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.
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.
This
inflammation of the pancreas has numerous root causes. The I GET SMASHED mnemonic covers these
causes:
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.
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
- 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.
- 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
- Diarrhea
- Nausea
and vomiting (occurs in 75-90% of patients)
- Greasy,
foul-smelling stools
- Weight
loss
- Patients
with chronic pancreatitis may not have symptoms until complications develop.
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)
- Heavy alcohol use, especially after bingeing,
but usually after 4-7 years of alcohol use
- High fat diet
- Infections
- Bacteria
- Legionella
- Leptospira
- Mycoplasma
- Salmonella
- Fungi
- Parasites
- Ascaris
- Cryptosporidium
- Toxoplasma
- Viruses
- 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%. 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. Be aware that the
mortality rate for severe acute pancreatitis is 2-9%. In cases of mild
pancreatitis, no oral intake of food or water is recommended until after nausea
and vomiting subside.
There are no currently proven medical therapies for acute
pancreatitis. About 15% of those who have had an attack of acute
pancreatitis will experience a repeat.
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).