Pancreatitis

Pancreatitis is inflammation in the pancreas. The pancreas is a long, flat gland that sits tucked behind the stomach in the upper abdomen. The pancreas produces enzymes that assist digestion and hormones that help regulate the way your body processes sugar (glucose).

Pancreatitis can occur as acute pancreatitis — meaning it appears suddenly and lasts for days. Or pancreatitis can occur as chronic pancreatitis, which describes pancreatitis that occurs over many years.

Mild cases of pancreatitis may go away without treatment, but severe cases can cause life-threatening complications.

Signs and symptoms of pancreatitis may vary, depending on which type you experience.

Acute pancreatitis signs and symptoms include:

• Upper abdominal pain
• Abdominal pain that radiates to your back
• Abdominal pain that feels worse after eating
• Nausea
• Vomiting
• Tenderness when touching the abdomen

Chronic pancreatitis signs and symptoms include:

• Upper abdominal pain
• Losing weight without trying
• Oily, smelly stools (steatorrhea)

Pancreatitis occurs when digestive enzymes produced in your pancreas become activated while inside the pancreas, causing damage to the organ.

During normal digestion, the inactivated pancreatic enzymes move through ducts in your pancreas and travel to the small intestine, where the enzymes become activated and help with digestion. In pancreatitis, the enzymes become activated while still in the pancreas. This causes the enzymes to irritate the cells of your pancreas, causing inflammation and the signs and symptoms associated with pancreatitis.

With repeated bouts of acute pancreatitis, damage to the pancreas can occur and lead to chronic pancreatitis. Scar tissue may form in the pancreas, causing loss of function. A poorly functioning pancreas can cause digestion problems and diabetes.

A number of causes have been identified for acute pancreatitis and chronic pancreatitis, including:

• Alcoholism
• Gallstones
• Abdominal surgery
• Certain medications
• Cigarette smoking
• Cystic fibrosis
• Endoscopic retrograde cholangiopancreatography (ERCP), when used to treat gallstones
• Family history of pancreatitis
• High calcium levels in the blood (hypercalcemia), which may be caused by an overactive parathyroid gland (hyperparathyroidism)
• High triglyceride levels in the blood (hypertriglyceridemia)
• Infection
• Injury to the abdomen
• Pancreatic cancer

Pancreatitis can cause serious complications, including:

• Acute pancreatitis can cause fluid and debris to collect in cyst-like pockets in your pancreas. A large pseudocyst that ruptures can cause complications such as internal bleeding and infection.
• Acute pancreatitis can make your pancreas vulnerable to bacteria and infection. Pancreatic infections are serious and require intensive treatment, such as surgery to remove the infected tissue.
• Breathing problems. Acute pancreatitis can cause chemical changes in your body that affect your lung function, causing the level of oxygen in your blood to fall to dangerously low levels.
• Damage to insulin-producing cells in your pancreas from chronic pancreatitis can lead to diabetes, a disease that affects the way your body uses blood sugar.
• Kidney failure. Acute pancreatitis may cause kidney failure, which can be treated with dialysis if the kidney failure is severe and persistent.
• Both acute and chronic pancreatitis can cause your pancreas to produce fewer of the enzymes that are needed to break down and process nutrients from the food you eat. This can lead to malnutrition, diarrhea and weight loss, even though you may be eating the same foods or the same amount of food.
• Pancreatic cancer. Long-standing inflammation in your pancreas caused by chronic pancreatitis is a risk factor for developing pancreatic cancer.

Tests and procedures used to diagnose pancreatitis include:

• Blood tests to look for elevated levels of pancreatic enzymes
• Computerized tomography (CT) scan to look for gallstones and assess the extent of pancreas inflammation
• Abdominal ultrasound to look for gallstones and pancreas inflammation
• Endoscopic ultrasound to look for inflammation and blockages in the pancreatic duct or bile duct
• Magnetic resonance imaging (MRI) to look for abnormalities in the gallbladder, pancreas and ducts

Your doctor may recommend other tests, depending on your particular situation.

Treatment for pancreatitis usually requires hospitalization. Once your condition is stabilized in the hospital and inflammation in the pancreas is controlled, doctors can treat the underlying cause of your pancreatitis.

If you’re experiencing pancreatitis, your doctor may admit you to the hospital for care.

Initial treatments to help control the inflammation in your pancreas and make you more comfortable may include:

• You’ll stop eating for a couple of days in the hospital in order to give your pancreas a chance to recover.

Once the inflammation in your pancreas is controlled, you may begin drinking clear liquids and eating bland foods. With time, you can go back to your normal diet.

If your pancreatitis persists and you still experience pain when eating, your doctor may recommend a feeding tube to help you get nutrition.

• Pain medications. Pancreatitis can cause severe pain. Your health care team will give you medications to help control the pain.
• Intravenous (IV) fluids. As your body devotes energy and fluids to repairing your pancreas, you may become dehydrated. For this reason, you’ll receive extra fluids through a vein in your arm during your hospital stay.

How long you stay in the hospital will depend on your situation. Some people recover quickly and others develop complications that require a longer hospitalization.

Once your pancreatitis is brought under control, your health care team can treat the underlying cause of your pancreatitis.

Treatment will depend on the cause of your pancreatitis, but examples of treatment may include:

• Procedures to remove bile duct obstructions. Pancreatitis caused by a narrowed or blocked bile duct may require procedures to open or widen the bile duct.

A procedure called endoscopic retrograde cholangiopancreatography (ERCP) uses a long tube with a camera on the end to examine your pancreas and bile ducts. The tube is passed down your throat, and the camera sends pictures of your digestive system to a monitor.

ERCP can aid in diagnosing problems in the bile duct and in making repairs.

• Gallbladder surgery. If gallstones caused your pancreatitis, your doctor may recommend surgery to remove your gallbladder (cholecystectomy).
• Pancreas surgery. Surgery may be necessary to drain fluid from your pancreas or to remove diseased tissue.
• Treatment for alcohol dependence.

Chronic pancreatitis may require additional treatments, depending on your situation. Other treatments for chronic pancreatitis may include:

• Pain management. Chronic pancreatitis can cause persistent abdominal pain. Your doctor may recommend medications to control your pain and may refer you to a pain specialist.

Severe pain may be relieved with surgery to block nerves that send pain signals from the pancreas to the brain.

• Enzymes to improve digestion. Pancreatic enzyme supplements can help your body break down and process the nutrients in the foods you eat. Pancreatic enzymes are taken in tablet form with each meal.
• Changes to your diet. Your doctor may refer you to a dietitian who can help you plan low-fat meals that are high in nutrients.

Once you leave the hospital, you can take steps to continue your recovery from pancreatitis, such as:

• Stop drinking alcohol.
• Stop smoking.
• Choose a low-fat diet.
• Drink more fluids