Tuesday, January 11, 2005

Politics: Latham and Pancreatitis

Posted by AmishThrasher at 1:39 am
The Pancreas
Mark Latham's one isn't working
Some time soon, I'll get a post up covering everything I've been up to of late. Until then, I noticed Latham is out with "Pancreatitis". Assuming that this isn't a ploy to allow him to keep a low profile, I've dug up some info on Latham's condition.

First, some background on what this organ is that is giving Mark these troubles: "The pancreas is a retroperitoneal organ that serves two functions: exocrine (it produces pancreatic juice containing digestive enzymes) [and] endocrine - it produces several important hormones". ( http://en.wikipedia.org/wiki/Pancreas ) Retroperitoneal means simply that it is located behind the peritoneum. So the pancreas is "not embedded in the peritoneal cavity, but lies behind peritoneum. Most of the digestive system is embedded in the peritoneum." ( http://en.wikipedia.org/wiki/Retroperitoneal ) You can find it behind "...the stomach on the posterior abdominal wall". ( http://en.wikipedia.org/wiki/Pancreas )

"In humans, the pancreas is a small elongated organ in the abdomen. It is described as having a head, body and tail. The pancreatic head abuts the second part of the duodenum while the tail extends towards the spleen. The pancreatic duct runs the length of the pancreas and empties into the second part of the duodenum at the ampulla of Vater. The common bile duct commonly joins the pancreatic duct at or near this point." ( http://en.wikipedia.org/wiki/Pancreas )

So what does this organ located behind our stomachs do? "The pancreas is the main source of enzymes for digesting fats (lipids) and proteins - the intestinal walls have enzymes that will digest polysaccharides. Pancreatic secretions contain bicarbonate ions and are alkaline in order to neutralize the acidic chyme that the stomach churns out." ( http://en.wikipedia.org/wiki/Pancreas ) "Due to the potency of its enzyme contents, it is a very dangerous organ to injure and a puncture of the pancreas tends to require careful medical intervention." ( http://en.wikipedia.org/wiki/Pancreas )

Now we're familiar with the basics of the pancreas, it's time to look into what Pancreatitis is, and why it's giving Mark such trouble. "There are two forms, which are different in causes and symptoms, and require different treatment" ( http://en.wikipedia.org/wiki/Pancreatitis ). The two forms are Acute, and Chronic.

"Acute pancreatitis is a rapidly-onset inflammation of the pancreas. Depending on its severity, it can have severe complications and high mortality despite treatment. While mild cases settle with conservative measures or endoscopy, severe cases require surgery (often more than one intervention) to contain the disease process." ...

-> Annual incidence in the US is 17 per 100,000 population. [1]
-> Prevalence in the US is 80,000 cases per year.

-> Severe abdominal pain often radiating through to the back.
-> Nausea, vomiting and loss of appetite.
-> Severe illness, sometimes requiring admission to intensive care and sometimes fatal.
-> Recovery may be followed by development of pancreatic pseudocyst, pancreatic dysfunction (malabsorption due to exocrine failure) or diabetes mellitus.

-> Gallstones;
-> Alcohol;
-> Trauma;
-> Steroid use;
-> Mumps;
-> Autoimmune disease;
-> Scorpion venom;
-> Hypercalcaemia;
-> Hypertriglyceridemia;
-> ERCP (a form of endoscopy);
-> Drugs
-> Duodenal ulcer;
-> Fat necrosis;
-> Pregnancy;
-> Idiopathic or unknown.

The most common causes of pancreatitis, accounting for more than 85% of all cases of pancreatitis in Western countries are chronic alcoholism and gallstones. Other causes include trauma (as from a steering wheel in an automobile accident), infection (the mumps virus being the most common), drugs (the diuretics furosemide and thiazides, and some antiretrovirals are common causes, as well as azathioprine and morphine), and cancer.

Gallstones that travel down the common bile duct and which subsequently get stuck in the Ampulla of Vater can cause obstruction in the outflow of pancreatic juices from the pancreas into the duodenum. The backflow of these digestive juices causes lysis (dissolving) of pancreatic cells and subsequent pancreatitis.

Classification by severity
Acute pancreatitis can be further divided in mild and severe pancreatitis. Mostly the Atlanta classification (1992) is used. In severe pancreatitis serious amount of necrosis determine the further clinical outcome. About 20% of the acute pancreatitis are severe with a mortality of about 20%. This is an important classification as severe pancreatits will need intensive care therapy whereas mild pancreatits can be treated on the common ward.

Necrosis will be followed by an systemic inflammation response syndrom (SIRS) and will determine the immediate clinical course. The further clinical course is then determined by bacterial infection. SIRS is the cause bacterial translocation from the patients colon.

There are several ways to help distinguish between these two forms. One is the above mentioned Ranson Score.

-> Supportive for shock.
-> Pain relief
-> Enzyme inhibitors are not proven to work.
-> While often severe, the disease is essentially self limiting.

In the management of acute pancreatitis, the treatment is to stop feeding the patient, giving him or her nothing by mouth, giving intravenous fluids to prevent dehydration. As the pancreas is stimulated to secrete enzymes by the presence of food in the stomach, having no food pass through the system allows the pancreas to rest.

While I'm no doctor, I somehow suspect that steroid abuse and pregnancy are the causes of Mark's particular case. There is also a second variety Mark Latham could possibly have:

Chronic pancreatitis can present as episodes of acute inflammation in a previously injured pancreas, or as chronic damage with persistent pain or malabsorption. The causes of relapsing chronic pancreatitis are similar to those of acute pancreatitis, though gallstone-associated pancreatitis is predominantly acute or relapsing-acute in nature, and more cases of chronic pancreatitis are of undetermined or idiopathic origin.

Patients with chronic pancreatitis can present with persistent abdominal pain or steatorrhea (diarhhea resulting from malabsorption of the fats in food, typically very bad-smelling and equally hard on the patient), as well as severe nausea. Patients with chronic pancreatitis often look very sick.

Among American adults, chronic pancreatitis most often occurs from the cumulative pancreatic destruction caused by repeated alcohol-induced episodes of acute pancreatitis. Cystic fibrosis is the most common cause of chronic pancreatitis in children. In up to one quarter of cases, no cause can be found. In other parts of the world, severe protein-calorie malnutrition is a common cause.

The abdominal pain can be very severe and require high doses of analgesics. Disability and mood problems are common, although early diagnosis and support can make these problems manageable.

Serum amylase and lipase may well not be elevated in chronic pancreatitis. Pancreatic calcification can often be seen on X-rays.

Treatment is directed, when possible, to the underlying cause, and to relief of the pain and malabsorption. Replacement pancreatic enzymes have proven somewhat effective in treating the malabsorption and steatorrhea.

Why the interest in Latham's gut? "(Mark Latham's) spokesman said on January 5 that Mr Latham had fallen ill with a repeat bout of pancreatitis about 10 days before and was under 'strict orders' from his doctors to rest up... A guest at Terrigal's Star of the Sea resort, Shirley Corbett, of Sydney, said yesterday that she and five friends saw Mr Latham, his wife, Janine, and two young sons, Oliver and Isaac, over the three days. 'He was with the kids at the pool. There was nothing unwell there about him.'" http://www.smh.com.au/news/National/He-looked-fine-to-me-Latham-at-resort-pool/2005/01/10/1105206053175.html

We don't know whether Mark has acute or chronic pancreatitis (or whether he is just an outright liar). But if he is indeed recovering from a repeat of acute pancreatitis, it is very much within the realm of possibility that he has been advised to take it easy for a little while; given that politics is a high stress job. My question is who is Shirley Corbett? What is her political affiliation? Or, if she's Labor, her factional affiliation? Is she a trained doctor? On what did she base her judgement that 'there was nothing unwill about him'? And what kind of evidence was she looking for to suggest that he was unwell? Then again, at least she had the credit to present her real name, rather than just going under 'anonymous sources'.

Assuming, of course, that was Mark to begin with.

More info at: http://en.wikipedia.org/wiki/Acute_pancreatitis , http://en.wikipedia.org/wiki/Pancreas and http://en.wikipedia.org/wiki/Chronic_pancreatitis