Pancreatitis
What is it?
The pancreas is a gland about five inches long
located behind the stomach. It is surrounded by
the liver, gallbladder, and small intestine. The
pancreas has two main functions. One is to produce
digestive fluids needed to neutralize stomach
acids and break down food. The second is to
produce hormones, such as insulin, that are needed
to metabolize sugar. There are two stages of
pancreatitis. The first is acute pancreatitis,
which is a sudden inflammation of the pancreas.
Acute pancreatitis can be mild or life
threatening. However, the pancreas can usually
return to normal function after the condition
clears up. When patients suffer repeated attacks
of acute pancreatitis, the pancreas gradually
becomes scarred. This leads to the second stage of
pancreatitis. Chronic pancreatitis is an ongoing
or recurring inflammation of the pancreas. When
the pancreas becomes inflamed, the digestive
enzymes that it produces begin to attack its own
tissues. Chronic pancreatitis always causes
permanent damage to the pancreas. Over time, it is
more difficult for the damaged pancreas to produce
normal digestive enzymes and hormones.
Who gets it?
Acute pancreatitis affects about 80,000 people
in the U.S. each year. Chronic pancreatitis occurs
more often in men than women.
What causes it?
Most cases of acute pancreatitis are caused by
gallstones or alcohol abuse. Most gallstones pass
through the pancreas and into the intestinal
tract. However, gallstones can sometimes get stuck
in the bile duct where they block the pancreatic
enzymes from draining. The enzymes then damage the
pancreas, causing the symptoms of acute
pancreatitis. Alcohol abuse can cause the small
pancreatic ducts to become clogged. Women with
acute pancreatitis are more likely to have
gallstones as the cause, while six times as many
men as women suffer from acute pancreatitis due to
alcoholism. Other less common causes of acute
pancreatitis include excessive levels of fats in
the blood stream, injury to the pancreas,
infections such as mumps, complications from
kidney transplants, injury to the pancreas during
surgery, heredity, parathyroid disorders, and
malformations of the pancreatic duct and bile
ducts. Pancreatitis can also be caused by certain
drugs, but these account for only around 5% of all
cases. Drugs that can cause pancreatitis include
azathioprine, 6-mercaptopurine, dideoxyinosine,
estrogens, furosemide, pentamidine, sulfonamides,
tetracycline, thiazide diuretics, and valproic
acid. Most chronic pancreatitis is due to alcohol
abuse, but can also be caused by gallstones,
excess fat in the blood, and heredity.
What are the symptoms?
The symptoms of pancreatitis begin as an attack
of acute pancreatitis. You will experience a
gradual or sudden severe abdominal pain. Pain
usually begins in the upper abdomen and penetrates
to your back. Your breathing may become shallow
because deep breathing causes more pain. This pain
continues for days and may get worse if you eat or
drink alcohol. You may get some relief from the
pain by sitting up and leaning forward. Other
symptoms include nausea and vomiting, fever,
swelling of the abdomen, rapid pulse, high or low
blood pressure, shock, feelings of faintness, and
jaundice (a yellowing of the skin or whites of
eyes). The symptoms of acute pancreatitis are
similar to chronic pancreatitis. However, as the
pancreas becomes unable to produce the enzymes
your body needs to digest and absorb nutrients,
fats and proteins are not digested or absorbed.
This is called exocrine failure. It causes
frequent, foul smelling bowel movements. As the
disease progresses, the pancreas loses its ability
to make insulin. This is called endocrine failure.
The pain occurs more often and lasts longer. You
will begin to lose weight and show symptoms of
diabetes, including increased thirst, appetite,
urination, fatigue, and weight loss. Although it
is unusual, chronic pancreatitis can lead to
pancreatic cancer. In very severe cases called
necrotizing pancreatitis, the pancreatic tissue
begins to die from the tissue damage. In patients
with necrotizing pancreatitis, the area between
the ribs and the hip bone will be reddish-purple
or greenish-brown, called Turner’s sign. Or, the
area around the navel may be bluish, called
Cullen's sign. Both conditions are caused by the
pancreas bleeding into the abdomen. Other serious
complications of chronic pancreatitis include
kidney, respiratory, and heart failure due to
shock; blood clots; pancreatic abscess (a
collection of pus that results in infection); and
pancreatic pseudocyst. Pancreatic pseudocyst
occurs when dead pancreatic tissue, blood, white
blood cells, enzymes, and fluid leaked from the
circulatory system grow together. Pseudocysts can
abscess and rupture.
How is it diagnosed?
To diagnose pancreatitis, your doctor will take
your medical history and perform a complete
medical examination. He or she will be
particularly interested in how much alcohol you
drink and if you have had symptoms of gallstones.
Diagnostic tests include blood and urine studies
for pancreatic enzymes and sugars, x-rays of the
abdomen and chest, ultrasound exam of the pancreas
and gallbladder, and computed tomography (CT) scan
of the pancreas. In severe cases of chronic
pancreatitis, your doctor may order an endoscopic
retrograde cholangiopancreatography (ERCP). An ERCP is a
way of looking at your pancreas through a slim
flexible tube, called an endoscope, that is
inserted into your mouth and down to the pancreas.
An endoscope is fitted with a tiny fiber optic
camera that gives the physician a detailed view of
the pancreas. During the ERCP, the physician can
remove a sample of tissue, a biopsy, from the
pancreas. Your doctor may also want a stool sample
to test for excess fats.
What is the treatment?
People with pancreatitis are usually
hospitalized until symptoms stabilize. Treatment
focuses on relieving pain, correcting blood sugar
and enzyme levels, and providing nutrition. Your
doctor will give you pain medication and
intravenous (IV) fluids to replace lost fluids and
restore lost nutrients. You may need a nasogastric
tube, a thin tube inserted through the nose to
suction stomach acids and stop nausea and
vomiting. A number of causes and complications of
pancreatitis require surgery. Removing the
gallbladder will improve pancreatitis caused by
gallstones. If the bile duct is severely enlarged,
you may need surgery to drain the pancreatic duct
or to remove part of the pancreas. If the pancreas
has become infected, your doctor will begin
antibiotic treatment. Pancreatic abscesses can be
drained by a needle inserted through the abdomen
into the abscess. Pancreatic pseudocysts can be
allowed to shrink on their own, but may require
surgery if they do not. A necrotizing pancreas is
treated by surgically removing the dead tissue. If
your condition is caused by alcohol abuse, the
only way to improve symptoms is to stop drinking
alcohol and follow your doctor’s treatment
recommendations. When you are ready to leave the
hospital, your doctor will recommend a diet that
will be easy for your body to digest. You may need
to take pancreatic enzyme supplements with every
meal to help with food absorption, and you may
need insulin to control blood sugar.
Self-care tips
The only cause of pancreatitis that can be
prevented is alcoholism. If you drink heavily and
have had attacks of acute pancreatitis, you must
stop drinking alcohol. If you have any symptoms of
pancreatitis, such as severe, penetrating
abdominal pain that lasts longer than 20 minutes,
or unexplained weight loss that lasts longer than
a few weeks, call your doctor. Avoid eating fatty
foods if you have gallstones, but your gallbladder
hasn’t been removed. If pancreatitis is caused by
drugs you are taking, your doctor should be able
to recommend an alternative. To prevent attacks,
follow your doctor’s recommendations for diet and
medication and avoid drinking alcohol.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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