Overview
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).
The pancreas is a large gland behind your stomach and next to your small intestine. Your pancreas does two main things:
- It releases powerful digestive enzymes into your small intestine to help you digest food.
- It releases insulin and glucagon into your bloodstream. These hormones help your body control how it uses food for energy.
Your pancreas can be damaged when digestive enzymes begin working before your pancreas releases them.
Types
he two forms of pancreatitis are acute and chronic.
- Acute pancreatitis is sudden inflammation that lasts a short time. It can range from mild discomfort to a severe, life-threatening illness. Most people with acute pancreatitis recover completely after getting the right treatment. In severe cases, acute pancreatitis can cause bleeding, serious tissue damage, infection, and cysts. Severe pancreatitis can also harm other vital organs such as the heart, lungs, and kidneys.
- Chronic pancreatitis is long-lasting inflammation. It most often happens after an episode of acute pancreatitis. Another top cause is drinking lots of alcohol for a long period of time. Damage to your pancreas from heavy alcohol use may not cause symptoms for many years, but then you may suddenly have severe pancreatitis symptoms.
Symptoms
Symptoms of acute pancreatitis
- Fever
- Higher heart rate
- Nausea and vomiting
- Swollen and tender belly
- Pain in the upper part of your belly that goes into your back. Eating may make it worse, especially foods high in fat.
Symptoms of chronic pancreatitis
The symptoms of chronic pancreatitis are similar to those of acute pancreatitis. But you may also have:
- Constant pain in your upper belly that radiates to your back. This pain may be disabling.
- Diarrhea and weight loss because your pancreas isn’t releasing enough enzymes to break down food
- Upset stomach and vomiting
Causes
Acute pancreatitis causes include:
- Autoimmune diseases
- Drinking lots of alcohol
- Infections
- Gallstones
- Medications
- Metabolic disorders
- Surgery
- Trauma
Some Causes of Acute Pancreatitis
| Cause | Examples |
|---|---|
| Drugs | ACE inhibitors, asparaginase, azathioprine, 2´,3´-dideoxyinosine, furosemide, 6-mercaptopurine, pentamidine, sulfa drugs, valproate |
| Infectious | Coxsackievirus B, cytomegalovirus, mumps, hepatitis A, hepatitis E |
| Inherited | Multiple known gene mutations, including a small percentage of cystic fibrosis patients |
| Mechanical/structural | Gallstones, endoscopic retrograde cholangiopancreatography (ERCP), trauma, pancreatic cancer or periampullary cancer, choledochal cyst, sphincter of Oddi stenosis, pancreas divisum |
| Metabolic | Hypertriglyceridemia, hypercalcemia (including hyperparathyroidism), estrogen use associated with high lipid levels |
| Toxins | Alcohol, methanol |
| Other | Cigarette smoking, pregnancy, postrenal transplant, ischemia caused by hypotension or atheroembolism, tropical pancreatitis |
Chronic pancreatitis causes include:
- Cystic fibrosis
- Family history of pancreas disorders
- Gallstones
- High triglycerides
- Longtime alcohol use
- Medications
Causes of Chronic Pancreatitis
| Causes | Examples |
|---|---|
| Toxins | Alcohol |
| Genetic | Cationic trypsinogen gene (PRSSI)Serine peptidase inhibitor Kazal-type 1 (SPINK1)Cystic fibrosis transmembrane conductance regulator gene (CFTR)Other genetic disorders |
| Obstructive | Pancreatic duct stricture (traumatic, iatrogenic, anastomotic, or malignant)Mass effect due to a tumorPossibly pancreas divisum (congenital anomaly causing division of the pancreatic duct)Possibly sphincter of Oddi dysfunction |
| Autoimmune | Type 1, related to IgG4 disease, and type 2 autoimmune pancreatitis |
| Idiopathic | Tropical pancreatitis |
| Other | Cigarette smoking |
Complications
Pancreatitis can have severe complications, including:
- Diabetes if there’s damage to the cells that produce insulin
- Infection of your pancreas
- Kidney failure
- Malnutrition if your body can’t get enough nutrients from the food you eat because of a lack of digestive enzymes
- Pancreatic cancer
- Pancreatic necrosis, when tissues die because your pancreas isn’t getting enough blood
- Problems with your breathing when chemical changes in your body affect your lungs
- Pseudocysts, when fluid collects in pockets on your pancreas. They can burst and become infected.
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
Treatment
Treatment for acute pancreatitis
If you have an attack of acute pancreatitis, you may receive strong drugs for pain. You may have to have your stomach drained with a tube placed through your nose. If the attack is prolonged, you may be fed and hydrated intravenously (through a vein).
You’ll probably need to stay in the hospital, where your treatment may include:
- Antibiotics if your pancreas is infected
- Intravenous (IV) fluids, given through a needle
- Low-fat diet or fasting. You might need to stop eating so your pancreas can recover. In this case, you’ll get nutrition through a feeding tube.
- Pain medicine
If your case is more severe, your treatment might include:
- Endoscopic retrograde cholangiopancreatography (ERCP), a procedure that involves the insertion of a tube down your throat into the stomach and upper intestines to take out gallstones if they’re blocking your bile or pancreatic ducts. A small cut is made to remove stones in the bile duct, or a plastic tube called a stent is inserted into the ducts to relieve the obstruction.
- Gallbladder surgery if gallstones caused your pancreatitis
- Pancreas surgery to clean out fluid or dead or diseased tissue
Treatment for chronic pancreatitis
If you have chronic pancreatitis, the doctor will focus on treating pain — guarding against possible addiction to prescription painkillers — and watching for complications that affect digestion. You may be placed on a pancreatic enzyme replacement therapy to restore the digestive tract’s ability to digest nutrients; this will also likely reduce the frequency of new attacks.
You might need:
- Insulin to treat diabetes
- Pain medicine
- Pancreatic enzymes to help your body get enough nutrients from your food
- Surgery or procedures to relieve pain, help with drainage, or treat blockages
Injection of anesthetics into the nerves near the spine may give pain relief. If the pain does not respond to medication or nerve blocks, the damaged pancreatic tissue may be surgically removed, but only as a last resort.
Pancreatitis diet
