- Pancreatitis: Description
- Pancreatitis: Symptoms
- Pancreatitis: Causes and Risk Factors
- Pancreatitis: examinations and diagnosis
- Pancreatitis: treatment
- Pancreatitis: Disease course
A BauchspeicheldrÃ¼senentzÃ¼ndung (Pancreatitis) can occur in acute and chronic form. The typical symptom of acute pancreatitis is a roundness in the back of the upper abdominal pain, which is often accompanied by nausea and vomiting. The chances of a cure depend on the shape and course of the pancreas inflammation. Read all about pancreatitis here.
ICD codes for this disease: ICD codes are internationally valid codes for medical diagnosis. They are found e.g. in doctor's letters or on disability certificates. K86K85
Dr. med. Mira Seidel
The first step in pancreatitis is to abstain from alcohol. He is considered the main cause of the disease.
Causes and risk factors
Examinations and diagnosis
Disease course and prognosis
The pancreatic pancreas lies transversely in the upper abdomen at the level of the duodenum, just behind the stomach. It is important for digestion and metabolic regulation. Of the endocrine Part of the pancreas produces hormones to regulate blood sugar levels (insulin and glucagon) that are delivered directly to the blood. Of the exocrine Part of it, however, produces important digestive enzymes that help to chemically break down the digestive glands in the small intestine from the stomach. Only then can the nutrients from the gut pass into the blood.
Normally, pancreatic digestive enzymes are activated in the gut first. A pancreatitis occurs when the pancreatic digestive enzymes become active in the pancreatic duct itself, before they enter the small intestine. In pancreatitis, the digestive enzymes attack the pancreatic tissue - the pancreas begins to "self-digest" (autodigestion). Then the organ becomes inflamed.
Depending on the course of the disease, two different forms of pancreatitis are distinguished:
The acute form pancreatitis occurs as a result of bile duct disease. It is usually very painful and also dangerous. Of an acute form of pancreatitis, about ten to twenty out of every 100,000 people in Germany are affected annually. It is therefore a rather common disease. Women are more likely to be affected by acute pancreatitis as they often suffer from gallstones, which can cause inflammation. Most patients with acute pancreatitis are between 40 and 60 years old.
Read all about pancreatitis - Acute pancreatitis.
The chronic form of pancreas inflammation returns time and time again, and arises in 80 percent of cases due to persistent alcohol abuse. About eight out of every 100,000 inhabitants in Germany suffer from a chronic form of the disease every year. Men continue to drink more alcohol than women and are therefore more likely to suffer from chronic pancreatitis. Most patients are between 45 and 54 years old.
Read all about pancreatitis - Chronic pancreatitis.
Read all about the typical signs of pancreas inflammation in the article Pancreatitis Ã ¢ â,¬â "Symptoms.
Pancreatitis: Causes and Risk Factors
Acute and chronic forms of pancreatitis have very different causes. While the acute form of pancreatitis most commonly develops from diseased bile ducts, excessive alcohol consumption is by far the most common cause of the chronic condition. But there are other, rarer triggers for pancreatitis.
In about 45 percent of cases, the acute form of pancreatitis is caused by a runoff of digestive enzymes (biliary pancreatitis). The bile duct joins the pancreas in the small intestine along with the pancreatic duct. The entry point of both passages is a small elevation of the mucous membrane of the small intestine called the Vater Papilla. Gallstones may get trapped and obstruct the drainage of the gall bladder and pancreas secretions. The pancreatic secretion contains numerous digestive enzymes, which are now already activated in the pancreas. Because they have a protein-splitting function, the pancreatic tissue is attacked and decomposed by these enzymes. In contrast to acute pancreatitis, gallstones play no role in chronic pancreatitis.
In 80 percent of chronic and 35 percent of acute cases, excessive alcohol consumption (alcohol abuse) is the cause. Those who drink too much regularly run the risk of the pancreas becoming more easily inflamed and the pancreatic tissue increasingly damaged and scarred.
Other causes of pancreatitis
In addition to these two most common triggers of pancreatitis, other causes could trigger pancreatitis. However, in 15 percent of acute cases of pancreatitis, no concrete trigger is found (idiopathic pancreatitis). Among the rare triggers of pancreatitis include:
- Increased fat content in the blood with blood lipid levels> 1000 mg / dl
- Increased calcium levels in the blood, for example, as a result of hyperparathyroidism (hyperparathyroidism)
- Medications, such as diuretics, beta blockers, ACE inhibitor estrogens, antiepileptics, etc.
- After medical interventions such as a gall bladder examination as part of endoscopic retrograde cholangiopancreatography (ERCP)
- Inherited pancreatitis as a result of a genetic defect (hereditary pancreatitis) or in the context of cystic fibrosis
- Viral infections (eg mumps, AIDS, hepatitis)
- As a result of an autoimmune reaction (autoimmune pancreatitis, AIP)
Pancreatitis: examinations and diagnosis
The right contact for suspected pancreatitis is your family doctor or a specialist in internal medicine and gastroenterology. Do not hesitate to visit the central emergency room of a nearby hospital if you have typical pancreatitis symptoms. Already by the exact description of your current complaints and possible pre-existing conditions the doctor receives informative information about your health status (anamnesis conversation). Your doctor may ask the following questions:
- Do you have gallstones?
- How much alcohol do you drink? Was there an above average consumption of alcohol recently?
- Did the symptoms occur suddenly?
- Do you suffer from nausea, vomiting or fever?
- Have you ever noticed elevated blood lipid levels or elevated calcium levels in a blood test?
- Do you have oily diarrhea?
- Do you take any medicine?
The doctor will perform a physical examination to better inspect the abdomen. In pancreatitis, the abdomen often feels "rubbery" on palpation. The reason for this is the increased air in the intestine. As a result of the pancreatitis, the intestine is like "paralyzed", therefore accumulate intestinal gases. In rare cases, bruising occurs on the flanks (Gray Turner sign) or around the belly button (Cullen sign) in the acute form. These are bleeding into the skin caused by the released digestive enzymes. If an obstruction blocks the outflow of bile and pancreatic secretions, gallbladder staining may cause the skin and eyes to turn yellow (jaundice).
The most important study to diagnose pancreatitis is the determination of various blood counts. As a result, pancreatitis can be excluded or confirmed. In addition, most imaging techniques are used to represent the inflammation of the pancreas:
Some blood tests may indicate that the pancreas is inflamed. Others help in the context of the so-called Ranson score to create a prognosis of the disease process.
The enzyme produced by the pancreas lipase is normally used to split fats in the small intestine. In pancreatitis, the lipase is more detectable in the blood due to the inflammatory cell dissolution (normal value: 30 to 60 units per liter). From a three times higher value, the suspicion of a pancreatitis is confirmed. However, the pancreatic lipase value gives no information about the severity of the disease.
The enzyme amylase is responsible for the cleavage of sugar molecules. Their concentration is also determined as it may be increased in pancreatitis. However, elevated levels are not specific to pancreatitis but may be higher than normal in other diseases (for example, salivary gland inflammation).
The Lactate dehydrogenase (LDH) is another protein that may be elevated in pancreatitis. Since LDH is found in many different cell types, an increase is not considered definitive evidence of pancreatitis, but may be an indication. Increased LDH in the blood generally indicates increased cell degeneration, as is the case with pancreatitis but also with other inflammations or tumors.
The C-reactive protein (CRP) increases early in an inflammatory reaction. It is formed by the liver. The CRP values help to classify the severity of the disease and its course.
In any case, also the calcium score analyzed in the blood: too much calcium may be the cause of pancreatitis as it promotes the formation of gallstones. On the other hand, the value may decrease due to pancreatitis. This is considered prognostically unfavorable.
Pancreatitis is often associated with tissue changes that can be detected by imaging techniques.
Ultrasound examination: An ultrasound examination of the abdomen (abdominal ultrasound) provides initial information on the cause of pancreatitis. For example, the doctor may see pent-up bile ducts or a gallstone in the pictures. The pancreas itself is usually difficult to detect with the ultrasound. Therefore, further imaging studies are necessary.
Computed Tomography (CT) and Magnetic Resonance Imaging (MRI): A CT scan helps to classify the severity of pancreatitis. An MRI has an even better image resolution and is also suitable for the diagnosis of pancreatitis. While in the acute form of pancreatitis above all signs of a current damage are to be seen (swelling, fluid around the pancreas, etc.), show in a chronic course of pancreatitis typically calcifications in the pancreas.
Endoscopic examination: Endoscopic retrograde cholangiopancreatography (ERCP) is used when a gallstone or tumor obstructs the flow of digestive juice. With this examination, the two excretory ducts of the gallbladder and pancreas can be displayed and a possible obstacle to passage can be identified. As with gastroscopy, a thin tube is advanced through the esophagus and stomach to the duodenum. In the ducts of bile and the pancreas, an X-ray contrast agent is injected. With the help of an x-ray machine, for example, gallstones can be detected and removed with the help of the endoscope.
Further examinations: Stool examination
If a suspected chronic pancreatitis is suspected, a stool examination can provide clarity. It measures the level of the pancreatic enzyme elastase, which is normally excreted unchanged with the stool. In tissue damage from chronic pancreatitis, less elastase gets into the small intestine and into the stool. Once the concentration of elastase 1 in the faeces is below 200 micrograms per gram of stool, there is an urgent suspicion that the function of the pancreas is limited.
The pancreatitis therapy depends on the form of the disease. The acute form of pancreatitis is potentially life threatening. Patients must therefore be monitored in the hospital. Sufficient hydration and adequate pain therapy are top priorities in the treatment. Also, the diet needs to be adjusted for pancreatitis.
Pancreatitis - fluid administration
In patients with pancreatitis, much fluid from the blood vessels enters the tissue. As a result, there is a lack of fluid in the blood vessels. The blood pressure drops, possibly to the cycle failure by a shock. Sufficient fluid intake via infusions is therefore one of the most important measures for the treatment of pancreatitis.
Pancreatitis - medicines
The acute form of pancreatitis can be very painful. Pain therapy is usually done with so-called opioids. The active ingredients pethidine or buprenorphine are considered to be the best tolerated. In many cases, an antibiotic is additionally administered to counteract the inflammation. To reduce the risk of blood clots (thrombosis) from pancreatitis, heparin is used - it inhibits blood clotting.
Until a few years ago, in an acute form of pancreatitis, a total relinquishment of food in the first 48 hours was an important part of pancreatitis therapy. Because a food intake of any kind stimulates the formation of digestive enzymes in the pancreas. This is problematic because it increases inflammation and pain.
Meanwhile, the patients are supplied with food via a small intestine probe. A thin tube is advanced through the mouth or nose to the small intestine, which is used to administer low-fat, low-fat diet. Since the end of the probe is behind the junction of the pancreas and thus the stomach remains empty, the pancreas is not stimulated to produce digestive secretions.
In addition, strict alcohol prohibition applies. If there is an alcohol addiction, an accompanying medical detoxification should take place.
Patients with chronic pancreatitis suffer from frequent diarrhea and heavy weight loss. Your diet is therefore based on easily digestible whole foods, with many small meals without bloating foods. The pancreatitis diet should aim for low carbohydrate and fat levels to cover the energy intake while relieving the digestive burden of the low fat diet.
Read more about the investigations
Pancreatitis: Disease course
The course and prognosis of pancreatitis are different, depending on whether an acute or chronic form is present. In both forms, however, complications may occur. Basically, any form of pancreatitis is a serious, potentially life-threatening disease. Especially if the following complications are life threatening:
During pancreatitis, pancreatic pseudocysts may form. These are encapsulated fluid collections in the pancreatic tissue, which are surrounded by collagen fibers and wound healing tissue. Unlike real cysts, they have no wall. The pancreatic pseudocysts can recede on their own within six weeks. If the affected suffer from discomfort, a small tube should be surgically applied, through which the fluid can flow. It becomes dangerous when the pseudocysts become infected or empty themselves into the body.
Acute form of pancreatitis - complications
If the acute form of pancreatitis progresses, the pancreatic tissue can be damaged to such an extent that the cells of the pancreas die off (necrotizing pancreatitis). The dead tissue provides a good breeding ground for bacteria. Due to the bacterial infection of the necrosis, an encapsulated collection of pus (abscess) can occur.
Also very dangerous are systemic complications that affect the whole body when an acute pancreatitis progresses untreated:
Volume deficiency shock
A dangerous complication of acute pancreatitis is a heavy fluid loss in the blood vessels - there is a lack of volume (intravascular hypovolaemia). In the worst case, the volume deficiency in the blood vessels is so pronounced that the body can no longer carry out vital functions (volume-loss shock).
Sepsis / SIRS (Systemic inflammatory response syndrome)
In some cases, the inflammation can spread to the rest of the body. In an acute pancreatitis, the surrounding organs of the digestive tract are the first to be affected. It comes to fever (over 38° C) or to a hypothermia (below 36° C). As a result of the inflammation, the blood vessels become more continuous and fluid can more easily escape into the surrounding tissue (edema formation). The heart tries to compensate for the resulting lack of blood volume and increases the heart rate to over 90 beats per minute. The respiratory rate also increases to over 20 breaths per minute, so that the remaining blood in the lungs can be oxygenated as much as possible.
The severe inflammatory reaction in the context of acute pancreatitis can affect the intestine in such a way that it comes to intestinal obstruction by intestinal paralysis. The patient suffers from symptoms such as abdominal pain, nausea and vomiting. When the intestinal obstruction is fully developed, no more stool leaves - it jams back. Those affected vomit it even in extreme cases. An intestinal obstruction is always a medical emergency that needs to be treated as quickly as possible.
Chronic form of pancreatitis - complications
In a chronic pancreatitis abscesses form. The inflamed tissue calcifies in some cases. As a result, the duodenum is sometimes narrowed so much that the porridge can no longer pass through unhindered.
Blood clots in spleen and hepatic veins: Persistent pancreatitis increases the risk of blood clot formation (thrombosis), which could occur in the nearby splenic vein or portal vein. Such a portal vein thrombosis causes the blood to back up and the blood pressure rises. Due to the increased pressure fluid escapes from the vessels and accumulates in the abdominal cavity.
Pancreatic cancer: prognosis
The prognosis of the acute form depends on various factors. Without further complications, the mortality rate is about one percent. If parts of the pancreas have already died (necrotizing pancreatitis), ten to 25 percent of patients die. In the case of an acute pancreatitis, intensive medical monitoring and therapy should be carried out immediately to ensure the best possible chances of recovery.
The chronic form of pancreatitis is usually slow and often associated with other diseases. Statistically, the life expectancy of people with chronic pancreatitis is reduced. About 50 percent of those die within ten to 15 years.However, death occurs less frequently as a result of the disease itself, but due to alcohol abuse, which is by far the most common cause of chronic pancreatitis.
If the pancreas does not function properly due to the inflammation, chronic diarrhea can cause the patient to lose a lot of weight. This weakens the entire organism and weakens it, making it prone to infection. Under absolute alcohol abstinence and appropriate treatment of indigestion is the prognosis of a chronic pancreatitis significantly cheaper.
Read more about the therapies
- feeding tube
These laboratory values are important