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Emmanuel Enabulele
I happened to be in a mellow mood as I wrote this. There is so much negativity in the horizon that an invitation to a funeral might just be an occasional tonic that one needs these days to move on.
The sad reality now is that birthdays and house warming celebrations are becoming less frequent and far inbetween.
So, apart from going to churches and mosques, beautiful dresses are left for burial ceremonies and weddings. We are still praying for happy days to come by.
Yours truly had the luck to attend one of those burial ‘receptions’ in my neighbourhood lately. For the records, I happen to live in a neighbourhood with a lot of aging pensioners and you can imagine the implication to me as a health care giver. For us, funerals are commonplace and not very far in between. So when it happens, the question is how many of his/her siblings are coming from abroad. That would give you an idea of how it’s going to be.
These days, they don’t ask you whether you are going to eat eba, amala or pounded yam. They simply ask you whether you are going to have rice or swallow. To us now, swallow is now a verb and a noun, not only a verb anymore. Well for me, I opted for swallow/ pounded yam. My brother when they brought it, the egusi soup was powerful. Then wait for it, when the liquids followed, I was wondering whether we were all in the same country. Nigerians love parties. I had requested for a Heineken larger beer feeling like a big boy. But when I saw what the real big boys were consuming, I found myself a place in a corner. Name it, Hennessey, Remy Martins, St Remy, Brigadier, and Johnnie Walker and so were flowing into their bowel! And I said to myself, our young men are drinking.That brings us to our discussion today: the causes of pancreatitis. Inasmuch as we may not want to accept it alcohol bestrides over our lives after water, air and light. There is hardly any aspect of our life that alcohol does not touch; from food, medicine and spirituality. It is the excessive and chronic consumption of alcohol that can lead to both acute and chronic inflammation of the pancreas. As a corollary of this, alcohol consumption is a known trigger of peptic ulcer disease, which has lately been identified to be caused by the bacterium H. pylori. When this ulceration penetrates the pancreas, inflammation of the pancreas can be the result. Thus when a patient with dyspepsia has the pains being referred to the back, it should be reminded that the ulcer is already penetrating the pancreas and could result in pancreatitis.
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READ ALSO: Acute pancreatitis
Just like any lesion, acute pancreatitis can be caused by blunt and penetrating traumas to the abdomen. In this vain also are infections. The worst culprits with regards to this are mainly viral infections. High on the list in our environment is Viral hepatitis. Ironically viral hepatitis can be caused by five unrelated viruses that have a predilection for the Liver cells, mainly hepatitis A, hepatitis B, hepatitis C, hepatitis D and hepatitis E. Other viruses that have been implicated include Yellow fever and cytomegalovirus. In addition to these there could be a situation where the immune system of the individual turns against its own body tissue. In this instance with the pancreas it is referred to as autoimmune pancreatitis. The hallmark of this condition is that it tends to run a chronic course but by and large responds to CORTICOSTEROIDS especially prednisone treatment.
Radiotherapy is a well-known option in the treatment of disseminated malignancies. A known side effect is that the radiation beams do not discriminate between cancer cells and normal cells. Thus sessions of radiotherapy on cancer cells close to the pancreas or in the pancreas can lead to adverse effect on the organ with attendant inflammation. There are other factors too numerous to be mentioned here especially drugs varying from antibiotics, steroids, diuretics to even chemotherapeutic agents for the treatment of cancer.
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Having so stated, there are other clinical conditions that may mimic pancreatitis. One of them is perforated peptic ulcer, which, in turn, may even be a precursor of pancreatitis. Acute inflammation of the gall bladder known as Cholecystitis, biliary colic resulting from the presence of gallstones in the bile duct and pneumonia, which is the inflammation of the lungs can all present like acute pancreatitis. One of the conditions that should not be left unmentioned is acute heart attack or myocardial infarction.
At this point it would be pertinent to mention some of the complications of acute pancreatitis. It is also good for us to recap that the pancreas is both an ENDOCRINE and EXOCRINE organ. As an endocrine organ it produces INSULIN while as an exocrine organ it secretes digestive enzymes. With this at the back of the mind, we expect a multisystem/organs involvement. Thus some of the complications include raised blood sugar and insulin dependent diabetes mellitus. This is as a result of damage of insulin producing beta cells. Also expected as a corollary to this, are poor digestion and malabsorption of ingested food. This is due to the failure of the exocrine function. Low level of calcium in the blood known as hypocalcemia as a result of fat saponification is a feature of acute pancreatitis. This can lead to twitching and tremors of the upper limbs.
Systemically, there could be a collapse of the cardiovascular system with myocardial infarction, abnormal heartbeat or arrhythmia and formation of abnormal blood clots in the vessels known as thrombosis. With regards to the gastrointestinal system, bleeding from stress ulcers and frank gastrointestinal obstruction has been known to complicate acute pancreatitis. There could also be complications in the nervous system resulting PSYCHOSIS, lodging of blood clots in the brain blood vessels known cerebral embolism and blindness from bleeding into the retina of the eyes.
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Other serious complications this time affecting the blood include anaemia and increase in white blood cells known as Leucocytosis. Well this is common in most acute inflammatory conditions. If perchance this happens in the pancreas with abscess collection, the condition usually is inevitably fatal. There could be a complete respiratory collapse in acute pancreatitis as a result of pneumonitis, collection of fluid in the potential space surrounding the lungs known as pleural effusion and acute respiratory distress syndrome.
