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Inflammation of the Pancreas

more about Inflammation of the Pancreas

  • Pancreas is an organ located behind the stomach and next to the liver and the gall bladder. Pancreatic juices contain enzymes, which help digest or break down food proteins. Normally the juices leave the pancreas via a duct like channel and join the common bile duct, which carries the secretions from the gallbladder, and pour the mixture into the duodenal portion of the stomach.
  • If the pancreas is damaged, the enzymes leak into the pancreatic tissue and start to auto-digest (eat itself) the cells, which results in hemorrhage, swelling, and local destruction within the pancreas. This process is inflammation. Inflammation of the pancreas can occur with an immediate injury to the pancreas (i.e. acute) or with slow, long term damage (chronic).
  • Pancreas is also the site where hormones such as Insulin, Glucagon and somatostatin are produced.

  • Flare-ups may have all signs of acute form
  • Stools may be oily, fatty and loose.
  • Severe abdominal pain that is often in the middle, may radiate to the back or shoulder:
    1. Pain may be sharp in nature
    2. Pain may be worse right after meals (fatty, greasy) and alcohol
  • Abdomen may be bloated, full of gas
  • Heartburn or Indigestion
  • Nausea
  • Vomiting
  • Fever
  • Clammy cold or sweaty skin.
  • Skin or whites of the eyes may be mildly jaundiced (yellowish)
  • There may be bleeding under the skin, Bruising, or rash.
  • The stool is clay-colored.
  • Chest pain or flank pain (lower back)
  • Discoloration around the umbilicus (belly button)
  • In acute cases, pain subsides within 48 hours.

  • Gallstones
  • Chronic alcohol use
  • Accident or trauma
  • Abdominal surgery
  • With procedures such as ERCP
  • Medications such as Tetracycline, steroids, valporic acid, estrogens, Tylenol and thiazide diuretics
  • High levels of blood Calcium or triglycerides
  • Infections:
    1. Mumps.
    2. Hepatitis A and B
    3. Coxsackie B
    4. Salmonella
    5. Campylobacter
    6. Mycoplasma Pneumonia
    7. Ascariasis
    8. HIV
  • Children:
    1. Cystic Fibrosis
    2. Kawasaki's syndrome
    3. Hemolytic uremic syndrome
    4. Reye's syndrome
  • Other:
    1. Kidney failure
    2. Scorpion venom
    3. Polyarteritis Nodosa
    4. Systemic lupus erythematosus
    5. Pancreas divisum-pancreatic split present at birth

  • Your doctor may consult with a radiologist and a digestive diseases specialist known as a gastroenterologist (GI).
  • Medical exam and a full history reveal risks symptoms and signs mentioned above.
  • Blood levels of pancreatic enzymes Amylase and Lipase are often elevated.
  • Blood is also sent for kidney tests, cell count, Electrolytes, and liver and gallbladder functions.
  • Blood levels of ALT, AST, Alkaline phosphatase and Bilirubin are often elevated with liver and gallbladder involvement.
  • Glucose and the number of white blood cells are increased with severe pancreatitis.
  • Calcium levels decrease in severe disease.
  • Blood and urine may be tested for drugs, alcohol or poisoning.
  • LDH, Trypsinogen, CEA, and Magnesium levels may be altered.
  • Stool may be sent for fecal fat test, which often shows fatty stool especially in the chronic form.
  • Blood samples, urine, and fecal samples may be sent in cases where an infection is suspected.
  • X-Rays - Plain radiographs of the abdomen may show air bubbles in the intestine (ileus).
    1. Chronic form may show white areas of Calcium deposits.
    2. X-Rays of lungs may show fluid in the acute case.
  • Ultrasound uses sound and CAT scan a computer to show a detailed image of the abdomen and the pancreas. In the chronic form they may show small cysts and Calcium deposits.
  • ERCP is a procedure in which a GI specialist inserts a flexible tube with a camera at its tip (Endoscope) into the stomach through the mouth and can reach the ducts, inject a dye and take an X-Ray.
  • Special tests such as removing fluid from a cyst in the pancreas can be done by a radiologist using a CAT scan guided needle procedure.

  • Males
  • Drug abuse
  • Alcohol use
  • Chronic form often in older individuals > 35-40
  • See cause

  • Admission to the hospital is necessary for acute attacks.
  • No food or fluids by mouth until pain and abdominal symptoms are resolved.
  • If vomiting may need a NGT, which is a tube, passed through the nose into the stomach.
  • Painkillers such as Demerol are injected.
  • Intravenous fluids are given at a specific rate via a pump and through a small plastic tube placed in a vein.
  • Blood levels are monitored for Calcium, Magnesium, glucose and other chemicals and levels adjusted accordingly.
  • Antibiotics may be given if infection is suspected.
  • A tube called the urinary catheter is placed into the urethra and passed into the bladder in sick patients who need accurate urine volume monitoring.
  • In most cases symptoms resolve within 48 hours.
  • Low fat and low protein food and fluids can be given as tolerated.
  • In chronic cases outpatient therapy is possible.
  • High protein diet and smaller meals are recommended.
  • No alcohol or caffeine.
  • If diabetes is present need to control sugars, use Insulin and see a dietitian for dietary advice.
  • Pancreatic enzyme supplementation such as Pancrease MT may help.
  • H2 blockers such as Tagamet can help in reducing stomach acid.
  • Must be careful when giving people with chronic pancreatitis addictive painkillers (Codeine, Vicodin, Tylenol 3 and 4). Try regular or extra strength Tylenol first.
  • In some acute or chronic cases surgery may be needed to remove a stone, gallbladder, drain a cyst or open a blocked duct.
  • Blood tests and radiographs may need to be repeated after discharge from the hospital.

  • For an acute attack you must go to the hospital immediately. In chronic cases avoid alcohol and other things that aggravate your condition.

  • Intestinal Obstruction
  • Acute pancreatitis
  • Pancreatic Cancer
  • Gallstones
  • Gallbladder infection or inflammation.
  • Mesenteric infarction - Sudden interruption of blood flow to the bowels or intestine.
  • Rupture or perforation of a stomach ulcer.
  • Penetrating stomach (peptic) ulcer.
  • Aortic aneurysm - ballooning of the large blood vessel, the aorta.

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