Pancreatitis simply means inflammation of the pancreas. Located in the upper part of the abdomen, behind the stomach, the pancreas plays an important role in digestion. The pancreas is a gland, producing two main types of substances: digestive juices and digestive hormones.
- Digestive juices include enzymes and bicarbonate. They travel through a small tube called the pancreatic duct that connects the pancreas to the small intestine to the small intestine (duodenum).
- There, the enzymes help in the break down of proteins and fats in the foods that you eat to permit the nutrients to be absorbed.
- The bicarbonate neutralizes stomach acid.
- Digestive hormones, mainly insulin and glucagon, are released into the bloodstream. They control the body's blood sugar level, a major source of energy, and are an important role in the cause of diabetes.
- Inflammation of the pancreas has various causes. Once the gland becomes inflamed, the condition can progress to swelling of the gland and surrounding blood vessels, bleeding, infection, and damage to the gland. There, digestive juices become trapped and start "digesting" the pancreas itself. If this damage persists, the gland may not be able to carry out normal functions.
- Pancreatitis may be acute (new, short-term) or chronic (ongoing, long-term). Either type can be very severe, even life-threatening. Either type can have serious complications.
- Acute pancreatitis usually begins soon after the damage to the pancreas begins. Attacks are typically very mild, but about 20% of them are very severe. An attack lasts for a short time and usually resolves completely as the pancreas returns to its normal state. Some people have only one attack, whereas other people have more than one attack, but the pancreas always returns to its normal state.
- Chronic pancreatitis begins as acute pancreatitis. If the pancreas becomes scarred during the attack of acute pancreatitis, it cannot return to its normal state. The damage to the gland continues, worsening over time.
About 80,000 cases of acute pancreatitis occur in the United States each year. Pancreatitis can occur in people of all ages, although it is very rare in children. Pancreatitis occurs in men and women, although chronic pancreatitis is more common in men than in women.
Acute pancreatitis usually begins with gradual or sudden pain in the upper abdomen that sometimes extends through the back. The pain may be mild at first and feel worse after eating. But the pain is often severe and may become constant and last for several days. A person with acute pancreatitis usually looks and feels very ill and needs immediate medical attention.
Other symptoms may include:
Severe acute pancreatitis may cause dehydration and low blood pressure. The heart, lungs, or kidneys can fail. If bleeding occurs in the pancreas, shock and even death may follow.
How is acute pancreatitis diagnosed?
While asking about a person's medical history and conducting a thorough physical examination, the doctor will order a blood test to assist in the diagnosis. During acute pancreatitis, the blood contains at least three times the normal amount of amylase and lipase, digestive enzymes formed in the pancreas. Changes may also occur in other body chemicals such as glucose, calcium, magnesium, sodium, potassium, and bicarbonate. After the person's condition improves, the levels usually return to normal.
Diagnosing acute pancreatitis is often difficult because of the deep location of the pancreas. The doctor will likely order one or more of the following tests:
- Abdominal ultrasound. Sound waves are sent toward the pancreas through a handheld device that a technician glides over the abdomen. The sound waves bounce off the pancreas, gallbladder, liver and other organs, and their echoes make electrical impulses that create a picture - called a sonogram - on a video monitor. If gallstones are causing inflammation, the sound waves will also bounce off them, showing their location.
- Computerized tomography (CT) scan. The CT scan is a noninvasive X-ray that produces three-dimensional pictures of parts of the body. The person lies on a table that slides into a donut-shaped machine. The test may show gallstones and the extent of damage to the pancreas.
- Endoscopic ultrasound (EUS). After spraying a solution to numb the patient's throat, the doctor inserts an endoscope - a thin, flexible, lighted tube - down the throat, through the stomach, and into the small intestine. The doctor turns on an ultrasound attachment to the scope that produces sound waves to create visual images of the pancreas and bile ducts.
- Magnetic resonance cholangiopancreatography (MRCP). MRCP uses magnetic resonance imaging, a noninvasive test that produces cross-section images of parts of the body. After being lightly sedated, the patient lies in a cylinder-like tube for the test. The technician injects dye into the patient's veins that helps show the pancreas, gallbladder, and pancreatic and bile ducts.
Alcohol abuse and gallstones are the two main causes of pancreatitis, accounting for 80% to 90% of all cases.
Pancreatitis from alcohol use usually occurs in individuals who have been long-term alcohol drinkers for at least five to seven years. Most cases of chronic pancreatitis are due to alcohol abuse. Pancreatitis is often already chronic by the first time the person seeks medical attention (usually for severe pain).
Gallstones form from a buildup of material within the gallbladder, another organ in the abdomen (please see previous illustration). A gallstone can block the pancreatic duct, trapping digestive juices inside the pancreas. Pancreatitis due to gallstones tends to occur most often in women older than 50 years of age.
The remaining 10% to 20% of cases of pancreatitis have various causes, including the following:
- exposure to certain chemicals,
- injury (trauma), as might happen in a car accident or bad fall leading to abdominal trauma,
- hereditary disease,
- surgery and certain medical procedures,
- infections such as mumps (not common),
- abnormalities of the pancreas or intestine,
- high fat levels in the blood.
In about 15% of cases of acute pancreatitis and 40% of cases of chronic pancreatitis, the cause is never known.
Self-Care at Home
For most people, self-care alone is not enough to treat pancreatitis. People may be able to make themselves more comfortable during an attack, but they will most likely continue to have attacks until treatment is received for the underlying cause of the symptoms.
If symptoms are mild, people might try the following preventive measures:
- Stop all alcohol consumption.
- Adopt a liquid diet consisting of foods such as broth, gelatin, and soups. These simple foods may allow the inflammation process to get better.
- Over-the-counter pain medications may also help. Avoid pain medications that can affect the liver such as acetaminophen (Tylenol and others). In individuals with pancreatitis due to alcohol use, the liver is usually also affected by the alcohol.
Medical treatment is usually focused on relieving symptoms and preventing further aggravation to the pancreas. Certain complications of either acute pancreatitis or chronic pancreatitis may require surgery or a blood transfusion.
Acute Pancreatitis Treatment
In acute pancreatitis, the choice of treatment is based on the severity of the attack. If no complications are present, care usually focuses on relieving symptoms and supporting body functions so that the pancreas can recover.
- Most people who are having an attack of acute pancreatitis are admitted to the hospital.
- Those people who are having trouble breathing are given oxygen.
- An IV (intravenous) line is started, usually in the arm. The IV line is used to give medications and fluids. The fluids replace water lost from vomiting or from the inability to take in fluids, helping the person to feel better.
- If needed, medications for pain and nausea are prescribed.
- Antibiotics are given if the health care practitioner suspects an infection may be present.
- No food or liquid should be taken by mouth for a few days. This is called bowel rest. By refraining from food or liquid intake, the intestinal tract and pancreas are given a chance to start healing.
- Some people may need a nasogastric (NG) tube. The thin, flexible plastic tube is inserted through the nose and down into the stomach to suck out the stomach juices. This suction of the stomach juices rests the intestine further, helping the pancreas recover.
- If the attack lasts longer than a few days, nutritional supplements are administered through an IV line.
Chronic Pancreatitis Treatment
In chronic pancreatitis, treatment focuses on relieving pain and avoiding further aggravation to the pancreas. Another focus is to maximize a person's ability to eat and digest food.
- Unless people have severe complications or a very severe episode, they probably do not have to stay in the hospital.
- Medication is prescribed for severe pain.
- A high carbohydrate, low fat diet; and eating smaller more frequent meals help prevent aggravating the pancreas. If a person has trouble with this diet, pancreatic enzymes in pill form may be given to help digest the food.
- People diagnosed with chronic pancreatitis are strongly advised to stop drinking alcohol.
- If the pancreas does not produce sufficient insulin, the body needs to regulate its blood sugar, and insulin injections may be necessary.