Pancreatitis:
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 very severe, life-threatening illness. The majority of patients with acute pancreatitis do recover completely after receiving the appropriate treatment.
Chronic pancreatitis occurs most commonly after a patient has had acute pancreatitis and is typically the result of ongoing inflammation of the pancreas. In approximately 90 percent of the cases, chronic pancreatitis is caused by prolonged alcohol use. It can also be caused by metabolic disorders. Damage to the pancreas from excessive alcohol use may not cause symptoms for many years, but the patient may suddenly develop severe pancreatitis symptoms, including severe pain and loss of pancreatic function, which can cause irregularities in digestion and blood sugar.
Symptoms of pancreatitis:
Most patients with acute pancreatitis have upper abdominal pain that can spread into their backs. Most of the time, this is aggravated by eating. The abdomen of a patient with pancreatitis may become swollen and very tender. Patients may also have associated nausea, vomiting, fever, and an increased heart rate.
The symptoms of chronic pancreatitis can be categorized in three levels of severity:
- 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 remain normal. This poor absorption occurs because the body is not secreting enough pancreatic enzymes to break down the food normally.
- Diabetes may develop if the insulin-producing cells of the pancreas become damaged
Diagnosis:
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 test blood, urine, and stool in order to monitor the progression of the disease.
Diagnostic tests may 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) and biopsy, an exam in which a fine needle is inserted into the pancreas to remove a small tissue sample
Treatment & Prevention options:
Treatment: Patients with acute pancreatitis are primarily given intravenous fluids and pain medications in the hospital. In some cases, the pancreatitis can be severe and patients need to be admitted into the hospital for monitoring. In the hospital, the patient is closely observed, 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 (approximately 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.
Patients must stop drinking alcoholic beverages, follow their physician's and dietitian’s dietary recommendations, and take the proper medications in order to reduce and stop the attacks of pancreatitis.
Related information:
| University of Missouri Health Care | This information is not intended to replace the advice of a doctor. |
