Pancreatitis

Overview

By Sarah Maurer

Pancreatitis is inflammation of the pancreas, which is a gland located in the upper part of the abdomen near the stomach, liver and gallbladder. Inflammation refers to the body's response to injury, infection or irritating substances. When the pancreas is inflamed, it may become swollen and sore and lose its ability to function properly.

One job of the pancreas is to produces digestive enzymes, which it secretes into the small intestine through the pancreatic duct. These enzymes activate in the presence of bile, a substance that is produced by the liver and stored in the gallbladder. Activated digestive enzymes break down food so nutrients can be absorbed into the body. In addition, the pancreas also makes insulin, a hormone that helps the body's cells convert blood glucose (sugar) into energy.

Pancreas (anterior view)Pancreatitis can begin as an acute illness, meaning that it comes on strong and suddenly, then goes away after a couple days of treatment. In some cases, pancreatitis is a chronic (long-term) condition that causes irreversible scarring, tissue damage and loss of pancreatic function.

Both forms of the disease can cause potentially serious complications, including:

  • Death of the pancreatic tissue
  • Formation of fluid-filled pockets (pseudocysts)
  • Internal bleeding
  • Infection that spreads to other parts of the body, resulting in shock and organ failure
  • Trouble breathing
  • Diabetes (due to insufficient insulin production)
  • Kidney failure
  • Chronic pain
  • Malnutrition
  • Increased risk of pancreatic cancer

Causes and Risk Factors

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Pancreatitis

About 210,000 people are hospitalized each year with pancreatitis. Men and people of African descent are at increased risk for the condition. Pancreatitis is most common between the ages of 35 and 64. Other risk factors include heavy drinking, smoking, family history of pancreatitis, and family history of high blood cholesterol and/or triglycerides.

Normally, digestive enzymes produced by the pancreas activate in the small intestine. However, when the pancreas or bile ducts are irritated, these enzymes may activate early inside the pancreas itself. The activated enzyme is an irritant and provokes an inflammatory response in the surrounding tissues.

Gallstones and alcoholism are the two most common causes of acute pancreatitis, accounting for about 80 percent of all cases. Gallstones are small "pebbles" of hardened bile. The liver and gallbladder (which produce and store bile, respectively) share a common duct system with the pancreas. Hepatic ducts from the liver merge with the cystic duct from the gallbladder to form the common bile duct. Further down this common bile duct, the pancreatic duct also merges with it to form the ampulla of Vater, which connects to the duodenum where the juices from these organs work to digest food. Gallstones in the common bile duct may irritate the pancreas by impeding flow in the pancreatic duct.

Heavy, chronic use of alcohol can also cause irritation.

Other causes of acute pancreatitis include:

  • Medications (corticosteroids, non-steroidal anti-inflammatories)
  • Some infections (mumps, hepatitis, mononucleosis, cytomegalovirus)
  • Abdominal injury or recent surgery
  • Tumors
  • Genetic abnormalities of the pancreas

The most common cause of chronic pancreatitis is chronic, heavy alcohol use. Other causes include:

  • Smoking
  • Medications
  • Cystic fibrosis
  • Hyperthyroidism
  • High blood cholesterol or triglyceride levels
  • Hereditary disorders
  • Autoimmune disease
  • Pancreatic cancer

In about 10 percent of pancreatitis cases, the cause is never diagnosed. Cases of pancreatitis where diagnostic procedures cannot establish a cause are called idiopathic.

Symptoms

Signs of acute pancreatitis include:

  • Pain in the upper abdomen that may radiate to the back or feel worse after eating. Pain is often sudden and severe.
  • Nausea
  • Vomiting
  • Swollen or tender abdomen
  • Fever
  • Rapid pulse

The following symptoms are associated with chronic pancreatitis:

  • Pain in the upper abdomen (usually less intense than in the acute form)
  • Vomiting
  • Unexplained weight loss
  • Diarrhea
  • Oily stools

Diagnosis and Treatment

Pancreatic duct and common bile duct merging to form ampulla of vaterLab tests are often the first step in diagnosing pancreatitis. These include blood tests to detect increased pancreatic enzyme levels and stool tests to check for poor absorption of fats.

Imaging tests are used to determine the size of the pancreas and detect related problems like gallstones:

  • CT scan uses X-rays to create three-dimensional images of organs
  • Ultrasound uses reflected sound waves to create an image. These may be directed through the abdominal wall or via a tube called an endoscope that is passed down the throat. Endoscopy is usually performed under light sedation.
  • Magnetic resonance imaging, or MRI, uses magnetic fields to create detailed pictures of body structures.

Most people who are diagnosed with pancreatitis are hospitalized. The main goal of treatment is to relieve symptoms and treat any infection that may be present. Treatment usually includes:

  • Fasting or tube feeding to give the pancreas a rest.
  • Pain medications.
  • Antibiotics (if infection is present).
  • IV fluids.

Further treatment depends on the underlying causes of the pancreatitis:

  • Endoscopic retrograde cholangiopancreatography (ERCP). In this procedure, an endoscope, or tube with a tiny camera in the end, is passed down the throat and used to examine the pancreas and bile ducts. Tools can be passed through the scope to relieve blockages and drain fluid.
  • Cholecystectomy. Surgical removal of the gallbladder may help people whose pancreatitis is caused by gallstones.
  • Pancreatic surgery. This is sometimes needed to remove diseased tissue or drain fluid-filled cysts.

People with chronic pancreatitis may require:

  • Pain management with medication or surgical techniques.
  • Enzyme supplements taken by mouth.
  • Insulin injections.
  • A low-fat diet that's also nutrient-rich.

Patients diagnosed with pancreatitis can help manage the condition and prevent its return through healthy lifestyle choices. One of the most important is to seek treatment for alcoholism. A primary care physician can provide referrals to appropriate programs. Patients may also benefit from smoking cessation, drinking plenty of fluids, limiting caffeine intake and eating a low-fat diet.

About 85 percent of acute pancreatitis cases are mild and clear up after a few days of treatment. Tissue death, or pancreatic necrosis, occurs in 15 to 20 percent of acute cases. This type usually requires surgical treatment and is more prone to complications.

The mortality rate for acute pancreatitis is about 5 percent. Most deaths are related to systemic infection and organ failure.

When the cause of pancreatitis is alcohol-related, the probability of recurrence is about 50 percent if the person continues to drink.

Prevention

Not all cases of pancreatitis are preventable. However, the most important thing a person can do to prevent the disease is to limit alcohol intake. It's especially important to avoid binge drinking (consuming several drinks close together).

In addition, quitting smoking may also reduce the risk of pancreatitis.

Sources

  • "Acute Pancreatitis." Peter Lee and Tyler Stevens, The Cleveland Clinic Foundation. http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/gastroenterology/acute-pancreatitis/. Accessed April 18, 2014.
  • "Diseases and Conditions: Pancreatitis." Mayo Foundation for Medical Education and Research, 2013. http://www.mayoclinic.org/diseases-conditions/pancreatitis/basics/definition/con-20028421. Accessed April 18, 2014.
  • "Pancreatitis." National Institute of Diabetes and Digestive and Kidney Diseases, 2012. http://digestive.niddk.nih.gov/ddiseases/pubs/pancreatitis/. Accessed April 18, 2014.
  • "Pancreatitis." University of Maryland Medical Center, 2013. https://umm.edu/health/medical/altmed/condition/pancreatitis. Accessed April 18, 2014.
  • "What Is Pancreatitis." USC Center for Pancreatic and Biliary Diseases. http://www.surgery.usc.edu/divisions/tumor/pancreasdiseases/pancreatitis%20overview.html. Accessed April 18, 2014.