Ohio State has a specialized Pancreas Clinic to care for patients with pancreatic disorders. In addition, Ohio State offers superb care for those with diabetes and for pancreatic cancer.
Pancreatitis refers to inflammation of the pancreas. It can occur when digestive enzymes start digesting the pancreas and/or the adjacent fat tissue. Pancreatitis can be acute (sudden and severe) or chronic (frequent, long lasting and slow to develop). Both forms are serious, can lead to complications and should be evaluated by a physician.
Acute pancreatitis may come on suddenly and usually goes away in a few days with supportive treatment. It is the most common gastrointestinal reason for hospitalization in the United States. This refers to inflammation of the pancreas that occurs suddenly and usually resolves; 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, tumors and genetic abnormalities of the pancreas
Severe acute pancreatitis may cause dehydration and low blood pressure. The heart, lungs, or kidneys can fail. In rare cases, shock and even death may follow.
Chronic 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 and difficulties digesting food. Chronic pancreatitis often develops between the ages of 30-40.
- The most common cause is heavy alcohol use
- Other causes include recurrent episodes of acute pancreatitis, hereditary causes of pancreatitis, and autoimmune pancreatitis
- 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 and develop scar tissue
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.
Because they both exhibit similar symptoms, acute and chronic pancreatitis are often confused.
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
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:
- Unexplained weight loss
- Diarrhea, especially if the stools are oily
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.
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)
For diagnosing chronic pancreatitis, 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, stool tests, or imaging tests to help diagnose chronic pancreatitis and monitor its progression.
Treatments for acute and chronic pancreatitis are similar.
- Hospital stay for intravenous (IV) fluids and treatment of severe symptoms, including pain and nausea
- Temporary dietary modifications
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 often 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.
For chronic pancreatitis, long-term treatment may include
- Enzyme therapy
- Nutritional changes
- Quitting smoking
- Abstinence from alcohol
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 also recommend an endoscopic procedure.
One type of surgery, a total pancreatectomy and auto islet transplantation, which utilizes a patient’s own islet cells, may be an option for patients without pre-existing diabetes.
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 smoking and alcohol use will help avoid additional damage to the pancreas.