Some years ago, a patient of mine came to visit following a hospital stay. He had been admitted with stomach pains and was quickly diagnosed as having pancreatitis, which is inflammation of the pancreas.
While glad of the definitive diagnosis, he was most put out by the never-ending questions he endured about his alcohol intake. The admitting doctor had dwelt heavily on this point. Several medical students had approached him in a joint manoeuvre, culminating in one of them whispering conspiratorially: "It's OK, you can tell us how much you drink, we're just medical students."
To say he was annoyed would be an understatement. I could empathise with his feelings, having known him for 10 years or so. A more abstemious gentleman, in all his habits, it would be hard to find.
So why were the doctors and students fixated on his drinking habits? Simply because of the strong association between pancreatitis and alcohol use. But there are many other possible causes of both acute and chronic pancreatitis, and in 25 per cent of cases of the latter, no cause is ever found.
The pancreas gland sits near the intestines and it secretes enzymes into the gut which help to digest food. A separate part of the gland also produces insulin, a deficiency of which causes diabetes.
Inflammation of the pancreas results from the premature activation of its enzymes while still within the gland. Normally these do not become chemically active until after they travel into the intestine; a premature activation causes "auto digestion", in which the pancreas literally begins to eat itself.
The first time this happens, acute pancreatitis is the result. Patients complain of quite severe pain in the upper part of the abdomen, which often radiates through to the back. Nausea, vomiting and swelling of the tummy are other common symptoms.
The patient with classic acute pancreatitis will look sick and anxious. He is often in clinical shock, with a raised pulse, low blood pressure and a mild fever. Bowel sounds are usually diminished or absent.
Blood-tests help to confirm the diagnosis. White cells are usually elevated, indicating inflammation. Amylase, one of the pancreatic enzymes, is often found in increased levels in the blood stream. A C.T. scan, however, is the most accurate test with which to confirm pancreatitis; it is also very good at assessing the severity of the disease.
Treatment consists of analgesics for the pain, resting the bowel by starving the patient, intravenous fluids to control the fluid and salt balance in the body and often a tube is passed into the stomach, through which stomach contents are suctioned, again with a view to resting the bowel.
In 90 per cent of patients, this approach succeeds in settling the inflammation, usually within seven to 10 days. If it does not succeed, then surgery to remove the diseased and necrotic part of the gland is required.
About 50 per cent of cases of acute pancreatitis are caused by drugs. Frusemide, a water tablet, the oral contraceptive pill and an antibiotic called tetracycline are just some of the drugs with a proven link.
Gallstones and blunt abdominal trauma are other causes for acute pancreatitis.
Chronic pancreatitis may take the form of repeated acute episodes or it may reflect chronic damage, with pain, diarrhoea and a condition called steatorrhoea. This is the medical name for loose, foul-smelling bowel motions, reflecting the loss of more than 90 per cent of pancreatic function. The lack of pancreatic enzymes means the body is unable to absorb nutrients and steatorrhoea results.
Treatment of chronic pancreatitis centres on taking pancreatic enzyme replacement therapy. It involves taking up to eight potent enzyme tablets with every meal. While not abolishing steatorrhoea entirely, this medication does help pain levels in about 75 per cent of cases.
Diet is important also. The ideal mix is one which is moderate in fat, high in protein and low in carbohydrate.
While there are many other causes for the disease apart from alcohol, patients with severe chronic pancreatitis secondary to alcohol abuse and who continue to drink have a 50 per cent mortality.
Those who abstain from alcohol and who stick to medical treatment have a much better prognosis.
But in referring to alcohol again, I risk annoying those of you who, like my patient of some years ago, have pancreatitis of a completely non-self-inflicted nature.
This is not my intention, because this column was requested by a number of such readers. I hope it answers at least some of your questions.
Contact Dr Houston at mhouston@irish-times.ie or leave messages on tel 01-6707711, ext 8511.