Monday, June 3, 2013

Idiopathic Pancreatitis

I actually started this post before the post below but never did come to any conclusions about what the heck caused my acute pancreatitis and if what a was feeling after my hospital stay was chronic pancreatitis. As I quote below acute pancreatitis is the most common thing people are admitted to hospitals for yet beyond the 2 most common causes for acute flare ups (alcohol and/or gallstones) the root causes can include any of 100 or more medications or substances. Or as I suspect in my case some of those and pressure on my abdomen from using a machine at the gym. As a fallible human when I started feeling more normal and didn't find much in the way of answers I lost interest in the topic. For now at least. If you like sciencey stuff or have an interest in what happen to me continue reading. Otherwise it's kinda dry stuff. 

I had done some searches but this last painful interlude really put me into overdrive. At the bottom of this post you'll see many links to some of the places I've looked for answers.

Besides making insulin your pancreas makes all of your various digestive juices. It contains many specialized cells that make various enzymes. Pancreatitis comes in 2 basic forms acute (painful inflammation) and chronic. Each of these has variations based on what has caused the condition. What put me in the hospital was the acute form. The chronic form is more of a dysfunction that make your body unable to digest food. These two problems are really quite different so I am not sure why they don't have names that are different. Must be a Latin thing. 

As you know, if you've used the internet for more than facebook, porn and eMail, the quality of information varies from cutting edge to harmfully dreadfully inaccurate.  

Abstracts of university studies like the ones I found through the National Institutes of Health are a solid source. Each one only tells a tiny portion of the story since they are based on usually a single hypophysis. These kind of studies are constantly challenged and slight changes in the structure of the studies that follow can get very different results. This is why the version of what is true in the practice of medicine is slow to change. They need to wait for results to filter down to some consistency. This is also a problem because the process of challenges continues after standards are established. Better ideas can come and go unnoticed depending on timing and industry politics. This is one reason I will always remain a skeptic of the healthcare industry. 

Established medical organizations and institutions also have websites. These can be trusted to give a version of the accepted knowledge on many topics. This is where my information gathering began to go off the rails. Each site has it's own take on what goes on. This video has the most 'to the point' explanation of the pancreas and pancreatitis.

Even this however is not consistent with other sources that are just as credible. 

After looking at a hundred web pages or so I found that there are a number of possible causes. 

"Acute pancreatitis occurs when intracellular protective mechanisms to prevent trypsinogen activation or reduce trypsin activity are overwhelmed."

"Its etiology and pathogenesis have been intensively investigated for centuries worldwide. In 1856, Claude Bernard suggested that bile reflux into the common pancreatic duct could trigger acute pancreatitis. Several subsequent studies led to theories fuelling the debate until 1901, when Eugene Opie proposed that gallstone migration into the common bile duct is the main cause of acute pancreatitis."

" . . acute biliary pancreatitis is bile-pancreatic duct obstruction, which increases pancreatic duct pressure, bile reflux, trypsin activation and pancreatic auto-digestion."

"In 10%-40% of patients however, no cause is identified (acute idiopathic pancreatitis). Identifying a cause in these patients is important, since the recurrence rate is high."

cholelithiasis (gallstones)
prolonged alcohol use
Idiopathic acute pancreatitis (it could be a lot of things.)
Microlithiasis (sludge)
infection (including mumps, hepatitis, rubella, and Epstein-Barr virus)
surgery that temporarily cuts off blood supply to the pancreas
injury to the abdomen
cystic fibrosis
cigarette smoking
family history of pancreatitis
Occult gallstones (This is when you have gallstones that hold séances)
Use of certain medications (such as corticosteroids, nonsteroidal anti-inflammatory drugs, and antibiotics such as tetracycline)

"The reported annual incidence of acute pancreatitis has ranged from 4.9 to 35 per 100,000 population. Acute pancreatitis is a leading cause of hospitalization in the United States." 

" The true nature of acute pancreatitis still remains to be elucidated. The causes of acute pancreatitis are various, and its mechanism is common." 

"Accurate assessment of disease incidence is difficult since mild disease may be missed. Similarly, death may occur before the diagnosis is made in severe and fulminant attacks. In one report, for example, the diagnosis of acute pancreatitis was not made until autopsy in 10 percent of patients."

A few days ago I mentioned that I had pancreatitis to some one who said 'oh yes my Mom had that, they said it was because she had too much irion." Oh geez I had done all these searches and hadn't run across that before. I did a search and found this
The major cause of chronic pancreatitis is alcohol abuse (in 90 percent of all cases). In the other 10 percent of all cases, chronic pancreatitis is a result of hemochromatosis (excess iron in the body) or heredity.
Yikes, every source indicates that a main cause is excess use of alcohol. (except the ones that don't mention it at all) Some say 60% some say 40% some have a different number. Few define just what amount of alcohol is excessive. Over a period of years is somewhat consistent. 

Then I proceeded to look up every drug or supplement that I have taken. Most are already on this list. I and a growing number of people have taken a dislike for the cholesterol lowering drugs called Statins*. In some cases you have to resort to looking things up by their class name. *HMG-CoA reductase inhibitors are on the list. Most of the things I take have been linked to pancreatitis in some way. None have a clear cut track record of being a consistent cause. I was suspicious of the Metformin I take for diabetes. Since it has something to do with insulin sensitivity. Turns out it does it's job through the liver and most of it's side effects are good.  

After all the web searching I don't have any firm answers. Even though my drinking has been mostly light and very sporadic (once or twice a month) the last dozen years I haven't ruled it out as a cause. The 25 years before had runs where I'd drink to excess 2 or 3 nights a week. I've never been any good at drinking by myself but during the holiday season with all it's social events, whew! 

Still what has triggered my attacks has yet to be established. The big one may have been Rye whiskey but this last one and the one last summer couldn't have been.

Did he say drain the stomach via a tube down the nose?

Comprehensive explanation of pancreatitis

Merck has created The Merck Manuals, a series of healthcare books for medical professionals and consumers. 

Ongoing studies

Drugs and drug classes associated with acute pancreatitis

Metformin effect on pancreatitis correlation is not causation.

The risk of acute pancreatitis associated with acid-suppressing drugs

However they pre blocked persons with other conditions that may be related.

Long-term use of novo-ranitidine may cause inflammation of the pancreas and the liver.
Read more:

Can Statins Cause Pancreatitis?

Drug Induced Pancreatitis Might Be a Class Effect of Statin Drugs

Add'l links

More trash talk about statins

Toxicity of Indomethacin 

And some good in prevention following a procedure

Plant poisons like cyanide also can cause pancreatitis

Cures, treatments and special Diets

Aloe vera juice

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