Acute pancreatitis

Inflammation of pancreas is pancreatitis. It can be acute, chronic or acute on chronic. Acute pancreatitis is one of the common reasons of hospitalization.

What is pancreas?

Pancreas is the part of both digestive and endocrine system. It is located behind the stomach in left side of the abdomen.

What are the functions?

Digestive (Exocrine) function

Pancreas release enzymes; trypsin and chymotrypsin which digest protein. Amylase digests carbohydrate and is useful in breakdown of fat.

Endocrine function

Insulin and glucagon are the two main important hormones which are released by pancreas. Insulin helps to decrease blood sugar level. Glucagon helps to increase blood sugar level.

Etiology

Alcohol is the leading cause, toxins which are released after digestion damages the pancreatic cells.

Post abdominal surgery; direct injury to pancreas during surgery or spasm of sphincter of Oddi.

Gallstones; obstruction of common bile duct obstructs pancreatic juice and damage it.

Drug induced; certain drugs like methyldopa, sulfonamides, tetracycline, estrogen or furosemide injures pancreas. However it is mild.

High triglyceride; is rare cause but can lead to acute pancreatitis.

Infection; certain infections like hepatitis, cytomegalovirus, HIV, or herpes simplex virus are likely to be reason.

Autoimmune; when the body fails to recognize own cells and attack it can lead to self destruction of pancreas.

Others; smoking, hereditary, pancreatic carcinoma, hemodialysis, cystic fibrosis are some of the other causes of acute pancreatitis.

Pathophysiology

In presence of toxin/infection trypsinogen is converted into trypsin. This trypsin activates the pancreatic enzymes; such as amylase and lipase. More the amount of enzymes there will be increase in metabolic process. The load on the pancreas induces cell damage and release Damage Associated Molecular Patterns (DAMPs). This leads to systemic inflammation. Inflammation in turn increase capillary permeability and damage endothelium with microvascular thrombosis. If the disease not managed properly at early stage the end result is Multiple Organ Dysfunction Syndrome.

Signs and symptoms

Abdominal pain in epigastric region; mild to moderate. Type of pain depends on cause of the condition. In biliary obstruction, sharp pain which radiates to the back. Metabolic/toxicologic cause late onset and is generalized dull pain.

Nausea and Vomiting are common symptoms.

Anorexia, i.e. no desire to have food.

On physical examination: Fever, increased heart rate and decreased blood pressure.

Abdominal examination reveals tenderness at epigastric region and guarding rigidity with decreased bowel sound.

Cullen's sign- Red discoloration of umbilical region due to hemorrhage.

Grey Turner's sign- Discoloration of sides of back.

Diagnosis

Level of lipase and amylase increases 3 times higher than upper limit of normal

Abdominal pain is consistent

Abdomen ultrasound/CT scan/MRI suggestive of acute pancreatitis

Stool test shows high level of fat

Endoscopy for figuring out blockage or inflammation

Differential Diagnosis

Acute peritonitis

Irritable bowel syndrome

Macroamylasemia

Malabsorption

Gallstones

Viral hepatitis

Carcinoma of pancreas

Treatment with homeopathy

1. Belladonna- For acute hemorrhagic pancreatitis

Indicated for abdominal pain which is tender and swollen.

Pain while coughing, sneezing on touching. Even bedclothes are unbearable.

For loss of appetite. Thirst for cold water. Uncontrolled vomiting.

Stool is greenish and dysenteric with stinging pain in rectum.

2. Iodine- For enlarged pancreatic gland

For both acute and chronic pancreatitis.

Eating well though losing flesh. Throbbing pain at the pit of the stomach. Enlargement of the mesenteric glands. Cutting pain in the abdomen.

Blood in stool. Constipation alternates with diarrhea. Constipation relieved by cold milk.

3. Iris Versicolor- For great burning

Indicated for great burning over the pancreatic region (left upper quadrant), when bile juice secretion increases.

Vomiting is sour, bloody and biliary. Decreased appetite.

For cutting pain in the abdomen. Burning at anal region. Anus is distress as if prolapsed. Anus is sore in the morning. Pain in the stomach before breakfast and from drinking water.

Colicky pain relieved by bending forward and by passing flatus.

Stool is thin, watery, soft, and yellow. Rumbling sound in abdomen with no pain.

4. Phosphorous- For oily and greasy stool

Large yellow spots on the abdomen. For weak, empty, all gone sensation.

Sour taste and sour eructations after every meal. Belching; large quantity of wind after eating.

Post operative vomiting. Throws up ingesta by the mouthfuls.

Too much of salt aggravates the complaints.

Stool is fetid, long, narrow and dog's like. After stool there is great weakness. For bleeding hemorrhoids.

Treatment with modern medicine

During the time of hospitalization, your doctor will advise you to do fasting for few hours until the symptom severity decrease.

Intravenous hydration at initial stage of illness plays a major role.

To give relief from pain, pain killer medications like analgesics are given.

After the condition improves, cause of the disease needs to be corrected; like in case of gallstone obstruction, cholecystectomy (gallbladder removal) is the choice of surgery.