Disease and Condition

Pancreatitis
What is it?The pancreas is a gland about five inches long located behind the stomach. It is surrounded by the liver, gallbladder, and small intestine. The pancreas has two main functions. One is to produce digestive fluids needed to neutralize stomach acids and break down food. The second is to produce hormones, such as insulin, that are needed to metabolize sugar. There are two stages of pancreatitis. The first is acute pancreatitis, which is a sudden inflammation of the pancreas. Acute pancreatitis can be mild or life threatening. However, the pancreas can usually return to normal function after the condition clears up. When patients suffer repeated attacks of acute pancreatitis, the pancreas gradually becomes scarred. This leads to the second stage of pancreatitis. Chronic pancreatitis is an ongoing or recurring inflammation of the pancreas. When the pancreas becomes inflamed, the digestive enzymes that it produces begin to attack its own tissues. Chronic pancreatitis always causes permanent damage to the pancreas. Over time, it is more difficult for the damaged pancreas to produce normal digestive enzymes and hormones.

Who gets it?
Acute pancreatitis affects about 80,000 people in the U.S. each year. Chronic pancreatitis occurs more often in men than women.

What causes it?
Most cases of acute pancreatitis are caused by gallstones or alcohol abuse. Most gallstones pass through the pancreas and into the intestinal tract. However, gallstones can sometimes get stuck in the bile duct where they block the pancreatic enzymes from draining. The enzymes then damage the pancreas, causing the symptoms of acute pancreatitis. Alcohol abuse can cause the small pancreatic ducts to become clogged. Women with acute pancreatitis are more likely to have gallstones as the cause, while six times as many men as women suffer from acute pancreatitis due to alcoholism. Other less common causes of acute pancreatitis include excessive levels of fats in the blood stream, injury to the pancreas, infections such as mumps, complications from kidney transplants, injury to the pancreas during surgery, heredity, parathyroid disorders, and malformations of the pancreatic duct and bile ducts. Pancreatitis can also be caused by certain drugs, but these account for only around 5% of all cases. Drugs that can cause pancreatitis include azathioprine, 6-mercaptopurine, dideoxyinosine, estrogens, furosemide, pentamidine, sulfonamides, tetracycline, thiazide diuretics, and valproic acid. Most chronic pancreatitis is due to alcohol abuse, but can also be caused by gallstones, excess fat in the blood, and heredity.

What are the symptoms?
The symptoms of pancreatitis begin as an attack of acute pancreatitis. You will experience a gradual or sudden severe abdominal pain. Pain usually begins in the upper abdomen and penetrates to your back. Your breathing may become shallow because deep breathing causes more pain. This pain continues for days and may get worse if you eat or drink alcohol. You may get some relief from the pain by sitting up and leaning forward. Other symptoms include nausea and vomiting, fever, swelling of the abdomen, rapid pulse, high or low blood pressure, shock, feelings of faintness, and jaundice (a yellowing of the skin or whites of eyes). The symptoms of acute pancreatitis are similar to chronic pancreatitis. However, as the pancreas becomes unable to produce the enzymes your body needs to digest and absorb nutrients, fats and proteins are not digested or absorbed. This is called exocrine failure. It causes frequent, foul smelling bowel movements. As the disease progresses, the pancreas loses its ability to make insulin. This is called endocrine failure. The pain occurs more often and lasts longer. You will begin to lose weight and show symptoms of diabetes, including increased thirst, appetite, urination, fatigue, and weight loss. Although it is unusual, chronic pancreatitis can lead to pancreatic cancer. In very severe cases called necrotizing pancreatitis, the pancreatic tissue begins to die from the tissue damage. In patients with necrotizing pancreatitis, the area between the ribs and the hip bone will be reddish-purple or greenish-brown, called Turner’s sign. Or, the area around the navel may be bluish, called Cullen's sign. Both conditions are caused by the pancreas bleeding into the abdomen. Other serious complications of chronic pancreatitis include kidney, respiratory, and heart failure due to shock; blood clots; pancreatic abscess (a collection of pus that results in infection); and pancreatic pseudocyst. Pancreatic pseudocyst occurs when dead pancreatic tissue, blood, white blood cells, enzymes, and fluid leaked from the circulatory system grow together. Pseudocysts can abscess and rupture.

How is it diagnosed?
To diagnose pancreatitis, your doctor will take your medical history and perform a complete medical examination. He or she will be particularly interested in how much alcohol you drink and if you have had symptoms of gallstones. Diagnostic tests include blood and urine studies for pancreatic enzymes and sugars, x-rays of the abdomen and chest, ultrasound exam of the pancreas and gallbladder, and computed tomography (CT) scan of the pancreas. In severe cases of chronic pancreatitis, your doctor may order an endoscopic retrograde cholangiopancreatography (ERCP). An ERCP is a way of looking at your pancreas through a slim flexible tube, called an endoscope, that is inserted into your mouth and down to the pancreas. An endoscope is fitted with a tiny fiber optic camera that gives the physician a detailed view of the pancreas. During the ERCP, the physician can remove a sample of tissue, a biopsy, from the pancreas. Your doctor may also want a stool sample to test for excess fats.

What is the treatment?
People with pancreatitis are usually hospitalized until symptoms stabilize. Treatment focuses on relieving pain, correcting blood sugar and enzyme levels, and providing nutrition. Your doctor will give you pain medication and intravenous (IV) fluids to replace lost fluids and restore lost nutrients. You may need a nasogastric tube, a thin tube inserted through the nose to suction stomach acids and stop nausea and vomiting. A number of causes and complications of pancreatitis require surgery. Removing the gallbladder will improve pancreatitis caused by gallstones. If the bile duct is severely enlarged, you may need surgery to drain the pancreatic duct or to remove part of the pancreas. If the pancreas has become infected, your doctor will begin antibiotic treatment. Pancreatic abscesses can be drained by a needle inserted through the abdomen into the abscess. Pancreatic pseudocysts can be allowed to shrink on their own, but may require surgery if they do not. A necrotizing pancreas is treated by surgically removing the dead tissue. If your condition is caused by alcohol abuse, the only way to improve symptoms is to stop drinking alcohol and follow your doctor’s treatment recommendations. When you are ready to leave the hospital, your doctor will recommend a diet that will be easy for your body to digest. You may need to take pancreatic enzyme supplements with every meal to help with food absorption, and you may need insulin to control blood sugar.

Self-care tips
The only cause of pancreatitis that can be prevented is alcoholism. If you drink heavily and have had attacks of acute pancreatitis, you must stop drinking alcohol. If you have any symptoms of pancreatitis, such as severe, penetrating abdominal pain that lasts longer than 20 minutes, or unexplained weight loss that lasts longer than a few weeks, call your doctor. Avoid eating fatty foods if you have gallstones, but your gallbladder hasn’t been removed. If pancreatitis is caused by drugs you are taking, your doctor should be able to recommend an alternative. To prevent attacks, follow your doctor’s recommendations for diet and medication and avoid drinking alcohol.


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