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Diseases & Conditions

Pancreatitis

Introduction

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

  1. Secreting powerful digestive enzymes into the small intestine to aid the digestion of carbohydrates, proteins, and fat.
  2. Releasing 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.

What is pancreatitis?

Pancreatitis is a rare disease in which the pancreas becomes inflamed. Pancreatic damage occurs when the digestive enzymes are activated and begin attacking the pancreas.

In very severe cases, 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.

Pancreatitis develops gradually and tends to become progressively worse. There are two forms of pancreatitis: acute and chronic.

Acute pancreatitis is a sudden inflammation of the pancreas that occurs over a short period of time. In more than 80 percent of the cases, acute pancreatitis is caused by bile duct stones or heavy alcohol use. Other causes include medications and very rarely, infections, trauma, metabolic disorders, and surgery. In about 10 to 15 percent of the cases, the cause of acute pancreatitis is unknown. The severity of acute pancreatitis may range from mild abdominal discomfort to a severe, life-threatening illness. However, the majority of patients with acute pancreatitis (greater than 80 percent) recover completely after receiving the appropriate treatment.

Chronic pancreatitis occurs most commonly after an episode of acute pancreatitis and is the result of ongoing inflammation of the pancreas. Chronic pancreatitis can be caused by prolonged alcohol use or smoking. It can also be caused by metabolic disorders. Very rarely, patients can have chronic pancreatitis that runs in families (hereditary pancreatitis). Patients with chronic pancreatitis may suffer with severe pain and loss of pancreatic function. This can cause abnormalities with digestion and blood sugar.

What are the symptoms of pancreatitis?

Most patients with acute pancreatitis have upper abdominal pain that radiates (spreads) to their backs. Patients may describe this as a "boring sensation" that is primarily aggravated by eating and slowly becomes worse. Their abdomens may be swollen and very tender. Patients may also have associated nausea, vomiting, fever, and an increased heart rate.

The symptoms of chronic pancreatitis may include the following:

  • Constant pain that radiates to the back. In some patients, the pain may be disabling.
  • Poor absorption of food, leading to weight loss. Patients may lose weight, even when their appetite and eating habits are normal. This poor absorption occurs because the body is not secreting enough pancreatic enzymes to break down the food normally.
  • Diabetes (elevated blood glucose) may develop if the insulin-producing cells of the pancreas become damaged.

How is pancreatitis diagnosed?

Acute pancreatitis is primarily suspected when a patient has the symptoms mentioned above and has risk factors such as heavy alcohol use or gallstone disease. Confirmation of pancreatitis is done by measuring levels of the two digestive enzymes, amylase and lipase, in the blood. High levels of these two enzymes strongly suggest acute pancreatitis. As the patient recovers, the digestive enzyme levels decrease to normal.

Chronic pancreatitis is generally suspected when a patient has the symptoms mentioned above and has risk factors such as a heavy alcohol use. Diagnosis can be difficult but is aided by such techniques as pancreatic function tests and radiographic imaging of the pancreas. In more advanced stages of the disease, when poor absorption or diabetes are present, the doctor can use blood, urine, and stool tests to monitor the progression of the disease.

Diagnostic tests include:

  • Pancreatic function test, in which the pancreatic function is measured by determining 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
  • Computed axial tomography scan (CAT scan), which can produce images of the pancreas so that abnormalities may be detected
  • ERCP (endoscopic retrograde cholangiopancreatography), an exam that shows the size and shape of the pancreas and its connections leading to the intestine
  • Esophagogastroduodenoscopy with ultrasound (EUS), an examination in which images of the pancreas are obtained from inside the stomach and intestine using sound waves

How is pancreatitis treated?

Patients with acute pancreatitis are primarily given intravenous fluids and pain medications in the hospital. In up to 20 percent of patients, the pancreatitis can be severe and patients 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. In these cases, surgery may be necessary to remove the damaged pancreatic tissue.

An acute attack of pancreatitis usually lasts only a few days, unless it is caused by gallstones. An acute attack of pancreatitis caused by gallstones may require removal of the gallbladder or endoscopic surgery of the bile duct.

Pancreatic surgery can be performed as a laparoscopic or "minimally invasive" procedure. During laparoscopic surgery, five or six small (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.

The need for surgery is determined by the severity of the pancreatitis. After the gallstones are removed and inflammation subsides, the pancreas usually returns to normal.

Chronic pancreatitis can be somewhat difficult to treat. Doctors will primarily 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 and insulin, since these substances are not being secreted or released by the pancreas. Pancreatic enzyme pills are usually prescribed to be taken before meals to aid in nutrient absorption. A low-fat diet may also be helpful.

Surgery may be necessary to relieve abdominal pain, restore drainage of pancreatic secretions, treat chronic pancreatitis caused by blockage of the pancreatic duct, or to reduce the frequency of attacks.

Patients must stop drinking alcoholic beverages, follow their physician's and dietitian's dietary recommendations, and take the proper medications in order to have fewer and milder attacks of pancreatitis.

Can pancreatitis be prevented?

When a cause is identified, further attacks can be prevented by removing the underlying cause (e.g., removing the gallbladder). Since alcohol and smoking are risk factors for pancreatitis, patients are counseled to completely avoid smoking and drinking alcohol. 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. Smoking cessation clinics are also available.

References

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 3/13/2012...#8103

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