Pancreatitis is inflammation of the pancreas and can be acute or chronic.
Acute PancreatitisAcute pancreatitis refers to inflammation of the pancreas that occurs suddenly and usually resolves with treatment of symptoms. However, it can be a life-threatening with severe complications. The most common cause of acute pancreatitis is the presence of gallstones that cause inflammation in the pancreas as they pass through the common bile duct. Chronic, heavy alcohol use can also result in acute pancreatitis. Other causes of acute pancreatitis include abdominal trauma, medications, infections, tumors and genetic abnormalities of the pancreas.
Acute pancreatitis usually begins with gradual or sudden pain in the upper abdomen that sometimes extends through the back. The pain may be mild at first and feel worse after eating. But it is often severe, may become constant and can last for several days. A person with acute pancreatitis usually looks and feels very ill and needs immediate medical attention. Other symptoms may include:
- Swollen and tender abdomen
- Nausea and vomiting
- Rapid pulse
Chronic PancreatitisChronic pancreatitis refers to inflammation of the pancreas that does not heal or improve. It often gets worse over time and can lead to permanent damage, such as diabetes. Chronic pancreatitis often develops between ages of 30-40.
The most common cause of chronic pancreatitis is many years of heavy alcohol use; however, it may result from genetic and autoimmune causes. The chronic form of pancreatitis can be triggered by one acute attack that damages the pancreatic duct. The damaged duct causes the pancreas to become inflamed. Scar tissue develops and the pancreas is slowly destroyed.
Hereditary pancreatitis can occur before age 30 but it might not be diagnosed for several years. A diagnosis of hereditary pancreatitis is likely if the person has two or more family members with pancreatitis in more than one generation.
Most people with chronic pancreatitis experience upper abdominal pain, although some people have no pain at all. The pain may spread to the back, feel worse when eating or drinking, and become constant and disabling. In some cases, abdominal pain goes away as the condition worsens, most likely because the pancreas is no longer making digestive enzymes. Other symptoms include:
- Weight loss
- Oily stools
While asking about your medical history and conducting a thorough physical examination, your doctor will order a blood test. During acute pancreatitis, the blood contains at least three times the normal amount of amylase and lipase, digestive enzymes formed in the pancreas. Changes may also occur in other body chemicals such as glucose, calcium, magnesium, sodium, potassium, and bicarbonate. After your condition improves, the levels usually return to normal.Diagnosing acute pancreatitis is often difficult because of the location of the pancreas. As a result, your doctor may order one or more of the following tests:
- Abdominal ultrasound
- Computerized tomography (CT) scan
- Endoscopic ultrasound (EUS)
- Magnetic resonance cholangiopancreatography (MRCP)
Because they both exhibit similar symptoms, acute and chronic pancreatitis are often confused. As with acute pancreatitis, your doctor will conduct a thorough medical history and physical examination. Blood tests may reveal whether the pancreas is still making enough digestive enzymes, but sometimes these enzymes appear normal even though the person has chronic pancreatitis.
In more advanced stages of pancreatitis, when malabsorption and diabetes can occur, the doctor may order blood, urine, and stool tests to help diagnose chronic pancreatitis and monitor its progression. After ordering X-rays of the abdomen, your healthcare provider may also request one or more of the tests used to diagnose acute pancreatitis—abdominal ultrasound, CT scan, EUS, and MRCP.
Treatment for acute pancreatitis requires a few days stay in the hospital for intravenous (IV) fluids, antibiotics and medication to relieve pain. The pancreas needs to rest, so you cannot eat or drink. If vomiting occurs, a tube may be placed through the nose and into the stomach to remove fluid and air.
Gallstones that cause acute pancreatitis require surgical removal of the stones and the gallbladder. If the pancreatitis is mild, gallbladder removal—called cholecystectomy—may proceed while the person is in the hospital. If the pancreatitis is severe, gallstones may be removed using ERCP. Cholecystectomy is delayed for a month or more to allow for full recovery.
Unless complications arise, acute pancreatitis usually goes away after a few days. In severe cases, the person may require nasogastric feeding—a special liquid given in a long, thin tube inserted through the nose and throat and into the stomach—for several weeks while the pancreas heals.
Before leaving the hospital, you will be advised not to smoke or drink alcoholic beverages. In some cases, the cause of the pancreatitis is clear, but in others, more tests are required after you are discharged and the pancreas has healed.
Treatment for chronic pancreatitis may require hospitalization for pain management, IV hydration and nutritional support. Nasogastric feedings may be necessary for several weeks if you continue to lose weight.
Chronic pancreatitis also can lead to calcification of the pancreas, which means the pancreatic tissue hardens from deposits of insoluble calcium salts. Surgery may be necessary to remove part of the pancreas. In cases involving persistent pain, your doctor may recommend surgery or other procedures to block the nerves in the abdominal area that can contribute to pain.
One type of surgery, a total pancreatectomy and auto islet transplantation, which utilizes a patient’s own islet cells, may also be an option.
After you resume your normal diet, the doctor may prescribe synthetic pancreatic enzymes if the pancreas does not secrete enough of its own. This will help you digest food and regain weight. You will also need to plan a nutritious diet that includes small, frequent meals. A dietitian can assist in developing a meal plan. As with acute pancreatitis, eliminating cigarette smoking and alcohol use will help avoid additional damage to the pancreas.