Pancreatitis

Pancreatitis is inflammation of the pancreas. The pancreas is a long, flat gland that sits tucked behind the stomach in the upper abdomen. The pancreas produces enzymes that help digestion and hormones that help regulate the way your body processes sugar (glucose).

Pancreatitis can occur as acute pancreatitis — meaning it appears suddenly and lasts for days. Some people develop chronic pancreatitis, which is pancreatitis that occurs over many years.

Mild cases of pancreatitis improve with treatment, but severe cases can cause life-threatening complications.

Symptoms

Signs and symptoms of pancreatitis may vary, depending on which type you experience.

Acute pancreatitis signs and symptoms include:

• Upper abdominal pain
• Abdominal pain that radiates to your back
• Tenderness when touching the abdomen
• Fever
• Rapid pulse
• Nausea
• Vomiting

Chronic pancreatitis signs and symptoms include:

• Upper abdominal pain
• Abdominal pain that feels worse after eating
• Losing weight without trying
• Oily, smelly stools (steatorrhea)

When to see a doctor

Make an appointment with your doctor if you have acute onset or persistent abdominal pain. Seek immediate medical help if your abdominal pain is so severe that you can't sit still or find a position that makes you more comfortable.

Causes

Pancreatitis occurs when digestive enzymes become activated while still in the pancreas, irritating the cells of your pancreas and causing inflammation.

With repeated bouts of acute pancreatitis, damage to the pancreas can occur and lead to chronic pancreatitis. Scar tissue may form in the pancreas, causing loss of function. A poorly functioning pancreas can cause digestion problems and diabetes.

Conditions that can lead to acute pancreatitis include:

• Gallstones
• Alcoholism
• Certain medications
• High triglyceride levels in the blood (hypertriglyceridemia)
• High calcium levels in the blood (hypercalcemia), which may be caused by an overactive parathyroid gland (hyperparathyroidism)
• Pancreatic cancer
• Abdominal surgery
• Cystic fibrosis
• Infection
• Injury to the abdomen
• Obesity
• Trauma

Endoscopic retrograde cholangiopancreatography (ERCP), a procedure used to treat gallstones, also can lead to pancreatitis.

Sometimes, a cause for pancreatitis is never found. This is known as idiopathic pancreatitis.

Risk factors

Factors that increase your risk of pancreatitis include:

• Excessive alcohol consumption. Research shows that heavy alcohol users (people who consume four to five drinks a day) are at increased risk of pancreatitis.
• Cigarette smoking. Smokers are on average three times more likely to develop chronic pancreatitis, compared with nonsmokers. The good news is quitting smoking decreases your risk by about half.
• Obesity. You're more likely to get pancreatitis if you're obese.
• Diabetes. Having diabetes increases your risk of pancreatitis.
• Family history of pancreatitis. The role of genetics is becoming increasingly recognized in chronic pancreatitis. If you have family members with the condition, your odds increase — especially when combined with other risk factors.

Complications

Pancreatitis can cause serious complications, including:

• Kidney failure. Acute pancreatitis may cause kidney failure, which can be treated with dialysis if the kidney failure is severe and persistent.
• Breathing problems. Acute pancreatitis can cause chemical changes in your body that affect your lung function, causing the level of oxygen in your blood to fall to dangerously low levels.
• Infection. Acute pancreatitis can make your pancreas vulnerable to bacteria and infection. Pancreatic infections are serious and require intensive treatment, such as surgery to remove the infected tissue.
• Pseudocyst. Acute pancreatitis can cause fluid and debris to collect in cystlike pockets in your pancreas. A large pseudocyst that ruptures can cause complications such as internal bleeding and infection.
• Malnutrition. Both acute and chronic pancreatitis can cause your pancreas to produce fewer of the enzymes that are needed to break down and process nutrients from the food you eat. This can lead to malnutrition, diarrhea and weight loss, even though you may be eating the same foods or the same amount of food.
• Diabetes. Damage to insulin-producing cells in your pancreas from chronic pancreatitis can lead to diabetes, a disease that affects the way your body uses blood sugar.
• Pancreatic cancer. Long-standing inflammation in your pancreas caused by chronic pancreatitis is a risk factor for developing pancreatic cancer.

Diagnosis

Tests and procedures used to diagnose pancreatitis include:

• Blood tests to look for elevated levels of pancreatic enzymes, along with white blood cells, kidney function and liver enzymes
• Abdominal ultrasound to look for gallstones and pancreas inflammation
• Computerized tomography (CT) scan to look for gallstones and assess the extent of pancreas inflammation
• Magnetic resonance imaging (MRI) to look for abnormalities in the gallbladder, pancreas and ducts
• Endoscopic ultrasound to look for inflammation and blockages in the pancreatic duct or bile duct
• Stool tests in chronic pancreatitis to measure levels of fat that could suggest your digestive system isn't absorbing nutrients adequately

Your doctor may recommend other tests, depending on your particular situation.

Treatment

Initial treatments in the hospital may include:

• Early eating. Old data suggested to stop eating for a couple of days in the hospital in order to give your pancreas a chance to recover. This is no longer practiced. Newer data have suggested that eating as soon as you tolerate food helps heal the pancreas.

  As the inflammation in your pancreas improves and pain symptoms improve, you should begin drinking clear liquids and eating bland foods. With time, you can go back to your normal diet.

  If your pancreatitis symptoms persist and you still experience pain when eating, your doctor may recommend a feeding tube to help you get nutrition.

• Pain medications. Pancreatitis can cause severe pain. Your health care team will give you medications to help control the pain.
• Intravenous (IV) fluids. As your body devotes energy and fluids to repairing your pancreas, you may become dehydrated. For this reason, you'll receive extra fluids through a vein in your arm during your hospital stay.

Once your pancreatitis is under control, your health care team will evaluate and treat the underlying cause of your pancreatitis. Depending on the cause of your pancreatitis, treatment may include:

• Procedures to remove bile duct obstructions. Pancreatitis caused by a narrowed or blocked bile duct may require procedures to open or widen the bile duct.

  A procedure called endoscopic retrograde cholangiopancreatography (ERCP) uses a long tube with a camera on the end to examine your pancreas and bile ducts. The tube is passed down your throat, and the camera sends pictures of your digestive system to a monitor. Anesthesia is used for this procedure.

  ERCP can aid in diagnosing problems in the bile duct and pancreatic duct and in removing obstructions, such as gallstones. In some people, however, ERCP can also lead to acute pancreatitis.

• Gallbladder surgery. If gallstones caused your pancreatitis, your doctor will recommend surgery to remove your gallbladder (cholecystectomy).
• Pancreas procedures. Endoscopic procedures may be necessary to drain fluid from your pancreas or to remove diseased tissue.
• Treatment for alcohol dependence. Drinking several drinks a day over many years can cause pancreatitis. If this is the cause of your pancreatitis, your doctor may recommend you enter a treatment program for alcohol addiction. Continuing to drink alcohol would worsen your pancreatitis and lead to serious complications.
• Medication changes: If a medication is deemed to be a cause of acute pancreatitis, your doctor may stop the medication and work with you to find alternative options.

Additional treatments for chronic pancreatitis

Depending on your situation, chronic pancreatitis may require additional treatments, including:

• Pain management. Chronic pancreatitis can cause persistent abdominal pain. Your doctor will evaluate you for causes of chronic pancreatitis and may recommend medications to control your pain. If necessary, you may be referred to a pain specialist.

  Severe pain may be relieved with options such as endoscopic ultrasound or injections to block nerves that send pain signals from the pancreas to the brain.

• Enzymes to improve digestion. In chronic pancreatitis leading to diarrhea or weight loss, pancreatic enzyme supplements can help your body break down and process the nutrients in the foods you eat. Pancreatic enzymes are taken with each meal.
• Changes to your diet. Your doctor may refer you to a dietitian who can help you plan low-fat meals that are high in nutrients.

Lifestyle and home remedies

Once you leave the hospital, you can take steps to continue your recovery from pancreatitis, such as:

• Stop drinking alcohol. Even if alcohol was not deemed to be the cause of acute pancreatitis, it is prudent to stop drinking alcohol while recovering. If you're unable to stop drinking alcohol on your own, ask your doctor for help. Your doctor can refer you to local programs to help you stop drinking.
• Stop smoking. If you smoke, quit. If you don't smoke, don't start. If you can't quit on your own, ask your doctor for help. Medications and counseling can help you quit smoking.
• Choose a low-fat diet. Choose a diet that limits fat and emphasizes fresh fruits and vegetables, whole grains, and lean protein.
• Drink more fluids. Pancreatitis can cause dehydration, so drink more fluids throughout the day. It may help to keep a water bottle or glass of water with you.

Alternative medicine

Alternative therapies can't treat pancreatitis, but some alternative therapies may help you cope with the pain associated with pancreatitis.

People with chronic pancreatitis may experience constant pain that isn't easily controlled with medications. Using complementary and alternative medicine therapies along with medications prescribed by your doctor may help you feel more in control of your pain.

Examples of alternative therapies that may help you cope with pain include:

• Meditation
• Relaxation exercises
• Yoga
• Acupuncture

Preparing for an appointment

Start by seeing your family doctor or a general practitioner if you have any signs or symptoms that worry you. If your doctor suspects you may have pancreatitis, you may be referred to a doctor who specializes in the digestive system (gastroenterologist).

Because appointments can be brief, and because there's often a lot to discuss, it's a good idea to be well prepared. Here's some information to help you get ready and know what to expect from your doctor.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, as well as any vitamins or supplements, that you're taking.
• Take a family member or friend along. Sometimes it can be difficult to absorb all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

For pancreatitis, some basic questions to ask your doctor include:

• What is likely causing my symptoms or condition?
• What are other possible causes for my symptoms or condition?
• What kinds of tests do I need?
• Is my condition likely temporary or chronic?
• What is the best course of action?
• What are the alternatives to the primary approach that you're suggesting?
• I have other health conditions. How can I best manage pancreatitis along with these conditions?
• Are there any restrictions that I need to follow?
• Should I see a specialist? What will that cost, and will my insurance cover it?
• Is there a generic alternative to the medicine you're prescribing?
• Are there any brochures or other printed material that I can take with me? What websites do you recommend?
• What will determine whether I should plan for a follow-up visit?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may allow more time to cover points you want to address. Your doctor may ask:

• When did you first begin experiencing symptoms?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?
• Have you had these symptoms before?
• Have you been diagnosed with pancreatitis in the past?
• Do you drink alcohol? If so, how much and how often do you drink?
• Did you start any new medications before your symptoms began?
• Is there a family history of any pancreas disease?

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