pancreatitis symptom

Acute Pancreatitis SymptomsThe most common symptom of acute pancreatitis is pain. Almost everybody with acute pancreatitis experiences pain.

• The pain may come on suddenly or build up gradually. If the pain begins suddenly, it is typically very severe. If the pain builds up gradually, it starts out mild but may become severe.
• The pain is usually centered in the upper middle or upper left part of the belly (abdomen).
• The pain may feel as if it radiates through to the back.
• The pain often begins or worsens after eating.
• The pain typically lasts a few days.
• The pain may feel worse when a person lies flat on his or her back.

People with acute pancreatitis usually feel very sick. Besides pain, people may have other symptoms.

• Nausea (Some people do vomit, but vomiting does not relieve the symptoms.)
• Fever, chills, or both
• Swollen abdomen which is tender to the touch
• Rapid heartbeat (A rapid heartbeat may be due to the pain and fever, or it may be a compensation if a person is bleeding internally.)

In very severe cases with infection or bleeding, a person may become dehydrated and have low blood pressure, in addition to the following symptoms:

• Weakness or feeling tired (fatigue)
• Feeling lightheaded or faint
• Lethargy
• Irritability
• Confusion or difficulty concentrating
• Headache

If the blood pressure becomes extremely low, the organs of the body do not get enough blood to carry out their normal functions. This very dangerous condition is called circulatory shock or is referred to simply as shock.
Chronic Pancreatitis Symptoms
Pain is less common in chronic pancreatitis.Some people have pain, but most people do not experience pain. For those people who do have pain, the pain is usually constant and may be disabling; however, the pain often goes away as the condition worsens. This lack of pain is a bad sign because it probably means that the pancreas has stopped working.Other symptoms of chronic pancreatitis are related to long-term complications, such as the following:

• Inability to produce insulin (diabetes)
• Inability to digest food (weight loss and nutritional deficiencies)
• Bleeding (low blood count, or anemia)
• Liver problems (jaundice)

When to Seek Medical Care

In most cases, the pain and nausea associated with pancreatitis are severe enough that a person seeks medical attention from a healthcare provider. Any of the following symptoms definitely warrant medical attention:

• Inability to take medication or to drink and eat because of nausea or vomiting
• Severe pain not relieved by nonprescription medications
• Difficulty breathing
• Pain accompanied by fever or chills, persistent vomiting, feeling faint, weakness, or fatigue
• Pain accompanied by presence of other medical conditions, including pregnancy

The healthcare provider may tell the person to go to a hospital emergency department. If a person is unable to reach a healthcare provider, or if a person's symptoms worsen after having visited a healthcare provider, an immediate visit to an emergency department is necessary.
Exams and test

When a healthcare provider identifies symptoms suggestive of pancreatitis, specific questions are asked about the person's symptoms, lifestyle and habits, and medical and surgical history. The answers to these questions and the results of the physical examination allow the healthcare provider to rule out some conditions and to zero-in on the correct diagnosis.
In most cases, laboratory tests are needed. The tests check for several possibilities, including the following:

• Pancreas, liver, and kidney functions (including levels of pancreatic enzymes amylase and lipase)
• Signs of infections
• Blood cell counts indicating signs of anemia
• Pregnancy test
• Blood sugar, electrolyte levels (an imbalance suggests dehydration) and calcium level

Results of the blood tests may be inconclusive if the pancreas is still making digestive enzymes and insulin.Diagnostic imaging tests are usually needed to look for complications of pancreatitis, including gallstones.Diagnostic imaging tests may include the following:

1. X-ray films may be ordered to look for complications of pancreatitis as well as for other causes of discomfort.
2. A CT scan is like an x-ray film, only much more detailed. A CT scan shows the pancreas and possible complications of pancreatitis in better detail than an x-ray film. A CT scan highlights inflammation or destruction of the pancreas.
3. Ultrasound is a very good imaging test to examine the gallbladder and the ducts connecting the gallbladder, liver, and pancreas with the small intestine.

• Ultrasound is very good at depicting abnormalities in the biliary system, including gallstones and signs of inflammation or infection.
• Ultrasound uses painless sound waves to create images of organs. Ultrasound is performed by gliding a small handheld device over the abdomen. The ultrasound emits sound waves that "bounce" off the organs and are processed by a computer to create an image. This technique is the same one that is used to look at a fetus in a pregnant woman.

Endoscopic retrograde cholangiopancreatography (ERCP) is an imaging test that uses an endoscope (a thin, flexible tube with a tiny camera on the end) to view the pancreas and surrounding structures.

1. ERCP is usually used only in cases of chronic pancreatitis or in the presence of gallstones.
2. To perform an ERCP, a person is first sedated. After sedation, an endoscope is passed through the mouth, to the stomach, and into the small intestine. The device then injects a temporary dye into the ducts connecting the liver, gallbladder, and pancreas with the small intestine (biliary ducts). The dye makes is easier for the healthcare provider to see any stones or signs of organ damage. In some cases, a stone can be removed during this test.

Pancreatitis Treatment

Self-Care at HomeFor most people, self-care alone is not enough to treat pancreatitis. People may be able to make themselves more comfortable during an attack, but they will most likely continue to have attacks until treatment is received for the underlying cause of the symptoms. If symptoms are mild, people might try the following preventive measures:

• Stop all alcohol consumption.
• Adopt a liquid diet consisting of foods such as broth, gelatin, and soups. These simple foods may allow the inflammation process to get better.
• Over-the-counter pain medications may also help.

Medical Treatment

Medical treatment is usually focused on relieving symptoms and preventing further aggravation to the pancreas. Certain complications of either acute pancreatitis or chronic pancreatitis may require surgery or a blood transfusion.Acute Pancreatitis TreatmentIn acute pancreatitis, the choice of treatment is based on the severity of the attack. If no complications are present, care usually focuses on relieving symptoms and supporting body functions so that the pancreas can recover.

• Most people who are having an attack of acute pancreatitis are admitted to the hospital.
• Those people who are having trouble breathing are given oxygen.
• An IV line is started, usually in the arm. The IV line is used to give medications and fluids. The fluids replace water lost from vomiting or from inability to take in fluids, helping the person to feel better.
• If needed, medications for pain and nausea are prescribed.
• Antibiotics are given if the health care provider suspects an infection may be present.No food or liquid should be taken by mouth for a few days. This is called bowel rest. By refraining from food or liquid intake, the intestinal tract and pancreas are given a chance to start healing.
• Some people may need a nasogastric (NG) tube. The thin, flexible plastic tube is inserted through the nose and down into the stomach to suck out the stomach juices. This suction of the stomach juices rests the intestine further, helping the pancreas to recover.
• If the attack lasts longer than a few days, nutritional supplements are administered through an IV line.

Chronic Pancreatitis Treatment

In chronic pancreatitis, treatment focuses on relieving pain and avoiding further aggravation to the pancreas. Another focus is to maximize a person's a
ility to eat and digest food.

1. Unless people have severe complications or a very severe episode, they probably do not have to stay in the hospital.
2. Medication is prescribed for severe pain.
3. A high carbohydrate low fat diet; and eating smaller more frequent meals help prevent aggravating the pancreas. If a person has trouble with this diet, pancreatic enzymes in pill form may be given to help digest the food.
4. People diagnosed with chronic pancreatitis are strongly advised to stop drinking alcohol.If the pancreas does not produce sufficient insulin, the body needs to regulate its blood sugar,and insulin shots may be necessary.

Surgery

If the pancreatitis is caused by gallstones, an operation to have the gallbladder and gallstones removed (cholecystectomy) is likely.If certain complications (for example, enlargement or severe injury of the pancreas, bleeding, pseudocysts, or abscess) develop, surgery may be needed to drain, repair, or remove the affected tissues.

Appendicitis

Appendicitis is acute inflammation of the vermiform appendix, typically resulting in abdominal pain, anorexia, and abdominal tenderness. Diagnosis is clinical, often supplemented by CT or ultrasound. Treatment is surgical removal.
In the US, acute appendicitis is the most common cause of acute abdominal pain requiring surgery. Over 5% of the population develops appendicitis at some point. It most commonly occurs in the teens and 20s but may occur at any age.
Other conditions affecting the appendix include carcinoids, cancer, villous adenomas, and diverticula. The appendix may also be affected by Crohn's disease or ulcerative colitis with pancolitis.
Etiology
Appendicitis is thought to result from obstruction of the appendiceal lumen, typically by lymphoid hyperplasia, but occasionally by a fecalith, foreign body, or even worms. The obstruction leads to distention, bacterial overgrowth, ischemia, and inflammation. If untreated, necrosis, gangrene, and perforation occur. If the perforation is contained by the omentum, an appendiceal abscess results.
Symptoms and Signs
The classic symptoms of acute appendicitis are epigastric or periumbilical pain followed by brief nausea, vomiting, and anorexia; after a few hours, the pain shifts to the right lower quadrant. Pain increases with cough and motion. Classic signs are right lower quadrant direct and rebound tenderness located at McBurney's point (junction of the middle and outer thirds of the line joining the umbilicus to the anterior superior spine). Additional signs are pain felt in the right lower quadrant with palpation of the left lower quadrant (Rovsing sign), an increase in pain from passive extension of the right hip joint that stretches the iliopsoas muscle (psoas sign), or pain caused by passive internal rotation of the flexed thigh (obturator sign). Low-grade fever (rectal temperature 37.7 to 38.3° C [100 to 101° F]) is common.Unfortunately, these classic findings appear in < name="sec02-ch011-ch011e-462">
Diagnosis

• Clinical evaluation
• Abdominal CT if necessary
• Ultrasound an option to CT

When classic symptoms and signs are present, the diagnosis is clinical. In such patients, delaying laparotomy to perform imaging tests only increases the likelihood of perforation and subsequent complications. In patients with atypical or equivocal findings, imaging studies should be done without delay. Contrast-enhanced CT has reasonable accuracy in diagnosing appendicitis and can also reveal other causes of an acute abdomen. Graded compression ultrasound can usually be done quickly and uses no radiation (of particular concern in children); however, it is occasionally limited by the presence of bowel gas and is less useful for recognizing nonappendiceal causes of pain. Appendicitis remains primarily a clinical diagnosis. Selective and judicious use of radiographic studies may reduce the rate of negative laparotomy.Laparoscopy can be used for diagnosis as well as definitive treatment; it may be especially helpful in women with lower abdominal pain of unclear etiology. Laboratory studies typically show leukocytosis (12,000 to 15,000/μL), but this finding is highly variable; a normal WBC count should not be used to exclude appendicitis.PrognosisWithout surgery or antibiotics, mortality is > 50%.With early surgery, the mortality rate is < name="sec02-ch011-ch011e-466b">

Treatment

1. Surgical removal
2. IV fluids and antibiotics

Treatment of acute appendicitis is open or laparoscopic appendectomy; because treatment delay increases mortality, a negative appendectomy rate of 15% is considered acceptable. The surgeon can usually remove the appendix even if perforated. Occasionally, the appendix is difficult to locate: In these cases, it usually lies behind the cecum or the ileum and mesentery of the right colon. A contraindication to appendectomy is inflammatory bowel disease involving the cecum. However, in cases of terminal ileitis and a normal cecum, the appendix should be removed.Appendectomy should be preceded by IV antibiotics. Third-generation cephalosporins are preferred. For nonperforated appendicitis, no further antibiotics are required. If the appendix is perforated, antibiotics should be continued until the patient's temperature and WBC count have normalized or continued for a fixed course, according to the surgeon's preference. If surgery is impossible, antibiotics—although not curative—markedly improve the survival rate. When a large inflammatory mass is found involving the appendix, terminal ileum, and cecum, resection of the entire mass and ileocolostomy are preferable. In late cases in which a pericolic abscess has already formed, the abscess is drained either by an ultrasound-guided percutaneous catheter or by open operation (with appendectomy to follow at a later date). A Meckel's diverticulum in a patient under the age of 40 should be removed concomitantly with the appendectomy unless extensive inflammation around the appendix prevents the procedure.