PANCREATITIS, according to medical internist Dr Samantha Nicholson Spence, is best described as the inflammation of the pancreas. The condition can either be acute or chronic — a sudden inflammation of the pancreas that occurs over a short period of time or becomes permanently damaged from inflammation over many years in the case of the latter — and could result in serious, life-threatening complications.
“What happens is that the pancreas get inflamed, it starts to release the digestive juices which can start the destruction of the organ itself. So it starts to break down — die —because it is such an intense inflammatory process it can cause widespread inflammation and this disorganised inflammation can occur all around the body,” Dr Nicholson explained.
This, she points out, is what is called a systemic inflammatory response syndrome (SIRS) and it can be so severe that the patient may develop respiratory failure and require mechanical ventilation (life support) and they can die even with that.
“They can also develop severe hypotension, which is low blood pressure. The patient can go into shock and require medications to keep the blood pressure high enough to sustain life. They can experience what is known as multi-organ failure where the patient may get heart attacks and go into kidney failure as a result, for example,” Dr Nicholson Spence said.
Since the complications are often so severe, she said that for the best possible outcome, it would be best for these cases to be managed in an intensive care setting. Unfortunately, Jamaica does not have enough intensive care spaces relative to the population, which is quite concerning since alcoholism, which is the second leading cause of pancreatitis, is on the rise in Jamaica and according to Dr Nicholson Spence is expected to continue to increase over the next few years.
“The most common cause of pancreatitis is gallstone disease, accounting for between 30 to 50 per cent of all cases. What usually happens is that a gallstone may block the outflow from the pancreatic duct and so the digestive enzymes back up in the pancreas and start firing and digesting the pancreas,” Dr Nicolson outlined.
She said that other causes of pancreatitis include medications, HIV medication in particular, and diabetes. She explained that the reason diabetes medications may lead to this condition is that diabetes is a disease of the pancreas.
“In the case of type 1 diabetes the pancreas is not producing insulin, or in the case of type 2, your body is not responding to the insulin that is being produced. So even though your body is producing more and more, your body is resistant to it. So since the medication targets the pancreas you may get pancreatitis as a side effect,” Dr Nicholson Spence underscored.
Other possible causes include very high triglyceride levels (fats in the blood), surgery and metabolic disorders. Sometimes, though, the cause is unknown.
“A person who develops chronic pancreatitis will not need to be admitted in the ICU because their symptoms will not be severe. What will happen is that because they would lose their pancreatic functions they wouldn't be able to digest any foods and so what will happen is that they will have fatty stools because they are no longer able to digest fats. The stool will carry a very strong odour and they will lose weight. This, of course, is because they are not able to digest the nutrients from the foods since they cannot digest anything in the first place. They may also experience bone damage and severe backaches,” Dr Nicholson Spence said.
“If there is a lot of death and destruction of the tissue, it serves as a nidus for infection and continued disorganised inflammation all over the body and so you have to reset that tissue. If there is stone blocking the ESPC (endoscopic retrograde colangeo pancreaticogram), what is done is that they put a stone down, get to the duct and open it out so that the stone can fall through.”
Most patients with acute pancreatitis experience nausea, vomiting and severe abdominal pain that radiates towards the back. Dr Nicholson Spence said that they might also have a fever but this does not always happen since it's more of an inflammatory than an infectious process. They may also have features of organ failure, so for example, if it starts affecting the lungs then the person starts getting short of breath. If it's affecting the kidneys then maybe the urine changes colour, or the legs and arms start swelling up. It also affects the ability of blood to clot because it affects the platelet count and so at any time the patient can just start bleeding from anywhere.
Treatment of patients with acute pancreatitis is centred on the control and management of any symptoms. This is generally done in the hospital over a few days and includes antibiotics if the pancreas is infected, intravenous fluids given through a needle, low-fat diet, or fasting since the patient may need to stop eating so the pancreas can recover.