Pancreatitis Fact Book

• Acute Pancreatitis
• Chronic Pancreatitis
• Pancreatitis in Children
• Points To Remember
• Keeping on Top of Your Condition
• For More Information

Pancreatitis is an inflammation of the pancreas. The pancreas is a large gland behind the stomach and close to the duodenum. The duodenum is the upper part of the small intestine. The pancreas secretes digestive enzymes into the small intestine through a tube called the pancreatic duct. These enzymes help digest fats, proteins, and carbohydrates in food. The pancreas also releases the hormones insulin and glucagon into the bloodstream. These hormones help the body use the glucose it derives from food for energy.

Normally, digestive enzymes do not become active until they reach the small intestine, where they begin digesting food. But if these enzymes become active inside the pancreas, they start "digesting" it.

Acute pancreatitis occurs suddenly and lasts for a short period of time and usually resolves. Chronic pancreatitis does not resolve itself and results in a slow destruction of the pancreas. Either form can cause serious complications. In severe cases, bleeding, tissue damage, and infection may occur. Cysts, which are fluid-filled sacs of tissue, may also develop. And enzymes and toxins may enter the bloodstream, injuring the heart, lungs, and kidneys, or other organs.

Acute Pancreatitis

Some people have more than one attack and recover completely after each, but acute pancreatitis can be a severe, life-threatening illness with many complications. About 80,000 cases occur in the United States each year; some 20 percent of them are severe.

Acute pancreatitis is usually caused by drinking too much alcohol or by gallstones. A gallstone can block the pancreatic duct, trapping digestive enzymes in the pancreas and causing pancreatitis. Some prescription drugs, pancreatic or intestinal abnormalities, abdominal trauma, or surgery can also cause pancreatitis. In some cases, recurrent pancreatitis is hereditary and caused by mutations in genes. In rare cases, the disease may result from infections, such as mumps, and in about 15 percent of the cases, the cause is unknown.

Symptoms

Acute pancreatitis usually begins with pain in the upper abdomen that may last for a few days. The pain may be severe and may become constant--just in the abdomen--or it may reach to the back and other areas. It may be sudden and intense or begin as a mild pain that gets worse when food is eaten. Someone with acute pancreatitis often looks and feels very sick. Other symptoms may include

• swollen and tender abdomen
• nausea
• vomiting
• fever
• rapid pulse

Severe cases may cause dehydration and low blood pressure. The heart, lungs, or kidneys may fail. If bleeding occurs in the pancreas, shock and sometimes even death follow.

Diagnosis

Besides asking about a person's medical history and doing a physical exam, a doctor will order a blood test to diagnose acute pancreatitis. During acute attacks, the blood contains at least three times more amylase and lipase than usual. Amylase and lipase are digestive enzymes formed in the pancreas. Changes may also occur in blood levels of glucose, calcium, magnesium, sodium, potassium, and bicarbonate. After the pancreas improves, these levels usually return to normal.

A doctor may also order an abdominal ultrasound to look for gallstones and a CAT (computerized axial tomography) scan to look for inflammation or destruction of the pancreas. CAT scans are also useful in locating pseudocysts. (See the section on chronic pancreatitis.)

Treatment

Treatment depends on how bad the attack is. If no complications in the form of kidney failure or lung problems occur, acute pancreatitis usually improves on its own. Treatment is designed to support vital functions and prevent complications. A hospital stay will be necessary so that fluids can be replenished intravenously.

Acute pancreatitis can also cause breathing problems. Many people develop hypoxia, which means that cells and tissues are not receiving enough oxygen. Doctors treat hypoxia by giving oxygen through a face mask. Despite treatment, some people still experience lung failure and require a ventilator.

If pancreatic cysts occur and are considered large enough to interfere with the pancreas's healing, your doctor may drain or surgically remove the cysts.

Sometimes a person cannot stop vomiting and needs to have a tube placed in the stomach to remove fluid and air. In mild cases, a person may not eat for 3 or 4 days and instead may receive fluids and pain relievers through an IV (intravenous) line.

Unless the pancreatic duct or bile duct is blocked by gallstones, an acute attack usually lasts only a few days. In severe cases, a person may be fed intravenously for 3 to 6 weeks while the pancreas slowly heals. This process is called total parenteral nutrition. However, for mild cases of the disease, total parenteral nutrition offers no benefit.

If an infection develops, the doctor may prescribe antibiotics. Surgery may be needed for extensive infections. Surgery may also be necessary to find the source of bleeding, to rule out problems that resemble pancreatitis, or to remove severely damaged pancreatic tissue.

Before leaving the hospital, a person will be advised not to drink alcohol and not to eat large meals. After all signs of acute pancreatitis are gone, the doctor will try to decide what caused it in order to prevent future attacks. In some people, the cause of the attack is clear, but in others, more tests are needed.

Gallstones and Pancreatitis

Gallstones can cause pancreatitis and they usually require surgical removal. Ultrasound or a CAT scan can detect gallstones and can sometimes give an idea of the severity of the pancreatitis. When gallstone surgery can be scheduled depends on how severe the pancreatitis is. If the pancreatitis is mild, gallstone surgery may proceed within about a week. More severe cases may mean gallstone surgery is delayed for a month or more.

After the gallstones are removed and inflammation goes away, the pancreas usually returns to normal.

Chronic Pancreatitis

If injury to the pancreas continues, from drinking alcohol, for example, chronic pancreatitis may develop. Chronic pancreatitis occurs when digestive enzymes attack and destroy the pancreas and nearby tissues, causing scarring and pain. The usual cause of chronic pancreatitis is many years of alcohol abuse, but the chronic form may also be triggered by only one acute attack, especially if the pancreatic ducts are damaged. The damaged ducts cause the pancreas to become infamed, tissue to be destroyed, and scar tissue to develop.

Damage from alcohol abuse may not appear for many years, and then a person may have a sudden attack of pancreatitis. In 70 to 80 percent of adult patients, chronic pancreatitis appears to be caused by alcoholism. This form is more common in men than in women and often develops between the ages of 30 and 40.

Chronic pancreatitis may also occur when the pancreatic duct is blocked or narrowed because of trauma or because pseudocysts have formed. Pseudocysts are cyst-like buildups of pancreatic fluid in the duct.

Some drugs can cause chronic pancreatitis too. In many cases, however, the cause is unknown. People with chronic pancreatitis may have one or even all three of the following problems: pain, diabetes, or malabsorption of food leading to weight loss.

In some cases, chronic pancreatitis is inherited. Hereditary pancreatitis usually begins in childhood but may not be diagnosed for several years. A person with hereditary pancreatitis usually has the typical symptoms that come and go over time. Episodes last from 2 days to 2 weeks.

A determining factor in the diagnosis of hereditary pancreatitis is two or more family members with pancreatitis in more than one generation. Treatment for individual attacks is usually the same as it is for acute pancreatitis. Any pain or nutrition problems are treated just as they are for chronic pancreatitis. Surgery can often ease pain and help manage complications.

Symptoms

Some people have no pain, but most do. Pain in the back and abdomen may be constant and disabling. In certain cases, abdominal pain goes away as the condition advances, probably because the pancreas is no longer making digestive enzymes.

People with chronic disease often lose weight, even when their appetite and eating habits are normal. The weight loss occurs because the body does not secrete enough pancreatic enzymes to break down food, so nutrients are not absorbed normally. Poor digestion leads to excretion of fat, protein, and sugar into the stool. If the insulin-producing cells of the pancreas (islet cells) have been damaged, diabetes may also develop at this stage.

Diagnosis

Diagnosis may be difficult, but new techniques can help. Pancreatic function tests help a doctor decide whether the pancreas is still making enough digestive enzymes. Using ultrasonic imaging, endoscopic retrograde cholangiopancreatography (ERCP), and CAT scans, a doctor can see problems indicating chronic pancreatitis. Such problems include calcification of the pancreas, in which tissue hardens from deposits of insoluble calcium salts. In more advanced stages of the disease, when diabetes and malabsorption occur, a doctor can use a number of blood, urine, and stool tests to help diagnose chronic pancreatitis and to monitor its progression.

Treatment

Relieving pain is the first step in treating chronic pancreatitis. The next step is to plan a diet that is high in carbohydrates and low in fat.

A doctor may prescribe pancreatic enzymes to take with meals if the pancreas does not secrete enough of its own. The enzymes should be taken with every meal to help the body digest food and regain some weight. Sometimes insulin or other drugs are needed to control blood glucose.

In some cases, surgery is needed to relieve pain. The surgery may involve draining an enlarged pancreatic duct or removing part of the pancreas.

For fewer and milder attacks, people with pancreatitis must stop drinking alcohol, stick to their prescribed diet, and take the proper medications.

Pancreatitis in Children

Chronic pancreatitis is rare in children. Trauma to the pancreas and hereditary pancreatitis are two known causes of childhood pancreatitis. Children with cystic fibrosis, a progressive, disabling, and incurable lung disease, may also have pancreatitis. But more often the cause is not known.

Points To Remember

• Pancreatitis begins when the digestive enzymes become active inside the pancreas and start "digesting" it.
  
  
• Pancreatitis has two forms: acute and chronic.
  
  
• Pancreatitis is often caused by gallstones or by alcohol abuse.
  
  
• Symptoms of acute pancreatitis include pain in the abdomen, nausea, vomiting, fever, and a rapid pulse.
  
  
• Treatment for acute pancreatitis can include intravenous fluids, oxygen, antibiotics, or surgery.
  
  
• Acute pancreatitis becomes chronic when pancreatic tissue is destroyed and scarring develops.
  
  
• Treatment for chronic pancreatitis includes easing the pain; eating a high-carbohydrate, low-fat diet; and taking enzyme supplements. Surgery is sometimes needed as well.
  
  

Keeping in tune with your disease or condition not only makes treatment less intimidating but also increases its chance of success, and has been shown to lower a patients risk of complications. As well, as an informed patient, you are better able to discuss your condition and treatment options with your physician.

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For More Information

Information about pancreatitis is also available from

American Gastroenterological Association
7910 Woodmont Avenue, Suite 700
Bethesda, MD 20814
Phone: (301) 654-2055
Fax: (301) 654-5920
Email: member@gastro.org
Internet: http://www.gastro.org/