Specific Health Concern >> Pancreas Disease - Acute
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In this video, Dr. Huntoon discusses what your symptoms indicate and what you should be aware of when making a choice with your health.
Having any symptom is NOT NORMAL. Understanding what the symptom means and supporting balance within the body is prudent for health.
Pancreatitis is not something to be ignored. You could die from this condition and it should be taken seriously. When you have passed all the Medical Tests, yet still have discomfort, come learn how to remedy this Once and For All!
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Acute Pancreatitis Click Here
COMMON DISORDERS OF THE PANCREAS
There are a variety of disorders of the pancreas including acute pancreatitis, chronic pancreatitis, hereditary pancreatitis, and pancreatic cancer.
The evaluation of pancreatic diseases can be difficult due to the inaccessibility of the pancreas. There are multiple methods to evaluate the pancreas. Initial tests of the pancreas include a physical examination, which is difficult since the pancreas is deep in the abdomen near the spine. Blood tests are often helpful in determining whether the pancreas is involved in a specific symptom but may be misleading. The best radiographic tests to evaluate the structure of the pancreas include CAT (computed tomography) scan, endoscopic ultrasound, and MRI (magnetic resonance imaging). Tests to evaluate the pancreatic ducts include ERCP (endoscopic retrograde cholangiopancreatography) and MRCP(magnetic resonance cholangiopancreatography). There are also instances in which surgical exploration is the only way to confirm the diagnosis of pancreatic disease.
Acute pancreatitis is a sudden attack causing inflammation of the pancreas and is usually associated with severe upper abdominal pain. The pain may be severe and last several days. Other symptoms of acute pancreatitis include nausea, vomiting, diarrhea, bloating, and fever. In the United States, the most common cause of acute pancreatitis is gallstones. Other causes include chronic alcohol consumption, hereditary conditions, trauma, medications, infections, electrolyte abnormalities, high lipid levels, hormonal abnormalities, or other unknown causes. The treatment is usually supportive with medications showing no benefit. Most patients with acute pancreatitis recover completely.
Acute pancreatitis is an inflammatory condition of the pancreas that is painful and at times deadly. Despite the great advances in critical care medicine over the past 20 years, the mortality rate of acute pancreatitis has remained at about 10%. Diagnosis of pancreatic problems is often difficult and treatments are therefore delayed because the organ is relatively inaccessible. There are no easy ways to see the pancreas directly without surgery, and available imaging studies are often inadequate. In addition to the acute form, there are hereditary and chronic forms of pancreatitis which can devastate a person over many years. Sufferers often endure pain and malnutrition, and are most likely left with a higher risk of pancreatic cancer.
Cause and Burden of Acute Pancreatitis
The most common cause of acute pancreatitis is stones in the gallbladder. Gallstones pass through the common bile duct to enter the small intestine. At the entry of the small intestine, the main pancreatic duct joins or lies immediately next to the common bile duct. It is believed that stones that get stuck in the common bile duct impinge on the main pancreatic duct, causing an obstruction of the normal flow of pancreatic fluid and leading to pancreatic injury. Another way that a stone can cause pancreatitis is by causing a backflow of bile into the pancreatic duct, resulting in pancreatic injury. Whereas the actual mechanism of how gallstones cause pancreatitis is not entirely certain, the association of gallstones and pancreatitis is clear.
There are several other causes of acute pancreatitis including:
Each year, there are more than 300,000 admissions to the hospital for treatment of acute pancreatitis, and the estimated cost of these admissions is greater than $2 billion. Between 16.5% and 25% of patients who develop acute pancreatitis experience a recurrent episode within the first several years. Preventing a recurrence is a major goal of treatment, with efforts focused on identifying the underlying cause and triggers to prevent future episodes.
Symptoms of Acute Pancreatitis
Acute pancreatitis usually begins with gradual or sudden pain in the upper abdomen that sometimes extends to the back. The pain may be mild at first and become worse after eating. The pain is often severe, constant, and commonly lasts for several days in the absence of treatment. A person with acute pancreatitis usually looks and feels very ill and needs immediate medical attention. Most cases require hospitalization for 3 to 5 days for close monitoring, pain control, and intravenous hydration. Other symptoms can include:
Acute pancreatitis is confirmed by medical history, physical examination, and typically a blood test (amylase or lipase) for digestive enzymes of the pancreas. Blood amylase or lipase levels are typically elevated 3 times the normal level during acute pancreatitis. In some cases when the blood tests are not elevated and the diagnosis is still in question, abdominal imaging, such as a computed tomography (CT) scan, might be performed.
After diagnosis is confirmed, certain imaging tests might be performed during hospitalization or after to help identify the cause. Such tests include:
This is commonly performed during hospitalization to specifically evaluate the gallbladder for stones because gallstones are the most common cause of acute pancreatitis. Ultrasound uses sound waves that bounce off the pancreas, gallbladder, liver, and other organs, and their echoes generate electrical impulses that create an image—called a sonogram—on a video monitor. If gallstones are causing inflammation, the sound waves will also bounce off of them, showing their location.
This test is not commonly required during acute pancreatitis. Compared to transabdominal ultrasound, it is relatively more invasive, in that a physician passes a flexible thin tube down into the stomach. A camera and ultrasound probe are attached to the end of the tube, which enable the physician to look at images of the gallbladder, pancreas, and liver. The images are more sensitive than those of transabdominal ultrasound in detecting small stones in the gallbladder and bile ducts that may have been missed. It can also visualize the pancreas for abnormalities. To read more about this, please click here.
MRCP uses magnetic resonance imaging (MRI), a noninvasive procedure that produces cross-section images of parts of the body. After being lightly sedated, the patient lies in a cylinder-like tube. The technician injects dye into the patient’s veins, which helps show the pancreas, gallbladder, and pancreatic and bile ducts. This is another sensitive test for evaluating the gallbladder, bile ducts, and pancreas for causes of acute pancreatitis.
A CT scan is a noninvasive radiograph (x-ray) that produces 3-dimensional images of parts of the body. The patient lies on a table that slides into a donut-shaped machine. Typically not performed initially for an episode of acute pancreatitis, it may be performed when a diagnosis is uncertain or several days into hospitalization to evaluate the extent of pancreatic damage when a patient is not recovering as quickly as expected.
One of the primary therapies for acute pancreatitis is adequate early fluid resuscitation, especially within the first 24 hours of onset. Pancreatitis is associated with a lot of swelling and inflammation. Giving fluids intravenously prevents dehydration and ensures that the rest of the organs of the body get adequate blood flow to support the healing process.
Initially, no nutrition is given to rest the pancreas and bowels during the first 24 to 48 hours. After 48 hours, a plan to provide nutrition should be implemented because acute pancreatitis is a highly active state of inflammation and injury that requires a lot of calories to support the healing process. In most cases, patients can start to take in food on their own by 48 hours. If this is not possible, then a feeding tube that is passed through the nose into the intestines can be used to provide nutrition. This method is safer than providing nutrition intravenously. There is no benefit to using probiotics for acute pancreatitis.
Intravenous medications, typically potent narcotic pain medications, are effective in controlling pain associated with acute pancreatitis. Nausea is a common symptom and can be due to pancreatic inflammation as well as slowing of the bowels. Effective intravenous medications are available for nausea. Pain and nausea will decrease as the inflammation resolves.
In addition to providing supportive care, underlying causes need to be promptly evaluated. If the acute pancreatitis is thought to be due to gallstones, medication, high triglycerides, or high calcium levels within the patient’s body (or other external causes), directed therapy can be implemented.
ERCP is a procedure in which a physician with specialized training passes a flexible, thin tube with a camera attached to the end through the patient’s mouth and into the first part of the small intestine, where the bile duct and pancreatic duct exit. With this device, a small catheter can be passed into the bile duct to remove gallstones that might have gotten stuck and are the cause of pancreatitis. In certain situations, a special catheter can also be passed into the pancreatic duct to help the pancreas heal.
Using a small wire on the endoscope, a physician finds the muscle that surrounds the pancreatic duct or bile duct and makes a tiny cut to enlarge the duct opening. When a pseudocyst is present, the duct is drained.
The endoscope is used to remove pancreatic or bile duct stones with a tiny basket. Gallstone removal is sometimes performed along with a sphincterotomy.
Using the endoscope, a physician places a tiny piece of plastic or metal that looks like a straw into a narrowed pancreatic or bile duct to keep it open.
Some endoscopes have a small balloon that a physician uses to dilate, or stretch, a narrowed pancreatic or bile duct. A temporary stent can be placed for a few months to keep the duct open.
It is well documented that one of the main side effects of ERCP is pancreatitis; however, there are several clearly defined situations when urgent ERCP is indicated for acute pancreatitis.
Basic and clinical evidence suggests that the development of both acute pancreatitis (AP) and chronic pancreatitis (CP) can be associated with oxidative stress. Findings show that free radical activity and oxidative stress indices are higher in the blood and duodenal juice of patients with pancreatitis.
Based on these findings, the idea of using antioxidant regimens in the management of both AP and CP as a supplement and complementary in combination with its traditional therapy is reasonable. In practice, however, the overall effectiveness of antioxidants is not known, and the best mixture of agents and dosages is not clear. Currently, a trial of a mixture of antioxidants containing vitamin C, vitamin E, selenium, and methionine is reasonable as one component of overall medical management.
In summation, there is no definite consensus on the dosage, length of therapy, and ultimately, the benefits of antioxidant therapy in the management of AP or CP. Further well-designed clinical studies are needed to determine the appropriate combination of agents, time of initiation, and duration of therapy.
The definition of severe acute pancreatitis includes cases in which a portion of pancreatic tissue is no longer viable because of injury—this is called necrosis. Over time, the body will resorb this dead tissue. In some cases, this dead tissue can become a source of infection. When infection is suspected, diagnosis can be made by needle biopsy, and if confirmed, medical treatment with antibiotics is required along with consideration of drainage.
Medicines Two Choices for You
Dr. Huntoon has a completely different perspective based on understandings given to him by one of his mentors, Dr. Victor Frank.
Over the past 27 years while applying the understandings of Dr. Frank and the teachings of Traditional Chinese Medicine (TCM), Dr. Huntoon has learned to address Pancreatitis by directly addressing the underlying CAUSE(S). This is based on a case by case basis since there are so many factors to consider and each person is treated for their unique, individual circumstances. He has also helped people eliminate the excess inflammation associated with Pancreatitis by using Whole Food Supplements and Homeopathic Remedies.
OTHER COMPLEMENTARY PANCREATITIS THERAPIES
Alternative therapies are those that can be used along with medical treatment to help the patient feel better. No one should begin an alternative therapy without speaking with his or her physician.
Research has found that patients with chronic pancreatitis who practice yoga 3 times per week can reduce pain, reduce the need for pain medication, and improve quality of life.1,2
Massage therapy involves touch and different techniques of stroking or kneading the muscles of the body. It can involve part of the body or be a full-body massage. Massage can be performed through one’s clothing or on the exposed skin. It can be performed in specialized chairs or on a table. Massage therapy should only be performed by a licensed massage therapist.
Massage is used for muscle and bone discomfort; improvement of circulation; reduction of swelling; relaxation; and pain control. It can be used as a complement to other treatments and as a stress reducer. Studies have shown that massage can improve the relaxation response and the general sense of well-being.
Therapeutic touch is a process of energy exchange, in which the practitioner uses the hands as a focus to help the healing process. It is based on the idea that humans are a form of energy. When we are healthy, the energy is flowing freely and is balanced. Disease is believed to reflect an imbalance or disturbance of the energy flow.
Therapeutic touch treatment can vary from 5 to 30 minutes, depending on the needs of the individual patient. Exact methods vary among practitioners, but generally they will hold their hands 2 to 4 inches away from the patient’s fully clothed body, moving them from head to toe, and over the front and back. Research has demonstrated that therapeutic touch promotes relaxation and a sense of comfort and well-being. Research has also shown therapeutic touch to be effective in decreasing anxiety and altering the perception of pain.
Physical exercise improves the overall functioning of the body and quality of life. Exercise can decrease stress, pain, nausea, fatigue, and depression. Regular exercise affects hormonal balance as well as most of the body systems. Regular participation in physical activity increases the heart rate and maintains an increased heart rate for a period of time.
Depending on your physical condition, and after the advice of your physician, you can begin walking 5 to 10 minutes twice a day, with a goal of increasing activity to 45 minutes at least 3 times a week. It is important that your exercise time be without interruptions. This is time for yourself. If you are unable to walk, there are other ways to exercise (eg, stretching, isometric exercises).
Meditation or relaxation encourages a state of freedom from anxiety, tension, and distress. A state of relaxation can be achieved using different methods, such as diaphragmatic breathing, progressive muscle relaxation, repetitive affirmation, prayer, yoga, or guided/visual imagery. When practiced regularly, meditation can improve sleep, concentration, and the ability to cope with stress. It can help with the management of pain, nausea, and anxiety. You can find free tapes and booklets about meditation at libraries and low-cost materials in stores. You can also choose to attend groups or work groups. Once you have learned the technique, meditation can be practiced at no cost.
Science is taking a closer look at the effects of “mirthful” laughter, that is, laughter that is provoked by happiness, not laughter that is the result of emotions such as embarrassment and anxiety. Whereas it is easy to see how laughter can boost one’s mood, many researchers are finding evidence that mirthful laughter can indeed boost one’s immune system. More research is necessary to elucidate the positive aspects of laughter.
The term acupuncture describes a set of procedures involving stimulation of anatomic points on the body by a variety of techniques. American practices of acupuncture incorporate medical traditions from China, Japan, Korea, and other countries. The acupuncture technique that has been most studied scientifically involves penetrating the skin with thin, solid, metallic needles that are manipulated by the hands or by electrical stimulation.
Acute pancreatitis is defined as the sudden inflammation of the pancreas manifested clinically by abdominal pain, nausea and dehydration that is usually self-limiting but occasionally can progress to severe disease and even death. There are many causes of acute pancreatitis – the two most common being alcohol use and gallbladder/bile duct disease. In this review, we will discuss the specific case of acute pancreatitis in pregnancy.
While acute pancreatitis is responsible for almost 1 out of every 200 hospital admissions in the United States annually, fortunately the rate of acute pancreatitis in pregnancy is rare. It is estimated that acute pancreatitis occurs in about 1 out of every 10,000 pregnancies – however, this rate varies depending on the region and type of hospital. Most cases of acute pancreatitis in pregnancy are caused by gallstone disease. It is thought with the weight and hormonal changes induced by pregnancy, gallstones are more likely to form and thus travel down the common bile duct to obstruct the pancreas duct outflow. Another proposed mechanism for acute pancreatitis in pregnancy is high fat levels in the blood called triglycerides. Again, the hormonal changes of pregnancy can predispose certain women to developing this condition. When the triglyceride levels become too high, oxygen cannot adequately travel to the pancreas via the bloodstream, and pancreatitis can ensue. Of course, all of the other reasons for developing acute pancreatitis – alcohol use, reaction to certain medications, trauma to the pancreatic duct – can also lead to acute pancreatitis in pregnancy
The treatment of acute pancreatitis in pregnancy is similar to that of non-pregnant patients with some exceptions. Resting the digestive tract by not eating, pain control and aggressive fluids given through an IV line are essential. Typically, if the reason is gallstone pancreatitis, removal of the gallbladder is deferred until after pregnancy. Often, a stent placed into the bile duct can be placed to temporize the situation until operative resection is needed. However, if waiting until the end of pregnancy is not possible, surgical resection can generally be performed safely. If the cause of acute pancreatitis is due to triglycerides, certain medications and dietary modifications can be used to help prevent recurrent attacks. However, if the attack occurs late in the third trimester, delivery is usually advocated, as this will cause an immediate decrease in the triglyceride level. Other causes of acute pancreatitis, such as traumatic ductal injury, need to be carefully assessed on an individual basis.
Fortunately, the rate of maternal mortality is less than 1% for acute pancreatitis in pregnancy. The rate of pre-term delivery, however, is about 20%. Also in patients with non gallstone pancreatitis, the rate of pre-term delivery appears to be somewhat higher. It is very important, therefore that pregnant patients present as soon as possible to the emergency room for evaluation should they develop any abnormal abdominal pain symptoms.
While a rare event, acute pancreatitis does occur in pregnancy. Fortunately, if treated early, generally pre-term labor can be avoided and the incidence of recurrent attacks minimized.
Timothy Gardner, MD is Director of Pancreatic Disorders at Dartmouth-Hitchcock Medical Center in Hanover, NH. He graduated from the University of Connecticut Medical School. He did his residency at Dartmouth-Hitchcock and his fellowship at the Mayo Clinic in Rochester, MN. He is a regular contributor for the National Pancreas Foundation website and newsletters.
Dr. Huntoon has a completely different perspective based on understandings given to him by one of his mentors, Dr. Victor Frank.
Over the past 28 years while applying the understandings of Dr. Frank and the teachings of Traditional Chinese Medicine (TCM), Dr. Huntoon has learned to address Pancreatitis by directly addressing the underlying CAUSE(S). This is based on a case by case basis since there are so many factors to consider and each person is treated for their unique, individual circumstances. He has also helped people eliminate the excess inflammation associated with Pancreatitis by using Whole Food Supplements and Homeopathic Remedies.
Working with a Holistic Chiropractor who has experience in addressing the underlying CAUSAL COMPONENTS associated with your Acute Pancreatitis is warranted.
Others have benefited from Acupuncture, Homeopathy and Naturopathy.
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