Pancreatitis, Acute and Chronic
The pancreas is a large gland located behind the stomach and beside the duodenum or upper part of the small intestine. The pancreas works to:
- Facilitate the digestion of carbohydrates, proteins and fat by the secretion of very powerful digestive enzymes into the small intestine.
- Release two hormones, insulin and glucagon, into the bloodstream. These hormones are involved in blood glucose metabolism.
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 itself; serious tissue damage, infection and fluid collections may occur. Severe pancreatitis can result in damage to other vital organs such as the heart, lung and kidneys.
There are two forms of pancreatitis: acute and chronic:
- Acute pancreatitis occurs suddenly and may result in life-threatening complications; however the majority of patients (80 percent) recover completely.
- Chronic pancreatitis is usually the result of longstanding damage to the pancreas from alcohol ingestion. Chronic pancreatitis is primarily marked by severe pain and loss of pancreatic function.
In about 80 percent of the cases, acute pancreatitis is caused by gallstones and alcohol ingestion (see list below). Other causes are usually due to medications and, very rarely, infections, trauma or surgery of the abdomen. In about 10 percent of the cases, the cause is unknown (idiopathic).
- Gallstones (45 percent)
- Alcohol (35 percent)
- Idiopathic (10 percent)
- Other, including medications, trauma or surgery (10 percent)
Medications that can cause acute pancreatitis include:
- Valproic acid
Types of trauma that can cause acute pancreatitis in rare cases include:
- Postoperative trauma (due to surgery)
- Hyperlipidemia (or excessive amounts of fat and fatty substances in the blood)
- Hypercalcemia (or an abnormally large amount of calcium in the blood)
- Ductal obstruction
- Infectious Agents
Infectious Agents can include:
- Coxsackie B virus
- Cytomegalovirus (CMV)
- E. coli
Chronic Pancreatitis Histology
In more than 90 percent of the cases, chronic pancreatitis is caused by prolonged alcohol ingestion resulting in pancreatic damage and scarring (see below list). In a small percentage of the cases, the cause is unknown and, very rarely, patients can have chronic pancreatitis that tends to run in families (hereditary pancreatitis).
Alcohol accounts for 70 percent of cases, while 20 percent are considered idiopathic, or of unknown origin.
Other causes, which account for 10 percent of cases, include:
- Tropical pancreatitis
- Hereditary pancreatitis
- Cystic Fibrosis
- Pancreas Divisum
Acute pancreatitis occurs in patients with a history of gallstone disease or heavy alcohol consumption. Chronic pancreatitis primarily occurs in patients between 30 and 40 years of age with longstanding alcohol ingestion. Chronic pancreatitis is also more common in men than women.
Most patient with acute pancreatitis have upper abdominal pain that travels through the back. Patients may describe this as a “piercing sensation” aggravated by eating. The abdomen may be swollen and very tender.
Symptoms of chronic pancreatitis include:
- Malabsorption of food leading to weight loss or diarrhea
- Increased heart rate
The pain of chronic pancreatitis is usually constant in nature and radiates to the back. In some patients, this pain may be disabling. The weight loss is usually due to the patient’s inability to secrete pancreatic enzymes to break down foods so nutrients are not absorbed normally. Finally, diabetes may develop if the insulin-producing cells in the pancreas are damaged.
Acute pancreatitis is suspected when a patient has symptoms and has risk factors such as alcohol ingestion or gallstone disease. Checking the blood for levels of digestive enzymes such as amylase and lipase helps physicians diagnose pancreatitis. High levels of these two enzymes in the blood are strongly suggestive of acute pancreatitis. As the patient recovers, the digestive enzyme levels will decrease to normal.
Chronic pancreatitis generally is suspected when the patient has symptoms and risk factors such as heavy alcohol ingestion.
Diagnosis can be difficult but today is aided by a number of new techniques, including pancreatic function tests and x-ray imaging of the pancreas gland with a CT scan or retrograde pancreatography (ERCP).
Acute pancreatitis is primarily treated with supportive management in the hospital. Generally, patients receive intravenous fluids and pain medication. In up to 20 percent of patients, the pancreatitis can be severe. The patient may need to be placed in the intensive care unit because of damage that has occurred to other vital organs such as the heart, lungs or kidneys. Some cases of severe pancreatitis require surgery to remove irreversibly damaged parts of the gland.
Chronic pancreatitis can be challenging to treat. Physicians will try to relieve pain and improve nutritional and metabolic problems that result from pancreatic function loss. Patients are generally given pancreatic enzymes and insulin to supplement what is not being secreted or released by the pancreas. In some instances, blockage of the pancreatic duct would require a surgical drainage procedure.
Online Medical Textbook
For additional information on gastrointestinal disorders, please visit the Cleveland Clinic Disease Management Project. This free and comprehensive source contains chapters written by experienced clinicians from Cleveland Clinic, and highlights the evaluation and management of common diseases.
It also discusses recommendations from national practice guidelines, and puts them in the context of the accumulated clinical experience of Cleveland Clinic experts.