Prepping for Pancreatitis

Precious little information on this rare and potentially life-threatening condition is found in off-grid medicine texts.  Survival and Austere Medicine, 3^rd Edition contains about a hundred words on it; other sources are silent.  The incidence of acute pancreatitis increased 10-fold between 1960 and 1980.[1]  Presumably, this is due to dietary changes in Americans, and a return to healthier eating may reduce the cases of pancreatitis.  In the meantime, we should be prepared to recognize the symptoms and treatment options.  After all, over 220,000 Americans are hospitalized for acute pancreatitis each year.[2]

This inflammation of the pancreas has numerous root causes.  The I GET SMASHED mnemonic covers these causes[3]:

I—Idiopathic (unknown)

G—Gallstones, genetic (cystic fibrosis)

E—Ethanol (alcohol, heavy use)

T—Trauma (injury)

S—Steroids

M—Mumps (and other infections), malignancy

A—Autoimmune

S—Scorpion stings/spider bites

H—Hyperlipidemia/hypercalcemia/hyperparathyroidism (metabolic disorders)

E—ERCP (endoscopic retrograde cholangiopancreatography, a diagnostic procedure that may cause pancreatitis)

D—Drugs (tetracyclines, furosemide, azathioprine, thiazides, and many others)

 

The first four letters of the mnemonic represent the most common causes of pancreatitis.[4]

Gallstones blocking the ducts that drain from the pancreas and heavy alcohol use account for 90% of all cases. 

SYMPTOMS

• Acute pancreatitis
• Pain in upper abdomen, sometimes spreading to the back, in 50-90% of patients[5]
• Pain may be mild or severe
• Pain may last for several days
• Fever
• Nausea and vomiting
• Rapid pulse
• Swollen or tender abdomen
• Patients with acute pancreatitis usually look and feel seriously ill.[6]
• Chronic pancreatitis
• Pain in the upper abdomen or upper left quadrant, spreading to the back, though some chronic pancreatitis patients have no pain
• Pain may become constant and severe
• Pain becomes worse after eating
• Pain may dissipate as condition worsens
• Pain is worse when lying on the back; lessens when sitting or in a fetal position[7]
• Diarrhea
• Nausea and vomiting (occurs in 75-90% of patients[8])
• Greasy, foul-smelling stools
• Weight loss 
• Patients with chronic pancreatitis may not have symptoms until complications develop.[9]

RISK FACTORS

• African-American (higher risk than Caucasian and Asian Americans)
• Age 30-40 years, especially due to alcohol use
• Family history of high triglycerides
• Gallstones, more common in older adults (women over the age of 60 are at greatest risk)[10]
• Heavy alcohol use, especially after bingeing, but usually after 4-7 years of alcohol use[11]
• High fat diet
• Infections 
• Bacteria[12
• Legionella
• Leptospira 
• Mycoplasma
• Salmonella 
• Fungi[13] 
• Aspergillus 
• Parasites[14] 
• Ascaris
• Cryptosporidium
• Toxoplasma
• Viruses[15] 
• Coxsackie
• Cytomegalovirus
• Hepatitis B
• Herpes simplex
• HIV
• Mumps
• Varicella-zoster
• Male
• Medications
• Statins
• ACE inhibitors
• Oral contraceptives/hormone replacement therapy
• Diuretics
• Oral hypoglycemic agents, including metformin
• Valproic acid
• Antiretroviral therapy
• Antipsychotics, including clozapine, risperidone, olanzapine
• Smoking
• Type-2 diabetes

DIAGNOSIS

It is important to understand that even with all the advantages of modern medicine, pancreatitis has a high misdiagnosis rate, up to 43%.[16]  It will be much more difficult to diagnose is a collapsed society without technology to aid the physician.  Diagnosis will be limited to best guess based on the symptoms listed above. 

TREATMENT

Treatment is supportive and depends on whether the pancreatitis is acute or chronic and mild or severe.  Complete rest for the patient and his gut means complete bed rest and nothing by mouth.  No food and all fluids and pain relief must be administered intravenously or rectally. [17] Be aware that the mortality rate for severe acute pancreatitis is 2-9%.[18] In cases of mild pancreatitis, no oral intake of food or water is recommended until after nausea and vomiting subside. [19]

There are no currently proven medical therapies for acute pancreatitis. [20]  About 15% of those who have had an attack of acute pancreatitis will experience a repeat.[21]

The diet may need to be adjusted to prevent future attacks, especially in the case of chronic pancreatitis.  Basically, caffeine should be limited.  No alcohol.  A low fat, low calorie, and low sugar diet combined with high fiber and small, frequent meals will yield the best results.

There are several herbal formulas used in traditional Chinese medicine.  Unfortunately, most of the ingredients are totally unfamiliar here in the western hemisphere.  A link to the article discussing these decoctions is provided below.

Dachengqi decoction includes Rheum (rhubarb), immature bitter orange, natni sulfas natura, Magnolia officinalis bark.

Qingyi decoction includes rheum, Chinese thorowax root, white peony root, Baikal skullcap root, Coptis chinenesis, and other herbs.

Yinchenchengyi decocotion includes Artemisia scoparia, Gardenia jasminoides, Magnolia officinalis bark, immature bitter orange, rheum, natni sulfas natura,

Huoxuequingyi decoction combines qingyi decoction (above) and Salvia miltiorrhiza. 

Rheum, Salvia miltiorrhiza, and natrii sulfas have also been used alone. 

Extensive searching online for alternative treatments revealed little.  Popular websites suggested using baking soda, dandelion, curcumin, garlic, licorice, milk thistle, activated charcoal, yogurt (with live cultures), beet juice, spinach, soy, and olive oil.  I searched the National Library of Medicine online for any studies using these substances and came up empty.  I believe there are herbs that could be used successfully, but the studies just haven’t been done.  I suspect the above named substances, in conjunction with dietary changes, may be helpful in preventing further attacks. 

References:

Li J, Zhang S, Zhou R, Zhang J, Li ZF. Perspectives of traditional Chinese medicine in pancreas protection for acute pancreatitis. World J Gastroenterol. 2017;23(20):3615-3623. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5449418/ (accessed 29 March 2022).

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[1] Abilio Munoz, et al., Diagnosis and management of acute pancreatitis, American Family Physician, Vol 62 No 1, 1 July 2000, https://www.aafp.org/afp/2000/0701/p164.html (accessed 29 March 2022).

[2] AP Shah, et al., Acute pancreatitis: current perspectives on diagnosis and management, Journal of Inflammation Research, Vol 11, https://www.dovepress.com/acute-pancreatitis-current-perspectives-on-diagnosis-and-management-peer-reviewed-fulltext-article-JIR (accessed 29 March 2022).

[3] Jeremy Jones, Causes of Pancreatitis Mnemonic, Radiopaedia, https://radiopaedia.org/articles/causes-of-pancreatitis-mnemonic (accessed 29 March 2022).

[4] Jeremy Jones, Causes of Pancreatitis Mnemonic, Radiopaedia, https://radiopaedia.org/articles/causes-of-pancreatitis-mnemonic (accessed 29 March 2022).

[5] Abilio Munoz, et al., Diagnosis and management of acute pancreatitis, American Family Physician, Vol 62 No 1, 1 July 2000, https://www.aafp.org/afp/2000/0701/p164.html (accessed 29 March 2022).

[6] Symptoms and causes of pancreatitis, https://www.niddk.nih.gov/health-information/digestive-diseases/pancreatitis/symptoms-causes (accessed 29 March 2022).

[7] Abilio Munoz, et al., Diagnosis and management of acute pancreatitis, American Family Physician, Vol 62 No 1, 1 July 2000, https://www.aafp.org/afp/2000/0701/p164.html (accessed 29 March 2022).

[8] Abilio Munoz, et al., Diagnosis and management of acute pancreatitis, American Family Physician, Vol 62 No 1, 1 July 2000, https://www.aafp.org/afp/2000/0701/p164.html (accessed 29 March 2022).

[9] Symptoms and causes of pancreatitis, https://www.niddk.nih.gov/health-information/digestive-diseases/pancreatitis/symptoms-causes (accessed 29 March 2022).

[10] AP Shah, et al., Acute pancreatitis: current perspectives on diagnosis and management, Journal of Inflammation Research, Vol 11, https://www.dovepress.com/acute-pancreatitis-current-perspectives-on-diagnosis-and-management-peer-reviewed-fulltext-article-JIR (accessed 29 March 2022).

[11] Abilio Munoz, et al., Diagnosis and management of acute pancreatitis, American Family Physician, Vol 62 No 1, 1 July 2000, https://www.aafp.org/afp/2000/0701/p164.html (accessed 29 March 2022).

[12] M. Economou, et al., Infectious cases of acute pancreatitis, Annals of Gastroenterology, Vol 13 No 2, 2000, http://www.annalsgastro.gr/files/journals/1/articlessos/4/submission/editor/4-16-1-ED.pdf (accessed 29 March 2022).

[13] M. Economou, et al., Infectious cases of acute pancreatitis, Annals of Gastroenterology, Vol 13 No 2, 2000, http://www.annalsgastro.gr/files/journals/1/articlessos/4/submission/editor/4-16-1-ED.pdf (accessed 29 March 2022).

[14] M. Economou, et al., Infectious cases of acute pancreatitis, Annals of Gastroenterology, Vol 13 No 2, 2000, http://www.annalsgastro.gr/files/journals/1/articlessos/4/submission/editor/4-16-1-ED.pdf (accessed 29 March 2022).

[15] M. Economou, et al., Infectious cases of acute pancreatitis, Annals of Gastroenterology, Vol 13 No 2, 2000, http://www.annalsgastro.gr/files/journals/1/articlessos/4/submission/editor/4-16-1-ED.pdf (accessed 29 March 2022).

[16] Abilio Munoz, et al., Diagnosis and management of acute pancreatitis, American Family Physician, Vol 62 No 1, 1 July 2000, https://www.aafp.org/afp/2000/0701/p164.html (accessed 29 March 2022).

[17] Survival and Austere Medicine, 3^rd Edition, 2017, 168.

[18] Abilio Munoz, et al., Diagnosis and management of acute pancreatitis, American Family Physician, Vol 62 No 1, 1 July 2000, https://www.aafp.org/afp/2000/0701/p164.html (accessed 29 March 2022).

[19] Abilio Munoz, et al., Diagnosis and management of acute pancreatitis, American Family Physician, Vol 62 No 1, 1 July 2000, https://www.aafp.org/afp/2000/0701/p164.html (accessed 29 March 2022).

[20] Abilio Munoz, et al., Diagnosis and management of acute pancreatitis, American Family Physician, Vol 62 No 1, 1 July 2000, https://www.aafp.org/afp/2000/0701/p164.html (accessed 29 March 2022).

[21] Shereen Lehman, What to eat if you have pancreatitis, Very Well Health, 28 December 2021, https://www.verywellhealth.com/diet-and-chronic-pancreatitis-2507165 (accessed 29 March 2022).