Symptoms and Diagnostic Path
Acute pancreatitis makes a person very ill, with
symptoms that include moderate to severe ABDOM-
INAL PAIN, ABDOMINAL DISTENTION; NAUSEA, VOMITING,
and FEVER. Often the PULSEand respiration rate are
rapid. When symptoms are severe, the person
may be in SHOCK, which is a life-threatening emer-
gency. The diagnostic path includes BLOODtests to
measure the levels of the DIGESTIVE ENZYMESamy-
lase and lipase, which become significantly ele-
vated with pancreatitis. ENDOSCOPIC RETROGRADE
CHOLANGIOPANCREATOGRAPHY(ERCP) can often iden-
tify signs of inflammation and can help determine
whether gallstones are obstructing the BILE DUCTS,
a common cause of acute pancreatitis. ULTRASOUND
or COMPUTED TOMOGRAPHY(CT) SCANalso can pro-
vide therapeutically useful information.
People who have chronic pancreatitis may have
intermittent upper ABDOMINAL PAIN, though with
advanced damage to the pancreas pain is less com-
mon. The primary symptom of chronic pancreati-
tis is persistent weight loss despite adequate
eating. This occurs because the damaged pancreas
is unable to produce the digestive enzymes the
SMALL INTESTINEneeds to absorb nutrients, so con-
sumed food passes through the gastrointestinal
tract largely useless in the context of meeting the
body’s NUTRITIONAL NEEDS. The same procedures
doctors use to diagnose acute pancreatitis help
diagnose as well as monitor chronic pancreatitis.
Specialized tests also can measure production of
pancreatic enzymes.
Treatment Options and OutlookTreatment for acute pancreatitis is primarily sup-
portive, with intravenous fluids to restore fluid
and electrolyte balance within the body as well as
to deliver GLUCOSE. Surgery becomes necessary
when there is bleeding in the pancreas. Though
illness can be severe, most people recover without
residual consequences. Some people do subse-
quently develop chronic pancreatitis. Other com-
plications may include RENAL FAILURE and the
development of fluid-filled pockets called pseudo-
cysts that often become infected.
Treatment for chronic pancreatitis is elimina-
tion of any contributing factors (such as alcohol
consumption or removal of gallstones), plus a
high-carbohydrate, low-fat diet to get basic nutri-
ents into the body. Enzyme supplements can
improve digestion. Complications include DIABETES
(requiring INSULIN THERAPY) and progressive loss of
pancreatic function.Risk Factors and Preventive Measures
Excessive alcohol consumption and gallstones are
the leading risk factors for pancreatitis; alcohol
abstinence and appropriate treatment for gall-
stones eliminates them. Other causes of pancreati-
tis are less defined and thus more difficult to
prevent. Prompt medical assessment of symptoms
and appropriate treatment improve the likelihood
for uneventful recovery.
See also ALCOHOLISM; ENDOSCOPY; PANCREATIC
CANCER.peptic ulcer disease A condition in which ulcers
form in the lining (mucosa) of the lower STOMACH
and upper DUODENUM(first segment of the SMALL
INTESTINE). The two most common causes of peptic
ulcer disease areINFECTIONwith HELICOBACTER PYLORI
and chronic or long-term use of NONSTEROIDAL
ANTI-INFLAMMATORY DRUGS(NSAIDS). Peptic ulcer dis-
ease affects millions of Americans. In most situa-
tions, appropriate treatment cures the condition.Symptoms and Diagnostic Path
The symptoms of peptic ulcer disease range from
mild and intermittent to severe and unrelenting.
Severe symptoms suggest a perforated ulcer,
which carries the risks of bleeding and infection. A
perforated ulcer requires immediate medical
attention.
Typical symptoms of peptic ulcer disease include- DYSPEPSIA(heartburn or stomach upset), com-
monly occurring one to three hours after eating
or at night - NAUSEAand VOMITING
- GASTROINTESTINAL BLEEDING
- loss of APPETITEor intolerance for spicy or fatty
foods
- unintended weight loss
Symptoms typically improve with ANTACIDSor
acid-reducing medications. Some people experi-
ence CHEST PAIN mistaken for HEART ATTACK.peptic ulcer disease 81