Pancreatitis – Acute and Chronic

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Overview

• What is the Pancreas?

  The pancreas is an important organ that lies in the abdomen behind the stomach. People do not often think about the pancreas until there is some abnormality such as pancreatitis, pancreatic cyst or pancreatic cancer. The pancreas has two main functions: digestion and blood sugar regulation. The pancreas produces many enzymes that are secreted out of a small duct into the intestine that help breakdown proteins, carbohydrates and fats to allow for absorption. Separately the pancreas produces hormones (insulin the most well known) that are secreted into our blood stream that helps regulate our blood sugar.

• What is Pancreatitis?

  Acute pancreatitis is a condition characterized by abrupt inflammation of the pancreas characterized by swelling and at times even destruction of pancreatic tissue. The most common causes of acute pancreatitis are gallstones and excessive alcohol consumption. Other causes include smoking, high triglyceride levels, high calcium levels, certain medications, abdominal trauma, viral infections, structural anatomic anomalies and genetic abnormalities. Chronic pancreatitis occurs when there is irreversible scar tissue that forms in the pancreas as a result of ongoing inflammation. Chronic pancreatitis can lead to impaired digestion of food and diabetes mellitus. The most common causes of chronic pancreatitis are excessive consumption of alcohol, heavy smoking, and recurrent episodes of acute pancreatitis for any number of reasons including genetic mutations. However, the cause is unknown in nearly a third of patients, despite an extensive evaluation.

Acute Pancreatitis

Acute pancreatitis is the sudden development of symptoms related to inflammation of the pancreas. The diagnosis of acute pancreatitis is made by a combination of symptoms, physical exam findings, and laboratory tests including amylase and lipase. If the diagnosis is uncertain, abdominal imaging studies such as a computed tomography (CT) scan may also be necessary.

• What are the Symptoms of Acute Pancreatitis?

  Pancreatitis is persistent severe abdominal pain towards the top of the abdomen or belly button that often will radiate to the back. The pain can be described as one of the worst pains a patient can experience. In addition to pain, there will be nausea, vomiting and anorexia (not wanting to eat). The symptoms of all types of pancreatitis are typically the same regardless of the cause.

  • Gradual or sudden onset of severe pain in the upper abdomen that may radiate to the back and usually persists for several days.
  • Nausea and vomiting
  • Fever

Chronic Pancreatitis

Chronic pancreatitis is a disease characterized by persistent symptoms and dysfunction related to irreversible damage of the pancreas. Symptoms include chronic abdominal pain, diarrhea and blood sugar elevation. The pancreas can no longer produce the necessary enzymes of digestion and sugar control. Fat cannot be broken down properly and will pass through the body creating greasy stools. Food products cannot be broken down properly resulting in nutrient deficiency. Insulin is no longer produced at the level needed resulting in elevated blood sugars and either a new diagnosis of diabetes or worsening diabetes if it is already is present.

Unfortunately chronic pancreatitis is irreversible. Smoking can and will worsen the disease and thus all patients with chronic pancreatitis are recommended to stop smoking. Chronic pancreatitis increases the risk for pancreatic cancer and regular screening for cancer is recommended.

• What are the Symptoms of Chronic Pancreatitis?
  • Recurrent abdominal pain (intermittent or constant)
  • Greasy or oily stools (steatorrhea)
  • Weight loss

What Should I Do If I Think I Have Pancreatitis?

If you are experiencing severe abdominal pain, call your doctor or go to the nearest emergency room. The doctor will take a medical history, perform a physical examination, and draw blood to tests for pancreatic enzymes (amylase and lipase). An ultrasound of the abdomen may be performed to exclude the presence of gallstones. Other abdominal imaging tests such as a CT scan or MRI may also be performed. Endoscopic procedures such as ERCP or EUS may also be warranted in some patients.

Treatment

• What is the Treatment for Acute Pancreatitis?

  Typically pancreatitis will require admission to the hospital. Pancreatitis is actually one of the most common gastrointestinal reasons for admission to a hospital in the US. Treatment will often include pain medicine, fluids given through an IV and occasionally diet modifications such as a liquid diet or occasionally even a special feeding tube. Historically, patients were advised not to eat anything in the setting of pancreatitis however we now know the early nutrition is important to prevent complications of pancreatitis such as infection. Endoscopy may be needed if any gallstones are stuck in the main bile duct. Surgery may be needed if there is a severe infection called necrosis. Lastly, gallbladder removal is almost always recommended during the initial hospitalization for pancreatitis to prevent a future attack if gallstones are found in the gallbladder itself. If the cause of the pancreatitis is not from gallstones but rather from alcohol, then complete alcohol cessation is recommended.

• What is the Treatment for Chronic Pancreatitis?

  The most important goal in the treatment of chronic pancreatitis is to provide pain relief and prevent progression of disease. If pain is difficult to control, you may be referred to a chronic pain specialist. At times, relief of pain may require endoscopic, radiologic, or surgical treatment. If your pancreas is found to be unable to provide sufficient enzymes for adequate digestion, you may benefit from enzyme supplements. Also, if your blood sugar level is very high and not controlled by diet or oral medications, insulin may be required. It is important to avoid alcohol. Complete sessation of smoking is recommended as it is a risk factor for progression of chronic pancreatitis and pancreatic cancer. In a few select patients, there is also the option of surgically removing the pancreas to reduce pain and transplanting the islets from the pancreas into the liver to potentially prevent diabetes. Since chronic pancreatitis is also a risk factor for pancreatic cancer, you should speak to your provider about ways to help reduce your risk of developing pancreatic cancer.