Pancreatitis

What is Pancreatitis?

Pancreatitis is an inflammation of the pancreas. The pancreas secretes enzymes that flow into the small intestine through a system of pancreatic ducts. These enzymes help to digest the fats, proteins and carbohydrates in food. Normally, these enzymes are not activated until they reach the small intestine. If they become active inside the pancreas, they will begin "digesting" it causing damage to the organ.

The primary symptom of pancreatitis is pain in the upper abdomen that may spread to the back. The pain is often more severe after eating. Other symptoms include a swollen and tender abdomen, nausea, vomiting, fever and rapid pulse. The type and severity of symptoms vary with each individual and with the type of pancreatitis.

Acute Pancreatitis

An attack of acute pancreatitis occurs when the pancreas becomes suddenly inflamed and then recovers within a short period of time. The first symptom of acute pancreatitis is pain that may come on suddenly or gradually get worse. A person with acute pancreatitis often looks and feels very sick. About 80,000 cases occur in the United States each year.

Acute pancreatitis is usually caused by excessive alcohol consumption or gallstones. A gallstone can block the pancreatic duct, trapping enzymes inside the pancreas. Other causes include physical abnormalities of the pancreas or intestine, abdominal trauma, surgery or other procedures such as ERCP (endoscopic retrograde cholangiopancreatography) and some prescription drugs. Rarely, the disease may result from an infection such as mumps. In about 15% of cases the cause is unknown.

Approximately 20% of acute pancreatitis cases are considered severe. Dehydration and low blood pressure may occur. The pancreas may bleed, leading to shock. Pancreatic enzymes released into the bloodstream can damage the heart, lungs and kidneys. These complications are serious and can be life threatening.

Chronic Pancreatitis

Chronic pancreatitis does not resolve and the pancreas is slowly destroyed. Pancreatic enzymes attack the pancreas and other nearby tissues causing inflammation, scarring and pain. The severity of symptoms can vary. A person may also experience acute attacks. Destruction of pancreatic tissue leads to some or all of the following problems: pain, diabetes and malabsorption of food leading to weight loss.

70 - 80% of chronic pancreatitis cases in adults are cause by alcoholism. An acute attack can trigger chronic pancreatitis if pancreatic tissue is destroyed and scarring develops . Other causes include a narrowing of the pancreatic ducts due to trauma or pseudocyst formatation. Pseudocysts are cyst-like buildups of pancreatic fluid in the ducts. Some drugs can cause chronic pancreatitis. In many cases the cause is unknown.

Hereditary Pancreatitis

Hereditary pancreatitis involves recurrent episodes of acute pancreatic attacks that can lead to chronic pancreatitis. It is a rare genetic condition that affects approximately 1,000 individuals in the United States . The first attacks typically occur before age twenty.

Autoimmune Chronic Pancreatitis

Autoimmune pancreatitis is also known as sclerosing pancreatitis or primary inflammatory pancreatitis. Autoimmune refers to a disease process in which the body's immune system attacks its own cells and tissues, in this case pancreatic tissue. Inflammation of the pancreas results in narrowing of the pancreatic ducts and chronic pancreatitis.

Diagnosis and Treatment

A medical history and physical exam will be taken. Blood tests will be done to diagnose acute pancreatitis. Blood levels of amylase and lipase (pancreatic digestive enzymes) are at least three times higher that normal during an acute attack. Imaging tests such as ultrasound and CT(computed tomography) scans may be ordered to look for gallstones, inflammation or other abnormalities in the pancreas such as pseudocysts.

Treatment of pancreatitis depends on the severity of the attack. If a gallstone is the cause of the attack, surgery to remove it may be performed and the person will usually recover completely. Other treatments are not considered curative, but rather deal with the numerous symptoms caused by pancreatitis. These treatments include pain medication, diet modification, and supportive treatments such as IV fluids and oxygen. Since eating fatty foods stimulates the production of pancreatic enzymes, a low-fat diet can help reduce symptoms of chronic pancreatitis and prevent acute attacks. Autoimmune pancreatitis is often treated with a course of steroids.

Pancreatitis and Pancreatic Cancer

Both chronic and hereditary pancreatitis are risk factors for pancreatic cancer. It is estimated that approximately 4% of patients develop pancreatic cancer within 20 years of diagnosis of chronic pancreatitis. Individuals with hereditary pancreatitis appear to have as much as a 40% lifetime risk of pancreatic cancer. In both cases, it is believed that pancreatic cancer develops as a result of prolonged tissue damage from chronic pancreatitis. A low-fat diet and other medical intervention that reduces the severity of the pancreatitis may help protect the pancreas.

Pancreatitis Resources

The Pancreas Foundation  866.726.2737

Pancreatitis Association International

Pancreas Web

The Pancreatitis Supporters Network

Pancreas.org