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Pancreatitis

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Pancreatitis facts*

*Pancreatitis facts Medically Edited by: Charles P. Davis, MD, PhD

• Pancreatitis is inflammation of the pancreas, the organ that secretes digestive enzymes into the gastrointestinal tract; it also synthesizes and secretes insulin and glucagon.
  
  
• Pancreatitis may be caused by gallstones (by blocking the pancreatic duct outlet), chronic alcohol use, trauma, medications, infections, tumors, and genetic abnormalities.
  
  
• Acute pancreatitis with upper abdominal pain that is often severe and constant over several days, and may be accompanied by fever, nausea, vomiting, tachycardia, and abdominal swelling; severe cases can develop dehydration, low blood pressure, shock, organ failure, and death.
  
  
• Acute pancreatitis is diagnosed preliminarily by the patient's history, physical exam and the levels of amylase and lipase in the blood (elevated in pancreatitis patients); other tests such as abdominal ultrasound, CT scan, endoscopic ultrasound, or MCRP (Magnetic resonance cholangiopancreatography) may be done to detect gallstones or to identify the damaged pancreas and other blood tests may need to be done (glucose and electrolyte levels)
  
  
• Acute pancreatitis is usually treated by hospitalization for IV fluid administration (and often antibiotics) as the patient is not to eat or drink for a few days; many patients will require an ERCP, a procedure that allows a flexible tube with attachments, including a camera, to be inserted into the ducts that empty into the GI tract and can be used to do several procedures such as gallstone removal, sphincterotomy, and others to help treat the patient.
  
  
• Chronic pancreatitis is pancreatic inflammation that does not heal, gets worse over time and results in permanent pancreatic damage; the most common cause is heavy alcohol use over years, but conditions such as hereditary disorders, cystic fibrosis, autoimmune problems and other causes result in chronic pancreatitis.
  
  
• Chronic pancreatitis has many of the same symptoms of acute, but may include diarrhea, oily stools and weight loss.
  
  
• Chronic pancreatitis is diagnosed essentially the same way acute is diagnosed and is often confused with acute pancreatitis; a good history of chronic problems that includes an accurate alcohol intake history, weight loss history or family history can help make the differential diagnosis.
  
  
• Chronic pancreatitis is treated similar to acute, but the hospital stay may be prolonged because of the need for pain, fluid and nutritional support; synthetic enzymes may be prescribed when a more normal diet can be consumed by the patient.
  
  
• Pancreatitis in children is rare, but can occur secondary to hereditary disease or trauma to the pancreas; often in these rare instances, the cause is unknown.
  
  
• Research is ongoing at the NIH (National Institutes of Health) to further understand causes and develop treatments for all types of pancreatitis.

What is pancreatitis?

Pancreatitis is inflammation of the pancreas. The pancreas is a large gland behind the stomach and close to the duodenum - the first part of the small intestine. The pancreas secretes digestive juices, or enzymes, into the duodenum through a tube called the pancreatic duct. Pancreatic enzymes join with bile - a liquid produced in the liver and stored in the gallbladder - to digest food. The pancreas also releases the hormones insulin and glucagon into the bloodstream. These hormones help the body regulate the glucose it takes from food for energy.

Normally, digestive enzymes secreted by the pancreas do not become active until they reach the small intestine. But when the pancreas is inflamed, the enzymes inside it attack and damage the tissues that produce them.

Pancreatitis can be acute or chronic. Either form is serious and can lead to complications. In severe cases, bleeding, infection, and permanent tissue damage may occur.

Both forms of pancreatitis occur more often in men than women.

What are the causes of acute pancreatitis?

Acute pancreatitis is inflammation of the pancreas that occurs suddenly and usually resolves in a few days with treatment. Acute pancreatitis can be a life-threatening illness with severe complications. Each year, about 210,000 people in the United States are admitted to the hospital with acute pancreatitis.¹ The most common cause of acute pancreatitis is the presence of gallstones - small, pebble-like substances made of hardened bile - that cause inflammation in the pancreas as they pass through the common bile duct. Chronic, heavy alcohol use is also a common cause. Acute pancreatitis can occur within hours or as long as 2 days after consuming alcohol. Other causes of acute pancreatitis include abdominal trauma, medications, infections, tumors, and genetic abnormalities of the pancreas.