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        How does the pancreas become unhealthy and if it does, what does this mean to your overall health and quality of life experiences?

     Pancreatitis is when the pancreas gland becomes inflamed and its metabolic functions become partially to fully ineffective.  Not only is this life sustaining metabolic function impaired with acute dysfunction, it is also a very painful experience.

     So where is the pancreas located and what’s its role in the bodies overall metabolic function?  The pancreas is a gland behind the stomach and below the liver.  The pancreas has two main functions.  It is responsible for enzyme secretion that aids in the digestion of carbohydrates, proteins and fat.  It also works in harmony with the liquid bile your liver produces to assist in digestion as well.  The bile is stored in the gall bladder, and is also activated when food is consumed.   The liver, pancreas, gall bladder and stomach’s small intestine entry way reside in close proximity to each other.  Together these organs perform a very high level metabolic function to regulate energy and food nutrient absorption through the digestive process.

     The combination of this bile liquid and pancreas hormonal secretion is absorbed through the small intestinal wall after food has been consumed and activated for digestion at the stomach’s exit and small intestine entry way (duodenum). When the pancreas stops producing these digestive enzymes, or these enzymes are blocked from doing their job in the intestines, all sorts of complex health problems can/do occur.

     The second function of the pancreas is the production and release of insulin and glucagon.   The release of these two hormones is responsible for maintaining blood glucose metabolism from the foods you consume for the bodies energy.  These hormones store and release the calorie energy when needed.  When blood sugar stops being regulated optimally by the pancreas, then one becomes diabetic.

     The enzymes secreted from the pancreas become active when absorbed by the small intestine.  However, if the enzymes are not released and held within the gland it becomes inflamed.  These trapped secretions then can begin to eat up the inside tissues of the pancreas after a meal.  At this point, one can bleed internally while the gland begins to experience tissue death.

     How does the pancreas get to a state of cannibalizing and destroying itself?  Let’s take a look at the statistics to hone in on the main culprit.  More cases of pancreatitis are seen in men than women.  And it appears that 70% of the pancreatitis cases in the United States are caused from alcohol abuse.  And 45% of these patients convert an acute condition to chronic due to the alcohol repeatedly inflaming and scarring the gland.  Then the patient experiences varying-to-constant pain in the abdomen and back.  In 10-15% of the total pancreatitis cases the cause of the disease is unknown.

     There are other ways in which acute pancreatitis occur:  Genetics, certain habits and diseases.  And in any case or cause, if the pancreatic ducts become blocked during digestion, the enzymes can become trapped within the pancreas.  Or if the bile secretion becomes blocked (gall stone blockage) this can be very painful and create other digestive ill-health issues. In either case, you’re going to experience a painful medical condition that requires treatment.  Other conditions linked to pancreatitis: Autoimmune problems, damage to ducts through surgery; an accident that damages the gall bladder, or pancreas; and high blood fat levels (hypertriglyceridemia).

 Symptoms: 

     You’ll experience pain tender to touch in upper left side, or middle of abdominal.  And this pain may be worse after eating, or drinking foods higher in fat.  The pain can also radiate to the back below the left shoulder blade and is felt worse when lying on the back.  Other symptoms can include: Indigestion, hiccups, clay-colored stools, skin rash, sores, swollen abdominal and mild yellowing of skin and whites of the eyes (jaundice).  Due to malabsorption of food, weight loss may be experienced because the gland does not release enzymes necessary to break down the food to feed the body adequately.  And if the insulin-producing cells of the pancreas are damaged, diabetes will ensue.

 Diagnostic tests:

     Imaging tests that show pancreas inflammation and damage: Abdominal CT scan, MRI, and ultrasound.  Endoscopic ultrasound (EUS) and biopsy for tissue sample.  Endoscopic Retrograde Cholangiopancreatography (ERCP) to look at bile ducts using contrasts and X-rays.  There is also a pancreatic function test to see what levels of digestive enzymes are being released.  And a glucose tolerance test to measure pancreas insulin production.

 Treatments:

     With acute pancreatitis patients are primarily treated with fluids and pain medication.  These attacks usually last a few days.  However if the gland is complicated by necrosis (tissue death), or inflammation, other damage can occur to heart, lungs, or kidneys.  During chronic cases, fluids may need to be drained around pancreas, or gallstones removed.  Blocked pancreas ducts may need to be opened.  In severe cases dead or infected pancreatic tissue may have to be surgically removed.  With chronic pancreatitis, continued alcohol consumption will increase the risk of further health complications.

 Prognosis:

     With most acute flare-ups, the symptoms after treatment go away in a few days to a week.  However, if acute turns to chronic pancreatitis then life-threatening illness may follow.  The death rate is high with hemorrhagic and necrotizing pancreatitis that can also impair the liver, heart and kidney function.  Pancreatitis can return any time and is really dependent on cause, and patient compliance with treatment and following lifestyle change recommendations.

 Risk Factors and Prevention:

     Avoid alcohol, or limit significantly your consumption of alcohol. A low-fat diet will be helpful to include proper medications for fewer and milder attacks if you experience acute pancreatitis.  Children with fevers should avoid aspirin; also if a child has a viral illness (to reduce the risk to Reye syndrome).  Risk factors for chronic pancreatitis: Alcohol, hereditary conditions (i.e., Cystic fibrosis), gallstone disease, high triglyceride condition and lupus.

     So how serious do you think acute pancreatitis is?  I’d say if you are experiencing early symptoms of an inflamed pancreas, or have had gall stones, or are a diabetic, I’d say your pancreas health is pretty important stuff to pay attention to.  And if you can change your behaviors and habits to never experience pancreatitis, count yourself fortunate.  Why is that?  Because once you have pancreatitis it could become chronic after a period of time.  Then you are looking at a permanent treatment program for life and possibly a painful and early death.

     Can treatment help alleviate and cure the most severe conditions? Of course treatment is going to alleviate much of the discomfort. But once the damage is done, you then become dependent on pharmaceuticals, frequent out/inpatient treatment, diagnostic testing, lab tests, and diet restrictions. This then becomes your cure.

 References

Banks PA, Freeman ML; Practice Parameters Committee of the American College of Gastroenterology. Practice guidelines in acute pancreatitis. Am J Gastroenterol . 2006;101:2379-2400.

 Frossard JL, Steer ML, Pastor CM. Acute pancreatitis. Lancet . 2008;371:143-152.

 Owyang C. Pancreatitis. In: Goldman L, Ausiello D, eds. Cecil Medicine . 23rd ed.

 Philadelphia, Pa: Saunders Elsevier; 2007:chap 147.

¹Russo MW, Wei JT, Thiny MT, et al. Digestive and liver disease statistics, 2004. Gastroenterology. 2004;126:1448–1453.

http://www.webmd.com/digestive-disorders/digestive-diseases-pancreatitis?

http://health.nytimes.com/health/guides/disease/acute-pancreatitis/overview.html?

http://digestive.niddk.nih.gov/ddiseases/pubs/pancreatitis/#acute

Marc T. Woodard, MBA, BS Exercise Science, USA Medical Services Officer, CPT, RET.  2011 Copyright, All rights reserved, Mirror Athlete Publishing @: http://www.mirrorathlete.org,  Sign up for your Free eNewsletter.