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ACUTE AND CHRONIC PANCREATIC DISEASES SURGERY IN INDIA

What Is Pancreatitis?

Pancreatitis is an inflammation of the pancreas. The pancreas is a large gland behind the stomach and close to the duodenum. The duodenum is the upper part of the small intestine. The pancreas secretes digestive enzymes into the small intestine through a tube called the pancreatic duct. These enzymes help digest fats, proteins, and carbohydrates in food. The pancreas also releases the hormones insulin and glucagon into the bloodstream. These hormones help the body use the glucose it takes from food for energy.

Normally, digestive enzymes do not become active until they reach the small intestine, where they begin digesting food. But if these enzymes become active inside the pancreas, they start “digesting” the pancreas itself.

Acute pancreatitis occurs suddenly and lasts for a short period of time and usually resolves. Chronic pancreatitis does not resolve itself and results in a slow destruction of the pancreas. Either form can cause serious complications. In severe cases, bleeding, tissue damage, and infection may occur. Pseudocysts, accumulations of fluid and tissue debris, may also develop. And enzymes and toxins may enter the bloodstream, injuring the heart, lungs, and kidneys, or other organs.

Symptoms of Chronic Pancreatitis in India

Upper abdominal pain and back pain with nausea and vomiting are the main symptoms of chronic pancreatitis. As the disease becomes more chronic, patients may develop malnutrition, weight loss and insulin-dependent diabetes.

The pain is usually a constant, dull pain that gets worse with eating food or drinking alcohol and lessens when sitting up and leaning forward. As the disease progresses, attacks last longer and happen more often. Attacks can last only few hours or as long as several weeks.

If a large area of the pancreas is damaged, its enzymes are not produced and can’t reach the intestines. As a result, food and nutrients are poorly absorbed. Bowel movements become frequent and foul smelling because of problems with fat absorption.

If the pancreas is unable to produce the hormone insulin, these symptoms of diabetes mellitus may develop : –

• Increased thirst
• Increased appetite
• Increased urination
• Fatigue
• Weight loss.

Acute Pancreatitis in India

Acute pancreatitis affects over 80,000 people in the United States every year. Sixty to eighty percent of these cases can be traced to two causes: gallstones and alcohol damage. Gallstones can block central ducts, preventing digestive enzymes from leaving the pancreas. Over time, alcoholism damages the gland and hinders its ability to function.

Diagnosis of Chronic Pancreatitis in India

The diagnosis of chronic pancreatitis is difficult because routine blood studies (such as amylase and lipase levels) do not necessarily show elevations. The most important clue to a proper diagnosis is an accurate medical history. There are many diagnostic tests that can be used for chronic pancreatitis. The evaluation should begin with a plain film of the abdomen. The finding of pancreatic calcification is virtually diagnostic of chronic pancreatitis but quite often this is not found.

Tests the doctor may use to confirm the diagnosis include : –

• Ultrasonography – This method uses high-frequency sound waves that are above the human audible range. An instrument sends sound waves into the patient’s abdomen, and the echoes that the sound waves produce as they bounce off internal organs create a picture called a sonogram.

• CT scanning (Computed Tomography) – This method of testing involves the use of an x-ray machine which is linked to a computer. The patient lies on a bed that passes through a hole, and the machine moves along the patient’s body, simultaneously taking multiple x-rays. The computer then pieces the x-rays together to produce detailed pictures.

• ERCP (Endoscopic retrograde cholangiopancreatography) – A method for taking x-rays of the common bile duct and the pancreatic ducts. The doctor passes a long, flexible tube called an endoscope down the throat, through the stomach, and into the small intestine. The doctor then injects dye into the ducts and takes x-rays.

• EUS (Endoscopic Ultrasound) – This is a test that combines ultrasound (sound waves) with an endoscope. The doctor places the tube (endoscope) into the stomach and the ultrasound machine (which is on the endoscope) is used to direct sound waves to the pancreas.

• MRI (Magnetic Resonance Imaging) – This method of testing involves the use of an x-ray machine which is linked to a computer. The patient lies on a bed that passes through a hole, and the machine moves along the patient’s body, simultaneously taking multiple x-rays. The computer then pieces the x-rays together to produce detailed pictures.

Treatment Options in India

For most acute attacks, pain management with analgesics is all that is required. If infection causes the inflammation, treatment may include antibiotics. Surgery may be required to remove gallstones, drain obstructed bile ducts or remove fluid-filled cysts.

After treatment, alcohol abstinence is highly recommended. Heavy meals should also be avoided, as they place greater demands on the pancreas to produce digestive enzymes.

Chronic Pancreatitis in India

The treatment for chronic pancreatitis depends on the symptoms. However, most therapies focus on pain management and nutritional support. Oral pancreatic enzyme supplements are utilized to aid in the digestion of food. Patients who develop diabetes require insulin to control the blood sugar. It is important to remember that no treatment will help relieve your pain if you drink alcohol. A diet low in fat is necessary and sometimes it is easier for the patient to eat more frequently in much smaller portions. The doctor may recommend surgery to relieve abdominal pain, to restore drainage of pancreatic secretions, or to reduce the frequency of attacks.

Self-Care at Home Surgery in India

For most people, self-care alone is not enough to treat pancreatitis. People may be able to make themselves more comfortable during an attack, but they will most likely continue to have attacks until treatment is received for the underlying cause of the symptoms

If symptoms are mild, people might try the following preventive measures : –

• Stop all alcohol consumption.
• Adopt a liquid diet consisting of foods such as broth, gelatin, and soups. These simple foods may allow the inflammation process to get better.
• Over-the-counter pain medications may also help.

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