The season of goodwill is upon us and with it an increase in the consumption of alcohol. It is therefore timely to mention one of the significant side effects of an excessive intake - pancreatitis. Quite apart from the effects of chronic alcoholism on our bodies, such as liver disease, obesity, diabetes and certain cancers, a binge with the bottle - and sometimes it doesn't take very much - can cause severe acute pancreatitis which can prove fatal. I have personally looked after several young adults who, despite our best efforts, have succumbed to the condition. This can only be described as a tragedy.
The pancreas is a gland situated high up in the abdomen towards the back. It is a part of the gut in that it produces some of the enzymes essential for digesting food. It also produces hormones such as insulin which is vital for controlling the sugar in our bodies and a lack of which causes diabetes. So we can't do without it which is why you need to look after it.
Acute pancreatitis is inflammation of the pancreas caused by the release of activated pancreatic enzymes. Alcohol and gall stones account for approximately 80% of cases, whilst the remaining 20% result from a number of causes such as drugs and infections. These enzymes can damage tissue and cause inflammation, swelling and sometimes death of the pancreatic gland itself (necrosis). If the inflammation is mild then it is usually confined to the pancreas, and the mortality is low; usually less than 5%. In severe pancreatitis there is a systemic inflammatory response and after approximately five days necrotic pancreatic tissue can become infected by bacteria from the gut. The high mortality of severe acute pancreatitis is usually caused by failure of vital organs such as the heart, lungs and kidney.
The management of the patient with pancreatitis is supportive which means immediate admission to hospital (usually intensive care) for intravenous fluids and rest. Some patients require support for their heart and lungs in the form of artificial ventilation and dialysis for their kidneys, whilst infected areas of pancreatic necrosis may require a surgical operation. The 50% mortality rate occurs because the body can only take so much.
Nobody wishes to be a killjoy this Christmas but a single patient affected by pancreatitis is sufficient to be reminded of that old adage: everything in moderation.