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Inflammation of the pancreas (pancreatitis): causes, symptoms, therapy
What is pancreatitis?
Acute pancreatitis is often caused by excessive alcohol consumption or gallstones. The disease can take an easy course, but it can also develop very seriously. Then it is potentially life threatening.
Chronic pancreatitis, on the other hand, is represented by intermittent, recurring, non-infectious inflammation. The most common background of the disease is chronic alcohol abuse.
Function of the pancreas (pancreas)
The pancreas is located in the upper abdomen, near the stomach, duodenum and spleen, and is about ten to 20 centimeters long. Their job is, among other things, to produce the enzymes necessary for digestion. Around 1.5 liters of pancreatic juice are produced in the pancreas every day - a secretion made up of water, ions and digestive enzymes. This fluid enters the small intestine through an outlet duct. There the food is broken down into its individual components so that the body can then use them further. In addition, the pancreas produces various hormones that regulate the sugar metabolism. One of them is insulin in particular.
Inflammation of the pancreas - cause
There are numerous causes of inflammation of the pancreas. Sudden pancreatitis (acute inflammation of the pancreas) is differentiated from slow, chronic inflammation. This chronic pancreatitis persists for a long time and is usually made worse by acute relapses.
Causes of Acute Pancreatitis
- Acute pancreatitis is often caused by alcohol consumption. The amount of alcohol is often not decisive, because in some people even a small dose triggers the inflammation of the organ.
- A disease of the biliary tract can also lead to pancreatitis. Because a gallstone can clog the bile duct and the pancreatic duct at the same time. Both flow together into the small intestine. Then the bile builds up. In addition, the pancreas becomes inflamed because the digestive juice cannot drain away.
- Smoking increases the risk of developing pancreatitis.
- In some patients, the cause of pancreatitis cannot be determined (idiopathic pancreatitis).
Rarer causes of acute pancreatitis:
- Viral infections such as mumps, HIV or viral hepatitis
- A greatly increased calcium level, for example if the parathyroid gland is overactive
- Certain medications, for example diuretics, ACE inhibitors, fat reducers, some antibiotics, cytostatics, pain relievers
- Severely increased blood lipid levels (> 1000 mg / dl)
- Mechanical obstacles in the duct of the gland, such as tumors
- Changes in the genetic makeup (including cystic fibrosis, hereditary pancreatitis)
- Organ injuries after accidents or abdominal surgery
Causes of chronic pancreatitis:
Chronic pancreatitis is a recurrent inflammation. In about 70 to 80 percent of cases, it is triggered by regular alcohol consumption. However, some people react with chronic inflammation of the pancreas even to a small amount of alcohol. Chronic pancreatitis often begins insidiously with mild to moderate symptoms. As with the acute form of the disease, this is epigastric pain, which is often belt-shaped around the abdomen. Usually the symptoms show up after eating.
Other causes of chronic pancreatitis are, for example, genetic factors, metabolic disorders or an autoimmune disease (autoimmune pancreatitis).
Pancreatitis - Symptoms
A common sign of acute pancreatitis is severe pain in the upper abdomen that occurs suddenly. In addition, there is often a bloated stomach, nausea and vomiting. The intensity of the symptoms depends on the severity of the inflammation.
Symptoms and possible complications of acute pancreatitis:
- Sudden, severe pain in the upper abdomen. These can radiate in the form of a belt into the back, sometimes also into the chest, and last for several days. Colic pain occurs when gallstones are the cause of the disease.
- Nausea and vomiting.
- Flatulence and a bloated stomach. Usually the stomach is inflated like a rubber and sensitive to pressure. Doctors speak of the so-called rubber belly.
- Flushed face
- Fever and general malaise.
- Circulatory problems. The released inflammatory substances make the vascular walls more permeable and fluid can more easily get into the surrounding tissue. The blood pressure drops and this can cause circulatory problems or even circulatory shock.
- Water retention in the abdomen and lungs. Fluid can also collect in the abdominal cavity (ascites, ascites) or between the lungs and chest wall (pleural effusion).
- Jaundice (jaundice). This can happen if the bile duct is affected in addition to the pancreas. Then the urine turns dark, the stool turns discolored and the conjunctiva of the eyes turns yellow.
- Bluish discoloration of the skin. Acute severe pancreatitis can lead to bluish-greenish spots (bruises) around the navel (Cullen's sign) or on the side flanks (Gray-Turner's sign). The discoloration is caused by small hemorrhages in the superficial fatty tissue. This is considered an unfavorable sign for the further course of the disease.
Possible complications of not treating acute pancreatitis:
Acute pancreatitis that is left untreated can cause complications throughout the body:
- Hypovolemic shock (volume deficiency shock): This occurs when blood vessels become more permeable due to the inflammation and too much fluid escapes into the surrounding tissue. A dangerous lack of volume in the vascular system arises and the blood pressure can then drop so much that the organs are no longer adequately supplied with oxygen. Affected people experience hypovolemic shock.
- Intestinal paralysis: Possible signs of intestinal paralysis are severe pain and gas. The patient may vomit stool. A bowel obstruction is life-threatening and must be treated as quickly as possible.
- Pancreatic pseudocysts: The cysts can develop after acute pancreatitis has subsided. They often stay small and do not cause any discomfort. They usually regress within a few weeks. However, they can also lead to symptoms such as upset stomach or bloating. If the pseudocysts get larger, they can tear and start to bleed. It is also possible that they become infected and form an abscess. To prevent this, in the case of larger cysts, the fluid is sucked off with a hollow needle (drainage). An operation is less often necessary.
- Necrotizing Infectious Pancreatitis: Rarely does acute pancreatitis result in necrotizing infectious pancreatitis. Due to the inflammation of the pancreas, glandular tissue dies (necrosis) and the dead tissue becomes infected with bacteria. A so-called SIRS (systemic inflammatory response syndrome) can occur. This means that the inflammation is spreading throughout the body. Affected people suffer from a high fever, rarely a low temperature, an accelerated pulse and rapid breathing. This is life-threatening because there is a risk of organ failure.
Symptoms of chronic pancreatitis:
Recurring, dull upper abdominal pain is the leading symptom of chronic pancreatitis. The pain can last a few hours, but can also drag on for days and also radiate into the back. As a result of the underactive pancreas, digestive disorders such as flatulence and diarrhea are possible. In the later stages, those affected usually suffer from a nutritional deficiency. Then there are voluminous fatty stools that smell foul. Due to the lack of absorption of fat-soluble vitamins, patients also suffer from vitamin deficiency symptoms. There is a significant weight loss.
If the hormone-producing part of the pancreas is damaged, too little insulin is made and diabetes develops. Chronic pancreatitis can lead to the same complications as the acute form of the disease. It is also possible that pancreatic cancer will develop.
Pancreatitis - course
The prognosis for acute pancreatitis is usually good. However, this assumes that there have been no complications. About 80 percent of those affected are healthy again after one to two weeks. The disease takes a more serious course in around 20 percent. It can then take weeks to months for patients to heal. In the case of severe acute pancreatitis, around 15 percent of those affected die.
Doctors use the so-called Ranson score to estimate the prognosis for acute pancreatitis. Different clinical parameters and laboratory values from the first 48 hours after admission to the hospital are used as a basis. After evaluating all the information, a mortality prognosis can be made. The higher the score in the Ranson Score, the greater the risk that a patient will die of the disease.
Pancreatitis - Diagnosis
If you have symptoms that indicate pancreatitis, you should consult a doctor immediately. If no practice is open, those affected are advised to go straight to the nearest hospital. If the symptoms are very severe, it may be advisable to call the emergency doctor.
The doctor will first inquire about the symptoms and possible causes of the disease. He will ask if the symptoms came on suddenly and if there are certain situations that trigger them. The patient should also provide information about the use of medication, any gallstones (if known) and alcohol consumption.
Symptoms similar to those of pancreatitis can occur in other conditions such as heart attack, appendicitis, biliary and renal colic, ectopic pregnancy, and pulmonary embolism. The doctor will therefore take this into account in the diagnosis.
The doctor examines whether the abdomen is relaxed or tight. If there is a so-called rubber belly, this is an indication of acute pancreatitis. In addition, the stomach is usually very sensitive to pain. Patients often bend their legs to relieve the discomfort. As part of the physical exam, the doctor will also check whether there are bruises on the side flanks or around the navel. He will also check whether the white area around the eyes or the skin has turned yellow.
The determination of certain blood values can be relevant for the diagnosis of pancreatitis. In the case of pancreatitis, increased levels of the pancreatic enzymes lipase and alpha-amylase can be detected in the blood. Since there are other reasons for this, a blood analysis is not the only examination if pancreatitis is suspected.
In addition, blood sugar, kidney and liver values and the calcium level are determined as part of the blood analysis. Elevated calcium levels can cause acute pancreatitis. If the values for gamma-GT and alkaline phosphatase (AP) are increased, this can indicate biliary congestion. In addition, inflammation values can be measured. For example, an increase in C-reactive protein (CRP) suggests inflammation in the body. The CRP value is also often used to monitor the progress of acute pancreatitis.
Patients' stools can provide more detailed information, for example about chronic pancreatitis or exocrine pancreatic insufficiency. In the laboratory, the level of the pancreatic enzyme elastase is measured in the sample. Healthy people excrete it unchanged in their stool. However, if the tissue is damaged, then less elastase reaches the small intestine and stool. The concentration of the enzyme in the faeces is then noticeably low.
The use of imaging techniques is important for a reliable diagnosis of pancreatitis. With the help of an ultrasound examination (sonography), for example, gallstones can be detected. They are among the most common causes of acute pancreatitis. In addition, the extent of the inflammation is clearly visible in the sonography. But also possibly other, disease-related changes, such as dead tissue, accumulation of water in the abdomen and lungs or swelling of the pancreas. If the findings are not clear, magnetic resonance imaging or computed tomography can facilitate the diagnosis, because both methods provide very detailed images. An X-ray examination is usually carried out to check the function of the lungs and intestines. This makes it easy to see possible accumulations of water between the lungs and chest wall, as well as possible air bubbles in a paralyzed intestine.
A biliary specimen can reveal whether the biliary tract is blocked by gallstones or whether there is a tumor in the area of the biliary tract. With this endoscopic retrograde cholangio-pancreatography (ERCP), existing gallstones can usually be removed at the same time.
The therapy of acute pancreatitis and also that of the acute flare-up of chronic pancreatitis take place in the hospital. During the acute phase, continuous monitoring in the intensive care unit is usually necessary. In order not to stimulate the secretion production of the pancreas any further, it is indicated in some patients - at least on the first day - to refrain from eating. These patients are then given fluids and nutrients via the veins (infusion). A quick and sufficient supply of fluids is relevant to support the circulation. Those affected who only suffer from a mild form of the disease are switched to a normal diet at an early stage, preferably to an easily digestible diet. Patients with severe forms are first given a gastric tube (enteral nutrition) before switching to normal diet.
Medication for pancreatitis:
If the pain is severe, often spasmodic, pain killers and antispasmodic drugs are given. A nasogastric tube may be necessary to drain gastric juice. If it becomes severe and there is additional bacterial inflammation, those affected are given antibiotics. To prevent possible thrombosis (blood clots), the anticoagulant heparin is often injected.
Surgery for pancreatitis:
Surgical removal of parts of the pancreas and rinsing of the abdominal cavity are necessary if the dead tissue of the pancreas is inflamed (necrotizing pancreatitis) or if the disease worsens. - If gallstones are the cause of acute pancreatitis (biliary pancreatitis), they are usually removed endoscopically as part of an ERCP. The doctor first uses shock waves to crush larger stones (shock wave therapy). If constrictions are found in the bile duct or pancreatic duct, these can be bridged. Patients should absolutely avoid alcohol and nicotine.
Homeopathy for pancreatitis
Inflammation of the pancreas can be life threatening. Therefore, if you have complaints, you should definitely visit a doctor or the nearest hospital. A distinction is made between acute pancreatitis and the chronic form. Homeopathic medicines - in addition to conventional medical therapy - can often be helpful against typical complaints such as severe upper abdominal pain, flatulence or nausea. When choosing the right active ingredient, it is best to seek advice from an experienced homeopath. These remedies are often recommended to alleviate the symptoms (selection):
- Nux vomica
Acupuncture for pancreatitis
Slowly progressing inflammations such as chronic pancreatitis are not only treated in traditional Chinese medicine with acupuncture, among other things. Modern western pain medicine also relies on acupuncture to relieve symptoms. It usually represents a component in the differentiated spectrum of treatment. In addition, even after an operation, chronic irritation conditions sometimes do not recede immediately and require specialized pain therapy. An experienced acupuncturist or a specialized pain center can assess whether therapy with the fine needles is appropriate for the individual symptoms.
Pancreatitis - ICD Code
In medicine, every illness is assigned its own ICD code.The abbreviation ICD stands for International Statistical Classification of Diseases and Related Health Problems. The classification system is recognized worldwide and is one of the most important for medical diagnoses. For example, “acute pancreatitis” is recorded under the ICD code “K85.-”. Entering these codes often helps with research on the Internet.
Pancreatitis - How Do I Find the Right Doctor?
There are many providers of doctor portals on the Internet. One example is the doctor's information from the Health Foundation. It partly contains a patient satisfaction score and usually has up-to-date postal data. It can be viewed at www.arzt-auskunft.de. If you are looking for a doctor who is familiar with the treatment of inflammation of the pancreas (pancreatitis) and whose practice is close to where you live, you can do research here.
Pancreatitis - How Do I Find the Right Hospital?
When looking for a suitable hospital that is well versed in the treatment of pancreatitis (pancreatitis), you can find some helpful links on the website www.aerzteblatt.de. Among other things to www.weisse-liste.de, www.kliniken.de and www.krankenhaus.de. The website www.kliniken.de offers a particularly comprehensive overview. There are currently 3,846 hospitals from Germany, Austria and Switzerland listed here. In addition, there is detailed information on the specialist departments of the clinics as well as quality reports.
Go to the homepage of www.kliniken.de: Under the menu item “Top-10” you can search specifically for diseases and diagnoses. For inflammation of the pancreas, enter the term “pancreatitis” in the left column (under “Diseases and diagnoses according to ICD10”). If you click on it, the field "VI Diseases of the digestive system" opens underneath. Now click on this and a new field "K80-K87 diseases of the gallbladder, biliary tract and pancreas" will appear. Another click and the field "K85 Acute Pancreatitis / Acute Inflammation of the Pancreas" opens. Go here again and the corresponding hospitals will appear on the right in the mask, sorted according to the ranking of their case numbers. First place is the Charité in Berlin, second place is the Augsburg Clinic and third place is the Nuremberg North Clinic, etc.
Pancreatitis - What does the health insurance company pay for and what do you have to pay for yourself?
Members of a statutory health insurance basically have the right to inpatient and outpatient care, to drugs and other services. As a rule, however, certain personal contributions (additional payments) are stipulated by law. These additional payments amount to 10 percent of the costs, but a maximum of 10 euros per additional payment. If the service costs less than 5 euros, the insured person must pay the actual price.
These limits also apply to pharmaceuticals. If the person concerned receives a particularly inexpensive preparation, there is no additional payment. The health insurances can determine fixed amounts that they reimburse if several preparations with the same active ingredient are available. Medicines, the price of which is 30 percent below this fixed amount, are reimbursed by health insurance companies without additional payment.
In addition, there is a regulation that the statutory health insurance no longer has to reimburse the individual price of the respective drug for certain preparations, but only the fixed amount that has been set for a group of comparable preparations. If the prescribed medication is more expensive, the patient has to pay the additional price himself plus the statutory additional payment for the reimbursed portion of the costs.
Co-payments also apply in the event of a hospital stay. They amount to 10 euros per calendar day, whereby the additional payment only has to be made for a maximum of 28 days per year. Several hospital stays can be combined in one year, so that the maximum additional payment for inpatient treatment is 280 euros per calendar year.
In the case of home nursing, a one-time fee of ten euros is due for the prescription. In addition, a personal contribution of 10 percent per day is to be borne. The co-payment is limited to 28 calendar days per calendar year and is only charged for adults over 18 years of age. The upper limit of EUR 280 per calendar year also applies to home care. Co-payments for hospital stays count towards the cap on co-payment for home nursing.
If the costs for household help are covered by the health insurance, the insured must make an additional payment of 10 percent of the costs incurred. The limits are at least 5 and a maximum of 10 euros per calendar day. This co-payment obligation applies to the entire period in which domestic help is used.
In the case of aids, the insured must make an additional payment of 10 percent of the selling price, with an upper and lower limit of 10 and 5 euros per prescription.
The amount of co-payments for rehabilitation measures depends on the measure and the respective cost bearer.
The costs for pain therapy in a pain clinic are usually covered by any statutory health insurance company, as it is a contracted medical service. However, additional costs (such as additional payments for prescriptions) may arise privately.
The costs of a classic body acupuncture are covered by all statutory health insurances for chronic pain in the lumbar spine or knee osteoarthritis. It is assumed that the pain has existed for at least six months. In such cases, legally insured persons are entitled to up to ten acupuncture sessions per case of illness within a maximum of six weeks. A new treatment can take place no earlier than twelve months after completion of the last acupuncture treatment. The health insurance will only reimburse the costs if the treatment is carried out by a qualified doctor. Acupuncture from a naturopath is not accepted. The costs are then to be paid privately.
Pancreatitis - What does the DFV take care of?
The outpatient supplementary health insurance DFV-AmbulantSchutz reimburses you for additional payments provided for by law for medicines, bandages, remedies and aids and travel costs as part of outpatient treatment. The DFV-AmbulantSchutz also offers you extended pension benefits and is also there to support you financially if a serious illness is diagnosed.
In the event of illness, with the additional hospital insurance DFV-KlinikSchutz Exklusiv, you do not wait longer than 5 days for an appointment with a specialist doctor.
You also benefit from head physician treatment, a single room, free choice of hospital and daily hospital allowance for an inpatient clinic stay. DFV-KlinikSchutz makes you a private patient in the hospital including international health insurance.
FAQ on: Pancreatitis
How do you recognize acute pancreatitis?
The first sign of acute pancreatitis is usually sudden and severe pain in the upper abdomen. They can radiate in a belt shape up to the back or chest. Other symptoms include gas, a bloated stomach (rubber belly), vomiting and nausea. - To make a reliable diagnosis, the doctor will perform a blood analysis based on the medical history and physical examination. The lipase level and pancreatic amylase are increased in the case of pancreatitis. In order to rule out possible diseases of other organs, controls using ultrasound and other imaging methods are often indicated.
What can you eat if you have pancreatitis?
In order to relieve the pancreas, you should not eat any food for a few days. This is especially true if those affected also suffer from nausea and vomiting. In severe pancreatitis and complications, patients receive the necessary nutrients through an infusion (parenteral nutrition). Later, nutrients can often be fed through a tube. - As soon as the doctor allows it, you can eat normally again. At first, light foods, consisting of rice gruel, rusks and tea, should determine the menu. After two to three weeks, fatty food is possible again in small quantities. Under no circumstances should alcohol or nicotine be consumed.
How long do you have to stay in hospital with pancreatitis?
In most cases, acute pancreatitis is treated as an inpatient. Serious cases are treated in the intensive care unit. Around 80 percent of patients recover within one to two weeks and can then go home. If the course is severe, the hospital stay lasts much longer, often several weeks to months.
Which drugs help with pancreatitis?
For the severe, often cramp-like pain of an acute or chronic pancreatitis, those affected receive painkillers and antispasmodic drugs if necessary. If the symptoms are only mild, therapy with Novaminsulfon can be used; if pain is severe, opioids such as pethidine are sometimes given. Epidural anesthesia (PDA) is also possible. Patients with severe disease and additional bacterial inflammation are given antibiotics. The anticoagulant heparin is usually administered to prevent thrombosis.
How can you prevent pancreatitis?
Eating a healthy diet is important in preventing acute inflammation of the pancreas. You should make sure to eat low-fat, drink little or no alcohol and seek medical treatment for possible diseases such as high blood lipid levels or overactive parathyroid glands. Nicotine should be avoided.
- Beger, H.G. et al: Diseases of the Pancreas, Springer Verlag 2013
- Herold, Gerd: Internal Medicine, Gerd Herold, edition 2019
- Kroesen, J. Anton; Klump, Bodo; Hoffmann, Jörg: Chronic Inflammatory Bowel Diseases: Handbook for Clinic and Practice, Thieme Verlag, 2nd edition 2009
- Professional Association of German Internists e.V., www.internisten-im-netz.de (accessed on 07/19/2020)
- Working group of the pancreatectomized e.V., www.bauchspeicheldruese-pankreas-selbsthilfe.de (accessed on July 20, 2020)
- German Society for Gastroenterology, Digestive and Metabolic Diseases: S3 Guideline Chronic Pancreatitis: Definition, Etiology, Diagnostics, Conservative, Interventional Endoscopic and Operative Therapy of Chronic Pancreatitis, www. dgvs.de (accessed on July 20, 2020)
- Die Techniker, www.tk.de (accessed on July 20, 2020)
- Homeopathy World, www.homoeopathiewelt.de (accessed on July 21, 2020)
- Clinic for Surgery, Center for Minimally Invasive Pancreatic Surgery, University Medical Center Schleswig-Holstein, Lübeck Campus, www.mic-pankreas.de (accessed on July 21, 2020)
- German Acupuncture Society: www.deutsche-akupunkt-gesellschaft.de (accessed on July 21, 2020)
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