Inflammation of the pancreas, a serious abdominal condition. The pancreas is the gland opening into the duodenum. The bile duct flows into the exit from the pancreas, which produces digestive enzymes to break down protein, fat and carbohydrate in the intestine so that they can be absorbed. The pancreas also produces hormones (insulin, glucagon) which pass directly into the bloodstream to regulate blood sugar levels. Pancreatitis induces a form of self-digestion. The enzymes produced by the pancreas for the breaking down of protein are activated within the gland (which normally happens in the intestine), with the result that the protein in the cells of the pancreas is broken down (autolysis). The direct mechanism which causes this is not always known. Several conditions are known which can lead to pancreatitis: mumps, bile duct conditions (often with gallstones), alcohol abuse and injury. Sometimes there is no clear cause. Pancreatitis usually starts with an acute phase, but after that can become chronic. Symptoms of acute pancreatitis are sudden very severe pain, often radiating to the back, nausea, vomiting, sweating and shock. Attacks often begin after a meal containing a great deal of fat or after consuming an abnormally large quantity of alcohol. Possible complications are kidney failure and accumulation of fluid in the lungs. The examination is directed at distinguishing pancreatitis from other abdominal conditions such as perforation of the stomach, a gallstone in the bile duct or sometimes even inflammation of the gall bladder or renal colic. First a blood test is made, establishing large numbers of white blood corpuscles, increased presence of blood sugar and pancreatic enzymes. Abdominal X-rays are not at all reliable. Treatment of acute inflammation is directed at reducing secretion of pancreatic juices, so that as few destructive enzymes as possible are produced. This is achieved by intravenous feeding, pumping out the contents of the stomach and by medication to suppress the formation of pancreatic enzymes. Powerful painkillers are often necessary; antibiotics are sometimes used. The condition can be completely cured, but sometimes pancreatic cysts and abscesses remain. It can be fatal. In approximately 10 per cent of cases chronic infection can result, with persistent attacks of pain and digestive difficulties. Progressive destruction of pancreatic tissue leads to inadequate enzyme production, causing

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