>Pancreatitis

What Is Pancreatitis?

The pancreas is a large gland located behind the stomach and next to the duodenum (the first section of the small intestine). The pancreas has two primary functions:

1. To secrete powerful digestive enzymes into the small intestine to aid the digestion of carbohydrates, proteins, and fat.
2. To release the hormones insulin and glucagon into the bloodstream. These hormones are involved in blood glucose metabolism, regulating how the body stores and uses food for energy.

Pancreatitis is a disease in which the pancreas becomes inflamed. Pancreatic damage occurs when the digestive enzymes are activated before they are secreted into the duodenum and begin attacking the pancreas.

There are two forms of pancreatitis: acute and chronic.

Acute pancreatitis

Acute pancreatitis is a sudden inflammation that occurs over a short period of time. In the majority of cases, acute pancreatitis is caused by gallstones or heavy alcohol use. Other causes include medications, infections, trauma, metabolic disorders, and surgery. In about 10% to 15% of people with acute pancreatitis, the cause is unknown.
The severity of acute pancreatitis may range from mild abdominal discomfort to a severe, life-threatening illness. However, the majority of people with acute pancreatitis (more than 80%) recover completely after receiving the appropriate treatment.
In very severe cases, acute pancreatitis can result in bleeding into the gland, serious tissue damage, infection, and cyst formation. Severe pancreatitis can also cause damage if enzymes and toxins are released into the bloodstream, which can harm other vital organs such as the heart, lungs, and kidneys.

Chronic pancreatitis

Chronic pancreatitis occurs most commonly after an episode of acute pancreatitis and is the result of ongoing inflammation of the pancreas. In more than 70% of the cases, chronic pancreatitis is caused by prolonged alcohol use. Other, less common causes include metabolic disorders. Very rarely, patients have chronic pancreatitis that tends to run in families (hereditary pancreatitis). Damage to the pancreas from excessive alcohol use may not cause symptoms for many years, but then the person may suddenly develop severe pancreatitis symptoms, including severe pain and loss of pancreatic function, resulting in digestion and blood sugar abnormalities.

What Are the Symptoms of Pancreatitis?

Symptoms of acute pancreatitis

• Upper abdominal pain that radiates (travels) to their back. Patients may describe this as a "boring sensation" that may be aggravated by eating, especially foods high in fat.
• Swollen and tender abdomen
• Nausea and vomiting
• Fever
• Increased heart rate.

Symptoms of chronic pancreatitis

The symptoms of chronic pancreatitis are similar to those of acute pancreatitis. Patients frequently experience constant pain in the upper abdomen that radiates to the back. In some patients, the pain may be disabling. Other symptoms may include weight loss caused by poor absorption (malabsorption) of food. This malabsorption occurs because the gland is not secreting enough enzymes to break down the food normally. Also, diabetes may develop if the insulin-producing cells of the pancreas become damaged.

What Causes Pancreatitis?

In the majority of cases, acute pancreatitis is caused by gallstones and alcohol use. Other causes include medications, lipid (triglyceride) disorders, infections, surgery, or trauma to the abdomen. In about 10% to 15% of people with pancreatitis, the cause is unknown.
In many people with chronic pancreatitis, the condition is caused by prolonged alcohol use, resulting in pancreatic damage and scarring. In other cases of chronic pancreatitis, the cause may be metabolic, hereditary, or simply unknown.

What Are the Risk Factors for Pancreatitis?

Pancreatitis can happen to anyone; however, it is more common in people with certain risk factors.
Risk factors of acute pancreatitis include:

• Gallstone disease
• Heavy alcohol consumption

Acute pancreatitis may be the first sign of gallstone disease. The link between gallstones and acute pancreatitis is the anatomical union of the ducts that drain the gallbladder and pancreas, called the ampulla or major papilla of the duodenum. The passage of gallstones from the gallbladder can become blocked at the ampulla, causing an obstruction of the pancreatic duct, which causes acute pancreatitis.
Risk factors for chronic pancreatitis include:

• Prolonged alcohol use

People with chronic pancreatitis are usually men between the ages of 30 and 45, but chronic pancreatitis may occur in females as well.

How Is Pancreatitis Diagnosed?

Pancreatitis is primarily suspected when a person reports symptoms of pancreatitis and also has risk factors such as heavy alcohol use or gallstone disease. To confirm acute pancreatitis, the doctor measures levels in the blood of the two digestive enzymes, amylase and lipase. High levels of these two enzymes strongly suggest acute pancreatitis.
Diagnosis can be difficult but is aided by a number of techniques such as pancreatic function tests and radiographic imaging of the pancreas. In more advanced stages of the disease, when malabsorption or diabetes is present, blood, urine, and stool tests will confirm the progression.
Diagnostic tests for pancreatitis include:

• Pancreatic function test, to determine if the pancreas is producing the appropriate levels of digestive enzymes
• Glucose tolerance test to measure damage to the cells in the pancreas that make insulin
• Ultrasound, which can produce images of the pancreas so that abnormalities may be detected
• CT scan (computed tomography scan), which can produce images of the pancreas so that abnormalities may be detected
• ERCP (endoscopic retrograde cholangiopancreatography) to look at the pancreatic and bile ducts using contrast and X-rays
• Endoscopic ultrasound (EUS) and biopsy, an exam in which a fine needle is inserted into a localized abnormality of the pancreas to remove a small tissue sample for study.

How Is Pancreatitis Treated?

Treatment for acute pancreatitis

People with acute pancreatitis are primarily treated with intravenous fluids and pain medications in the hospital. In up to 20% of patients, the pancreatitis can be severe and patients may need to be admitted to an intensive care unit (ICU). In the ICU, the patient is closely monitored, since pancreatitis can cause damage to the heart, lungs, or kidneys. Some cases of severe pancreatitis can result in death of pancreatic tissue (pancreatic necrosis). In these cases, surgery may be necessary to remove the damaged tissue if a secondary infection develops.
An acute attack of pancreatitis usually lasts only a few days, unless it is complicated by necrosis or fluid collections in or around the gland. An acute attack of pancreatitis caused by gallstones may require removal of the gallbladder or endoscopic surgery of the bile duct. After the gallstones are removed and the inflammation subsides, the pancreas usually returns to normal.
Pancreatic or gallbladder surgery can be performed as laparoscopic, or "minimally invasive," procedures. During laparoscopic surgery, small (usually 5- to 10-millimeter) incisions are made in the abdomen. The laparoscope and surgical instruments are inserted through these incisions. The surgeon is guided by the laparoscope, which transmits a picture of the internal organs on a monitor. The advantages of laparoscopic surgery include smaller incisions, less risk of infection, less pain and scarring, and a more rapid recovery.
 

Treatment for chronic pancreatitis

Chronic pancreatitis can be somewhat difficult to treat. Doctors will try to relieve the patient's pain and improve the nutritional and metabolic problems that result from loss of pancreatic function. Patients are generally given pancreatic enzymes or insulin, if these substances are not being secreted or released by the pancreas. Pancreatic enzyme pills are usually prescribed to be taken with meals to aid in nutrient absorption. A low-fat diet may also be helpful.
Surgery may help relieve abdominal pain, restore drainage of pancreatic secretions, treat chronic pancreatitis caused by blockage of the pancreatic duct, or reduce the frequency of attacks.
Patients must stop drinking alcoholic beverages, follow their doctor and dietitian's dietary recommendations, and take the proper medications in order to have fewer and milder attacks of pancreatitis.

Can Pancreatitis Be Prevented?

Since most cases of pancreatitis are caused by alcohol abuse, prevention is directed at responsible drinking, or no drinking at all. If heavy drinking is a concern, talk to your doctor or health care provider about a referral to an alcohol treatment center. In addition, you may benefit from a support group such as Alcoholics Anonymous.