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Beware, the pancreas is a 'nasty, unforgiving organ'

 Illustration of human pancreas with gallbladder, duodenum and blood vessels. [iStockphoto]

Pancreatitis is the inflammation of the pancreas which is a large organ at the back of the stomach next to the small intestines.

 It releases enzymes that help digest food and also regulates how the body manages glucose by releasing insulin and glucagon into the bloodstream.

Inflammation occurs when digestive enzymes become activated while still in the pancreas, irritating the cells of your pancreas and the tissue around it.

The main causes of pancreatitis are gall stones which can become lodged in the pancreatic duct and cause inflammation and heavy alcohol intake. More rare causes include medications, trauma, infection and abdominal surgery. In some cases, the cause is unknown.

The most common form of the disease is acute pancreatitis, which is a sudden inflammation that lasts for a short while. About 80 per cent of these cases are mild but it can also cause severe, life-threatening illness.

Most people with acute pancreatitis recover completely after getting the right treatment. In severe cases, it can cause bleeding, serious tissue damage and infection. It can also cause harm to other vital organs such as the kidneys, lungs and heart.

Symptoms of acute pancreatitis include pain in the upper part of the belly that radiates the back, tenderness when touching the abdomen, fever, rapid pulse, nausea and vomiting.

The doctor can make a diagnosis of pancreatitis based on a physical examination and taking the patient’s history. To confirm the diagnosis, blood tests are done to measure the levels of two digestive enzymes (amylase and lipase) produced by the pancreas. High levels of these enzymes indicate acute pancreatitis. In addition, ultrasound and CT scans provide images of the pancreas, gall bladder and bile duct that can show abnormalities.

Treatment of pancreatitis should be handled by a doctor who specializes in the digestive system. The pancreas is a “nasty and unforgiving organ”, the more you prod it the more vicious it gets. The best approach is to support the patient by managing the pain, give intravenous therapy as you monitor the pancreas and give it time to repair itself.

The doctor can perform an endoscopic procedure, or surgery to remove a gallstone, a blockage, or damaged part of the pancreas, or the tissue surrounding it. If the pancreas is not functioning well, supplemental enzymes and insulin will be administered. Antibiotics are not necessary during the first week as the disease is inflammatory, not an infection

Depending on the damage done to the other vital organs, in more severe cases the patient might require oxygen, dialysis, or a ventilator.

The best way to prevent pancreatitis is to have a healthy lifestyle. Avoid alcohol, get regular exercise, maintain a healthy weight, stop smoking and reduce fatty foods.

These healthy lifestyle choices will also help to avoid gallstones, which cause 40 per cent of acute pancreatitis cases. Sometimes removing the gallbladder might be recommended to avoid repeat gallstones.

Most people with a mild case of acute pancreatitis take a few days to fully recover. However, those with severe pancreatitis are more likely to have life-threatening complications such as infection of the pancreas, bleeding in the damaged pancreas, heart, lung or kidney failure from spreading infection, or if the pancreas leaks toxins into the blood.

-Dr Karan Gandhi, is a Hepatobiliary and Gastrointestinal Surgeon, Aga Khan University Hospital, Nairobi.

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