Pancreatitis- Acute and Chronic
OVERVIEW | CAUSES | RISK FACTORS | SYMPTOMS | COMPLICATION | DIAGNOSIS | TREATMENT | PREVENTION | REFERENCES
OVERVIEW
Pancreatitis is inflammation in 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).
Pancreatitis can occur as acute pancreatitis — meaning it appears suddenly and lasts for days. Or pancreatitis can occur as chronic pancreatitis, which is pancreatitis that occurs over many years.
Mild cases of pancreatitis may go away without treatment, but severe cases can cause life-threatening complications.
CAUSES
Pancreatitis occurs when digestive enzymes become activated while still in the pancreas, irritating the cells of your pancreas and causing inflammation.
With repeated bouts of acute pancreatitis, damage to the pancreas can occur and lead to chronic pancreatitis. Scar tissue may form in the pancreas, causing loss of function. A poorly functioning pancreas can cause digestion problems and diabetes.
Conditions that can lead to pancreatitis include:
- Abdominal surgery
- Alcoholism
- Certain medications
- Cystic fibrosis
- Gallstones
- High calcium levels in the blood (hypercalcemia), which may be caused by an overactive parathyroid gland (hyperparathyroidism)
- High triglyceride levels in the blood (hypertriglyceridemia)
- Infection
- Injury to the abdomen
- Obesity
- Pancreatic cancer
Endoscopic retrograde cholangiopancreatography (ERCP), a procedure used to treat gallstones, also can lead to pancreatitis.
Sometimes, a cause for pancreatitis is never found.
RISK FACTORS
Factors that increase your risk of pancreatitis include:
- Excessive alcohol consumption. Research shows that heavy alcohol users (people who consume four to five drinks a day) are at increased risk of pancreatitis.
- Cigarette smoking. Smokers are on average three times more likely to develop chronic pancreatitis, compared with nonsmokers. The good news is quitting smoking decreases your risk by about half
- Obesity. You're more likely to get pancreatitis if you're obese.
- Family history of pancreatitis. The role of genetics is becoming increasingly recognized in chronic pancreatitis. If you have family members with the condition, your odds increase — especially when combined with other risk factors.
SYMPTOMS
Signs and symptoms of pancreatitis may vary, depending on which type you experience.
Acute pancreatitis signs and symptoms include:
- Upper abdominal pain
- Abdominal pain that radiates to your back
- Abdominal pain that feels worse after eating
- Fever
- Rapid pulse
- Nausea
- Vomiting
- Tenderness when touching the abdomen
Chronic pancreatitis signs and symptoms include:
- Upper abdominal pain
- Losing weight without trying
- Oily, smelly stools (steatorrhea)
When to see a doctor
Make an appointment with your doctor if you have persistent abdominal pain. Seek immediate medical help if your abdominal pain is so severe that you can't sit still or find a position that makes you more comfortable.
COMPLICATIONS
Pancreatitis can cause serious complications, including:
- Pseudocyst. Acute pancreatitis can cause fluid and debris to collect in cystlike pockets in your pancreas. A large pseudocyst that ruptures can cause complications such as internal bleeding and infection.
- Infection. Acute pancreatitis can make your pancreas vulnerable to bacteria and infection. Pancreatic infections are serious and require intensive treatment, such as surgery to remove the infected tissue.
- Kidney failure. Acute pancreatitis may cause kidney failure, which can be treated with dialysis if the kidney failure is severe and persistent.
- Breathing problems. Acute pancreatitis can cause chemical changes in your body that affect your lung function, causing the level of oxygen in your blood to fall to dangerously low levels.
- Diabetes. Damage to insulin-producing cells in your pancreas from chronic pancreatitis can lead to diabetes, a disease that affects the way your body uses blood sugar.
- Malnutrition. Both acute and chronic pancreatitis can cause your pancreas to produce fewer of the enzymes that are needed to break down and process nutrients from the food you eat. This can lead to malnutrition, diarrhea and weight loss, even though you may be eating the same foods or the same amount of food.
- Pancreatic cancer. Long-standing inflammation in your pancreas caused by chronic pancreatitis is a risk factor for developing pancreatic cancer.
DIAGNOSIS
Tests and procedures used to diagnose pancreatitis include:
- Blood tests to look for elevated levels of pancreatic enzymes
- Stool tests in chronic pancreatitis to measure levels of fat that could suggest your digestive system isn't absorbing nutrients adequately
- Computerized tomography (CT) scan to look for gallstones and assess the extent of pancreas inflammation
- Abdominal ultrasound to look for gallstones and pancreas inflammation
- Endoscopic ultrasound to look for inflammation and blockages in the pancreatic duct or bile duct
- Magnetic resonance imaging (MRI) to look for abnormalities in the gallbladder, pancreas and ducts
Your doctor may recommend other tests, depending on your particular situation.
TREATMENT
Initial treatments in the hospital may include:
- Fasting. You'll stop eating for a couple of days in the hospital in order to give your pancreas a chance to recover.
Once the inflammation in your pancreas is controlled, you may begin drinking clear liquids and eating bland foods. With time, you can go back to your normal diet.
If your pancreatitis persists and you still experience pain when eating, your doctor may recommend a feeding tube to help you get nutrition. - Pain medications. Pancreatitis can cause severe pain. Your health care team will give you medications to help control the pain.
- Intravenous (IV) fluids. As your body devotes energy and fluids to repairing your pancreas, you may become dehydrated. For this reason, you'll receive extra fluids through a vein in your arm during your hospital stay.
Once your pancreatitis is under control, your health care team can treat the underlying cause of your pancreatitis. Depending on the cause of your pancreatitis, treatment may include:
- Procedures to remove bile duct obstructions. Pancreatitis caused by a narrowed or blocked bile duct may require procedures to open or widen the bile duct. A procedure called endoscopic retrograde cholangiopancreatography (ERCP) uses a long tube with a camera on the end to examine your pancreas and bile ducts. The tube is passed down your throat, and the camera sends pictures of your digestive system to a monitor. ERCP can aid in diagnosing problems in the bile duct and pancreatic duct and in making repairs. In some people, particularly the elderly, ERCP can also lead to acute pancreatitis.
- Gallbladder surgery. If gallstones caused your pancreatitis, your doctor may recommend surgery to remove your gallbladder (cholecystectomy).
- Pancreas surgery. Surgery may be necessary to drain fluid from your pancreas or to remove diseased tissue.
- Treatment for alcohol dependence. Drinking several drinks a day over many years can cause pancreatitis. If this is the cause of your pancreatitis, your doctor may recommend you enter a treatment program for alcohol addiction. Continuing to drink may worsen your pancreatitis and lead to serious complications.
Additional treatments for chronic pancreatitis
Depending on your situation, chronic pancreatitis may require additional treatments, including:
- Pain management. Chronic pancreatitis can cause persistent abdominal pain. Your doctor may recommend medications to control your pain and may refer you to a pain specialist.
Severe pain may be relieved with options such as endoscopic ultrasound or surgery to block nerves that send pain signals from the pancreas to the brain. - Enzymes to improve digestion. Pancreatic enzyme supplements can help your body break down and process the nutrients in the foods you eat. Pancreatic enzymes are taken with each meal.
- Changes to your diet. Your doctor may refer you to a dietitian who can help you plan low-fat meals that are high in nutrients.
The best way to prevent pancreatitis is to have a healthy lifestyle. Aim to:
- Maintain a healthy weight.
- Get regular exercise.
- Stop smoking.
- Avoid alcohol.
These healthy lifestyle choices will also help you avoid gallstones, which is one of the major causes of acute pancreatitis cases. Your provider may recommend removing your gallbladder if you have painful gallstones multiple times.
REFERENCE
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2886461/
- https://my.clevelandclinic.org/health/diseases/8103-pancreatitis
- https://www.hopkinsmedicine.org/gastroenterology_hepatology/diseases_conditions/faqs/chronic_pancreatitis.html
- https://www.mayoclinic.org/diseases-conditions/pancreatitis/diagnosis-treatment/drc-20360233
