancreas, in fact, is very important for the secretion of enzymes that help digest complex carbohydrates and lipids; moreover, it produces the hormones insulin and glucagon, which regulate the level of glucose in the blood.Pancreatitis, ie inflammation of the pancreas, can be due to various causes. The most common is represented by diseases of the biliary tract, in particular by stones in the gallbladder and liver. These small pebbles can, in fact, end up in the choledochus, a small duct that conveys the bile from the gallbladder to the initial part of the small intestine; the pancreatic duct also opens into the choledochus, so that its obstruction prevents the pancreas from pouring its digestive juices into the intestine. By stagnating in the pancreas, digestive enzymes can already be activated inside the gland, even damaging it severely. The result it is a strong inflammatory reaction, which induces the progressive death of pancreatic cells. The result is severe pain in the abdomen, nausea, heaviness in the stomach, digestive difficulties and vomiting. The pathological picture is however very variable: it ranges from forms mild, which resolve in a few days, to severe forms, which can have an even fatal evolution.

Pancreatitis can come in two different forms: acute and chronic. Acute pancreatitis occurs suddenly and violently. It manifests itself with severe pain in the upper abdomen, radiating to the back and often associated with nausea, vomiting, sweating and fever. The main complications of this acute inflammation are represented by the damage of the pancreatic tissue, with the formation of pseudocysts that can become infected and form abscesses. In the most serious cases, however, the complications can be systemic and the disease can evolve into septicemia, a state of shock, renal and respiratory failure. Chronic pancreatitis, on the other hand, is a less violent inflammatory process, but which lasts over time leading to the progressive destruction of the gland, therefore to its dysfunction. Over time, the pancreas tends to calcify, replacing damaged pancreatic cells with scar tissue. The main symptom of chronic pancreatitis is continuous or intermittent abdominal pain associated with slow weight loss. Chronic pancreatitis also leads to the development of digestive problems, malabsorption of many nutrients, but above all it causes diabetes.

As anticipated, pancreatitis can be due to various causes. As we have seen, it is often attributable to the presence of gallstones; however, the obstacle to the correct outflow of pancreatic juice can also be linked to other diseases, such as cystic fibrosis. The abuse of some drugs, such as diuretics, estrogens, tetracyclines and cortisone, can have toxic effects on pancreatic cells The same goes for chronic alcohol consumption, a very important trigger. At the basis of pancreatitis, there can also be other diseases of the gastrointestinal system, anatomical abnormalities of the pancreas, sharp increase in blood triglycerides, tumors, hypercalcemia and some infections. especially viral. Pancreatitis is also a possible complication of trauma to the pancreas, such as in the case of a strong blow to the abdomen, improperly performed diagnostic maneuvers and surgical interventions on nearby organs, such as the stomach, duodenum and Sometimes, the origin of pancreatitis remains unknown. For chronic pancreatitis, it is necessary to observe are that the inflammatory process can persist for multiple causes, not yet fully known. Probably, genetic and autoimmune factors participate in the origin, in the sense that the inflammation can be triggered by an abnormal reaction of the immune system, which turns against the healthy cells of the pancreas, damaging them.

Turning to the diagnosis of pancreatitis, the first useful clues derive from the analysis of the symptoms reported by the patient. Then, thanks to blood tests, it is possible to find an increase in pancreatic enzymes. In fact, if the pancreatic tissue is damaged, these enzymes pass into the blood circulation and can be highlighted by simple blood tests.Due to the damage to the pancreas, it is also common to find hyperglycemia, a sign of reduced insulin production. Ultrasound and CT scan are also used for diagnostic purposes. Ultrasound can give an idea of ​​the extent of pancreatic damage and, at the same time, is useful for revealing the presence of gallstones. Other tests, such as abdominal CT scan performed with contrast medium and magnetic resonance, allow to recognize pancreatitis even more clearly, discriminate between mild and severe forms and monitor the course of the disease.

The treatment of pancreatitis first of all involves the elimination of the cause that caused the inflammation of the pancreas. For example, depending on the case, it is possible to intervene surgically to remove the stones that obstruct the choledochus, to abstain from alcohol consumption, to avoid alcohol. excess of dietary fats and the ingestion of heavy foods. The treatment is initially conservative, based on fasting and the administration of nutrients through the use of a nasogastric tube. This therapy, in practice, aims to put the pancreas at rest, therefore neither liquids nor food should be ingested, but only elementary nutrients that do not require digestion. In addition to all this, pharmacological treatment is established. Medical therapy is mainly based on pain control with analgesics and administration of rehydrating solutions to combat the loss of fluids caused by vomiting and sweat For patients affected by the forms more serious, antibiotic therapy may also be prescribed to prevent infection of damaged and necrotic pancreatic tissue. Mild forms of acute pancreatitis can subside within days, without consequences. The more severe and chronic forms, on the other hand, may require repeated surgical interventions, which aim to drain the pancreatic duct and remove the fragments of damaged tissue.