Pancreatitis (Acute and Chronic)

Illustration of the Pancreas

Pancreatitis is a condition characterized by inflammation of the pancreas.

The pancreas is an abdominal gland situated behind the stomach in the upper abdomen. The main function of the pancreas is to secrete hormones and enzymes that help with digestion and regulate blood sugar (glucose) metabolism. The digestive enzymes are released via the pancreatic duct into the small intestine where they are activated to help break down fats and proteins. The digestive hormones (insulin and glucagon) produced by the pancreas are released into the bloodstream where they help regulate blood sugar levels.

Pancreatitis is categorized as being either acute or chronic, which is defined as the following:

• Acute pancreatitis generally develops suddenly, and it is usually a short-term (a few days to weeks) illness that typically resolves with appropriate medical management.
• Chronic pancreatitis, which typically develops after multiple episodes of acute pancreatitis, is a long-term condition that can last for months or even several years.

Pancreatitis is a condition that may be mild and self-limiting, though it can also lead to severe complications that can be life-threatening. The acute form of pancreatitis, in its most severe form, can have deleterious effects on many other body organs, including the lungs and kidneys.

Normally, digestive enzymes released by the pancreas are not activated to break down fats and proteins until they reach the small intestine. However, when these digestive enzymes are activated while still in the pancreas, inflammation and local damage to the pancreas occurs leading to pancreatitis.

The causes of pancreatitis include:

• Alcohol consumption
• Gallstones
• High triglyceride levels
• Abdominal injury or surgery
• Certain medications
• Exposure to certain chemicals
• Smoking
• Family history of pancreatitis
• Cystic fibrosis
• Pancreatic cancer

Alcohol consumption and gallstones account for over 80% of all cases of pancreatitis in the U.S.

Pancreatitis causes upper abdominal pain which can range from mild to severe.

The pain may come on suddenly or it may develop gradually. Often, the pain will start or worsen after eating, which can also occur with gallbladder or ulcer pain. Abdominal pain tends to be the hallmark of acute pancreatitis. People with acute pancreatitis usually feel very ill.

Acute pancreatitis signs and symptoms may include:

• Abdominal pain that may radiate to the back
• Nausea and vomiting
• Worsening pain after eating
• Tenderness to the touch of the abdomen
• Fever and chills
• Weakness and lethargy

In chronic pancreatitis, abdominal pain also can be present, but it is often not as severe, and some people may not have any pain at all.

Chronic pancreatitis signs and symptoms may include:

• Abdominal pain
• Unintentional weight loss
• Foul-smelling, oily stool

There are several tests that alone, or in combination, will help establish the diagnosis of pancreatitis.

Blood tests

Amylase and/or lipase levels are typically elevated in cases of acute pancreatitis. These blood tests may not be elevated in cases of chronic pancreatitis. These are usually the first tests performed to establish the diagnosis of pancreatitis, as these results are generally readily and quickly available.

Other blood tests may be ordered, for example:

• Liver and kidney function tests
• Tests for infection
• Tests for anemia

Imaging studies

A CT (computed tomography) scan of the abdomen may be ordered to visualize the pancreas and to evaluate the extent of inflammation, as well as any of the potential complications that can arise from pancreatitis, such as bleeding or pseudocyst (a collection of fluid) formation. The CT scan may also detect gallstones (a major cause of pancreatitis) and other abnormalities of the biliary system.

Ultrasound imaging can be used to look for gallstones and abnormalities in the biliary system. Because ultrasound imaging does not emit radiation, this modality is frequently the initial imaging test obtained in cases of pancreatitis.

Depending on the underlying cause of pancreatitis and the severity of the illness, additional testing may be ordered.

In most cases of acute pancreatitis, admission to the hospital is needed, whereas some cases of chronic pancreatitis can be managed in an outpatient setting.

Depending on the underlying cause of pancreatitis, management may vary to address the specific cause. In general, however, the following treatment regimen will always be initiated for the treatment of pancreatitis.

First-line treatment will involve:

• Fasting helps the pancreas to rest and recover.
• IV fluids to prevent dehydration while fasting
• Pancreatitis can be very painful, thus intravenous pain medication is often necessary.

If pancreatitis is due to an obstructing gallstone, surgical intervention may be required to remove the gallstone and/or remove the gallbladder. Intervention may also be required to treat a pseudocyst or to remove part of the affected pancreas.

If alcohol consumption is the cause of pancreatitis, abstinence from alcohol and an alcohol rehabilitation program will be recommended.

If a medication or chemical exposure is found to be the cause of pancreatitis, then removal of the medication or offending exposure is recommended.

If high triglycerides are the cause of pancreatitis, then your healthcare professional may prescribe medication to decrease the patient's triglyceride levels.

In general, the above treatment regimen is the mainstay of pancreatitis management.

Pain medication and medication to control nausea may also be prescribed.

In cases of chronic pancreatitis, your healthcare professional also may prescribe pancreatic enzyme supplements to help the body digest certain nutrients.

For people with pancreatitis, low-fat meals that are high in nutrients is the recommended diet. Adequate fluid intake is also recommended to prevent dehydration.

The prognosis for pancreatitis depends on many different factors, such as the underlying condition causing pancreatitis, the severity of pancreatitis, and the patient's age and underlying medical problems. Patients with pancreatitis can experience everything from a brief self-limited illness with a full recovery to a severe course of illness that can lead to life-threatening complications and death. If an individual has repeated episodes of acute pancreatitis, they may develop chronic pancreatitis, a lifelong condition that can lead to a decreased quality of life.

Pancreatitis can be a life-threatening illness with severe complications.

Complications of pancreatitis may include:

• Diabetes: Damage to the pancreas can lead to diabetes due to the disruption in the secretion of insulin.
• Pseudocyst formation: During acute pancreatitis, fluid, and debris can collect in and around the pancreas. If rupture of this fluid-containing sac occurs, severe pain, infection, and internal bleeding can result.
• Malnutrition: Damage to the pancreas can lead to a decrease or absence of digestive enzymes produced, which can affect the absorption of various nutrients. This may lead to malnutrition and unintentional weight loss.
• Pancreatic cancer: Chronic pancreatitis is a risk factor for the development of pancreatic cancer.
• Infection: Individuals with pancreatitis are at risk for the development of infection, which can lead to multi-organ failure, sepsis, and ultimately death.

Certain lifestyle changes can decrease the chances of someone getting pancreatitis, such as alcohol and smoking cessation. Consuming a low-fat diet and maintaining a healthy weight can decrease the risk of developing gallstones, a leading cause of pancreatitis.