Sunday, April 23, 2017


Pancreatitis-Pancreatitis is inflammation of the pancreas.The pancreas is a large organ behind the stomach that produces digestive enzymes.There are two main types,acute pancreatitis and chronic pancreatitis.Signs and symptoms of pancreatitis include pain in the upper abdomen, nausea and vomiting.The pain often goes into the back and is usually severe.In acute pancreatitis a fever may occur and symptoms typically resolve in a few days.In chronic pancreatitis weight loss,fatty stool,and diarrhea may occur.Complications may include infection,bleeding,diabetes mellitus,or problems with other organs.The most common causes of acute pancreatitis are gallstones and heavy alcohol use.Other causes include direct trauma,certain medications,infections such as mumps,and tumors among others.Chronic pancreatitis may develop as a result of acute pancreatitis.It is most commonly due to many years of heavy alcohol use.Other causes include high levels of blood fats,high blood calcium,some medications,and certain genetic disorders such as cystic fibrosis among others.Smoking increases the risk of both acute and chronic pancreatitis.Diagnosis of acute pancreatitis is based on a threefold increase in the blood of either amylase or lipase. In chronic pancreatitis these tests may be normal.Medical imaging such as ultrasound and CT scan may also be useful.Acute pancreatitis is usually treated with intravenous fluids,pain medication, and sometimes antibiotics.Typically no eating or drinking is allowed and a tube may be placed into the stomach.A procedure known as an endoscopic retrograde cholangiopancreatography (ERCP) may be done to open the pancreatic duct if blocked.In those with gallstones the gallbladder is often also removed.In chronic pancreatitis,in addition to the above,temporary feeding through a nasogastric tube may be used to provide adequate nutrition.Long-term dietary changes and pancreatic enzyme replacement may be required.And occasionally surgery is done to remove parts of the pancreas.Globally,in 2013 about 17 million cases of pancreatitis occurred.This resulted in 123,000 deaths, up from 83,000 deaths in 1990.Acute pancreatitis occurs in about 30 per 100,000 people a year.New cases of chronic pancreatitis develop in about 8 per 100,000 people a year and currently affect about 50 per 100,000 people in the United States.[6] It is more common in men than women.Often chronic pancreatitis starts between the ages of 30 and 40 while it is rare in children.Acute pancreatitis was first described on autopsy in 1882 while chronic pancreatitis was first described in 1946.Signs and symptoms-The most common symptoms of pancreatitis are severe upper abdominal or left upper quadrant burning pain radiating to the back,nausea,and vomiting that is worse with eating.The physical examination will vary depending on severity and presence of internal bleeding.Blood pressure may be elevated by pain or decreased by dehydration or bleeding.Heart and respiratory rates are often elevated.The abdomen is usually tender but to a lesser degree than the pain itself.As is common in abdominal disease,bowel sounds may be reduced from reflex bowel paralysis.Fever or jaundice may be present.Chronic pancreatitis can lead to diabetes or pancreatic cancer.Unexplained weight loss may occur from a lack of pancreatic enzymes hindering digestion.Causes-Eighty percent of cases of pancreatitis are caused by alcohol or gallstones.Gallstones are the single most common cause of acute pancreatitis.Alcohol is the single most common cause of chronic pancreatitis.Some medications are commonly associated with pancreatitis,most commonly corticosteroids such as prednisolone,but also including the HIV drugs didanosine and pentamidine,diuretics,the anticonvulsant valproic acid,the chemotherapeutic agents L-asparaginase and azathioprine,estrogen by way of increased blood triglycerides,and antihyperglycemic agents like metformin,vildagliptin,and sitagliptin.It may be noted here that the drugs used to treat conditions that are themselves associated with increased events of pancreatitis...

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