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Pancreatitis

Pancreatitis is an inflammation of the pancreas. The pancreas
is a large gland behind the stomach and close to the
duodenum. The duodenum is the upper part of the small
intestine. The pancreas secretes digestive enzymes into the
small intestine through a tube called the pancreatic duct.
These enzymes help digest fats, proteins, and carbohydrates
in food. The pancreas also releases the hormones insulin and
glucagon into the bloodstream. These hormones help the
body use the glucose it takes from food for energy.

Normally, digestive enzymes do not become active until they
reach the small intestine, where they begin digesting food. But
if these enzymes become active inside the pancreas, they start
"digesting" the pancreas itself.Acute pancreatitis occurs
suddenly and lasts for a short period of time and usually
resolves. Chronic pancreatitis does not resolve itself and
results in a slow destruction of the pancreas. Either form can
cause serious complications. In severe cases, bleeding, tissue
damage, and infection may occur. Pseudocysts, accumulations
of fluid and tissue debris, may also develop. And enzymes and
toxins may enter the bloodstream, injuring the heart, lungs,
and kidneys, or other organs.

Acute Pancreatitis
Some people have more than one attack and recover
completely after each, but acute pancreatitis can be a severe,
life-threatening illness with many complications. About 80,000
cases occur in the United States each year; some 20 percent
of them are severe. Acute pancreatitis occurs more often in
men than women.

Acute pancreatitis is usually caused by gallstones or by
drinking too much alcohol, but these aren't the only causes. If
alcohol use and gallstones are ruled out, other possible causes
of pancreatitis should be carefully examined so that
appropriate treatment—if available—can begin.
Symptoms

Acute pancreatitis usually begins with pain in the upper
abdomen that may last for a few days. The pain may be severe
and may become constant—just in the abdomen—or it may
reach to the back and other areas. It may be sudden and
intense or begin as a mild pain that gets worse when food is
eaten. Someone with acute pancreatitis often looks and feels
very sick. Other symptoms may include swollen and tender
abdomen, nausea, vomiting, fever and rapid pulse.

Severe cases may cause dehydration and low blood pressure.
The heart, lungs, or kidneys may fail. If bleeding occurs in the
pancreas, shock and sometimes even death follow.

Diagnosis
Besides asking about a person's medical history and doing a
physical exam, a doctor will order a blood test to diagnose
acute pancreatitis. During acute attacks, the blood contains at
least three times more amylase and lipase than usual. Amylase
and lipase are digestive enzymes formed in the pancreas.
Changes may also occur in blood levels of glucose, calcium,
magnesium, sodium, potassium, and bicarbonate. After the
pancreas improves, these levels usually return to normal.

A doctor may also order an abdominal ultrasound to look for
gallstones and a CAT (computerized axial tomography) scan to
look for inflammation or destruction of the pancreas. CAT
scans are also useful in locating pseudocysts.
Treatment

Treatment depends on the severity of the attack. If no kidney
or lung complications occur, acute pancreatitis usually
improves on its own. Treatment, in general, is designed to
support vital bodily functions and prevent complications. A
hospital stay will be necessary so that fluids can be replaced
intravenously.

If pancreatic pseudocysts occur and are considered large
enough to interfere with the pancreas's healing, your doctor
may drain or surgically remove them.

Unless the pancreatic duct or bile duct is blocked by
gallstones, an acute attack usually lasts only a few days. In
severe cases, a person may require intravenous feeding for 3
to 6 weeks while the pancreas slowly heals. This process is
called total parenteral nutrition. However, for mild cases of the
disease, total parenteral nutrition offers no benefit.

Before leaving the hospital, a person will be advised not to
drink alcohol and not to eat large meals. After all signs of
acute pancreatitis are gone, the doctor will try to decide what
caused it in order to prevent future attacks. In some people,
the cause of the attack is clear, but in others, more tests are
needed.

Complications
Acute pancreatitis can cause breathing problems. Many people
develop hypoxia, which means that cells and tissues are not
receiving enough oxygen. Doctors treat hypoxia by giving
oxygen through a face mask. Despite receiving oxygen, some
people still experience lung failure and require a ventilator.

Sometimes a person cannot stop vomiting and needs to have
a tube placed in the stomach to remove fluid and air. In mild
cases, a person may not eat for 3 or 4 days and instead may
receive fluids and pain relievers through an intravenous line.

If an infection develops, the doctor may prescribe antibiotics.
Surgery may be needed for extensive infections. Surgery may
also be necessary to find the source of bleeding, to rule out
problems that resemble pancreatitis, or to remove severely
damaged pancreatic tissue.

Acute pancreatitis can sometimes cause kidney failure. If your
kidneys fail, you will need dialysis to help your kidneys remove
wastes from your blood.

If injury to the pancreas continues, chronic pancreatitis may
develop. Chronic pancreatitis occurs when digestive enzymes
attack and destroy the pancreas and nearby tissues, causing
scarring and pain. The usual cause of chronic pancreatitis is
many years of alcohol abuse, but the chronic form may also be
triggered by only one acute attack, especially if the pancreatic
ducts are damaged. The damaged ducts cause the pancreas to
become inflamed, tissue to be destroyed, and scar tissue to
develop.

While common, alcoholism is not the only cause of chronic
pancreatitis. The main causes of chronic pancreatitis are
alcoholism, blocked or narrowed pancreatic duct because of
trauma or pseudocysts have formed, heredity and unknown
cause (idiopathic)

Damage from alcohol abuse may not appear for many years,
and then a person may have a sudden attack of pancreatitis.
In up to 70 percent of adult patients, chronic pancreatitis
appears to be caused by alcoholism. This form is more
common in men than in women and often develops between
the ages of 30 and 40.

Hereditary pancreatitis usually begins in childhood but may not
be diagnosed for several years. A person with hereditary
pancreatitis usually has the typical symptoms that come and
go over time. Episodes last from 2 days to 2 weeks. A
determining factor in the diagnosis of hereditary pancreatitis is
two or more family members with pancreatitis in more than
one generation. Treatment for individual attacks is usually the
same as it is for acute pancreatitis. Any pain or nutrition
problems are treated just as they are for acute pancreatitis.
Surgery can often ease pain and help manage complications.

Other causes of chronic pancreatitis are, congenital conditions
such as pancreas divisum, cystic fibrosis, high levels of calcium
in the blood (hypercalcemia), high levels of blood fats
(hyperlipidemia or hypertriglyceridemia), some drugs and
certain autoimmune conditions

Symptoms
Most people with chronic pancreatitis have abdominal pain,
although some people have no pain at all. The pain may get
worse when eating or drinking, spread to the back, or become
constant and disabling. In certain cases, abdominal pain goes
away as the condition advances, probably because the
pancreas is no longer making digestive enzymes. Other
symptoms include nausea, vomiting, weight loss, and fatty
stools.

People with chronic disease often lose weight, even when their
appetite and eating habits are normal. The weight loss occurs
because the body does not secrete enough pancreatic
enzymes to break down food, so nutrients are not absorbed
normally. Poor digestion leads to excretion of fat, protein, and
sugar into the stool. If the insulin-producing cells of the
pancreas (islet cells) have been damaged, diabetes may also
develop at this stage.

Diagnosis
Diagnosis may be difficult, but new techniques can help.
Pancreatic function tests help a doctor decide whether the
pancreas is still making enough digestive enzymes. Using
ultrasonic imaging, endoscopic retrograde
cholangiopancreatography (ERCP), and CAT scans, a doctor
can see problems indicating chronic pancreatitis. Such
problems include calcification of the pancreas, in which tissue
hardens from deposits of insoluble calcium salts. In more
advanced stages of the disease, when diabetes and
malabsorption occur, a doctor can use a number of blood,
urine, and stool tests to help diagnose chronic pancreatitis
and to monitor its progression.

Treatment
Relieving pain is the first step in treating chronic pancreatitis.
The next step is to plan a diet that is high in carbohydrates
and low in fat.

A doctor may prescribe pancreatic enzymes to take with meals
if the pancreas does not secrete enough of its own. The
enzymes should be taken with every meal to help the body
digest food and regain some weight. Sometimes insulin or
other drugs are needed to control blood glucose.

In some cases, surgery is needed to relieve pain. The surgery
may involve draining an enlarged pancreatic duct or removing
part of the pancreas.

For fewer and milder attacks, people with pancreatitis must
stop drinking alcohol, stick to their prescribed diet, and take
the proper medications.

Content Source NIDDK.NIH