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Oh My Aching Pancreas

Doc, I’ve just got a real bad old-fashioned gut ache.”  Mr. Simms had his hand on his upper mid to left abdomen and winced as he made his statement.

“It started yesterday and it’s just getting worse.  Goes right through from my front to my back.  Makes me feel like I need to puke but I haven’t yet.  But I sure don’t have an appetite.  Got a little diarrhea too.

Mr. Simms could possibly have been describing ulcer pain, acute gastritis, gallbladder pain or a short list of other problems.  But as it turned out, what was causing this rather intense abdominal pain was pancreatitis.

When pancreatitis is suspected, a couple of simple blood tests can confirm it.  An ultrasound of the abdomen may help to look for complications or causes.

Besides Mr. Simms’ typical symptoms of pancreatitis, many sufferers get fever, most get bloating and a minority get jaundice (yellow color to the skin and eyes).

The pancreas sits under the stomach in the mid to left upper part of the abdomen.  It is responsible for the body’s insulin production as well as producing some fifteen important digestive enzymes.

Pancreatitis, as the name implies, is an inflammation (rarely an infection) of the pancreas.  It occurs when the digestive enzymes of the pancreas are auto-digesting and inflaming the gland itself.  Some of the more common causes or triggers include:

  • A gallstone blocking outflow of the pancreas (about 40% of cases)
  • Excess alcohol intake (about 35% of cases)
  • Abdominal trauma (about 5% of cases)
  • A hodgepodge of other causes including very high triglyceride levels, medication side effects, infections, tumors, toxins and overly high calcium level.

Pancreatitis is a pretty big deal with a 10-15% mortality rate, depending on the severity.  Fortunately it is also fairly rare with an incidence of 1 in 2,500 people per year, most commonly in middle-aged individuals.

The treatment is fairly straightforward.  Once the diagnosis has been made, the person is generally hospitalized and put on intravenous fluids and pain meds and given nothing by mouth until the signs of inflammation start to subside.  Occasionally an obstructing gallstone or diseased gallbladder may need to be removed or a cyst in the pancreas may need to be drained.  The patient is observed for complications such as infection or failure of other organs. Eventual recovery usually occurs allowing the resumption of a normal diet.

Happily, most of us will never experience the penetrating abdominal pain of pancreatitis.  But if you ever do, getting it diagnosed and treated promptly is key to successfully treating it.  That’s one good thing about pain; it makes it harder to ignore what we shouldn’t ignore.

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