Your pancreas is no one-trick pony. It plays an important role in many processes of the body. So, when things go awry, and the pancreas becomes inflamed, you may be faced with some serious health problems.
You might not know as much about your pancreas as you do about your stomach or intestines, but your pancreas is a crucial part of the digestive system. The pancreas produces enzymes, or digestive juices, that help the body break down food.
On top of that, the pancreas produces important hormones that regulate the body. Specifically, it produces insulin and glucagon - two hormones that manage the glucose (sugar) taken from food for energy. In other words, these hormones manage levels of blood sugar, which is central to diabetes.
When the pancreas becomes inflamed, it is called pancreatitis. When the pancreas is healthy, its digestive juices do not become active until they have made it to the small intestine. In pancreatitis, however, the enzymes activate inside the pancreas, attacking and damaging the tissue that originally produced them.
Pancreatitis can be acute, meaning it suddenly appears and lasts for days. It can also be chronic, which means it lasts for years.
The following article explains the signs, symptoms, and causes of pancreatitis, how the condition is diagnosed, and how it is treated.
What is acute pancreatitis?
In acute pancreatitis, inflammation happens suddenly and, if treated, goes away within a few days. Even though acute pancreatitis does not last long, it is still a serious, life-threatening condition.
Hundreds of thousands of Americans are admitted to the hospital every year for acute pancreatitis.
Causes of Acute Pancreatitis
Gallstones (small, stone-like substances made of hardened bile) are the most common cause of acute pancreatitis. When these small stones pass from the gallbladder into the bile duct, they can damage the pancreas, leading to inflammation.
Acute pancreatitis can also happen after drinking too much alcohol. The condition can develop anytime from a couple hours to two days after drinking alcohol.
Other causes of acute pancreatitis include:
- trauma to the abdomen
- prescription drugs
- tumors or cancer
Signs and Symptoms of Acute Pancreatitis
The main symptom of acute pancreatitis is pain in the upper abdomen. This pain can come on gradually or suddenly. Sometimes, the pain can run through to the back. In many cases, the pain is intense and can last continually for days.
Other symptoms of acute pancreatitis may include:
- a swollen and tender abdomen
- a fast pulse
In the worst cases, acute pancreatitis can lead to heart, lung, or kidney failure. If your pancreas starts to bleed, you could experience shock or even die.
Dehydration and low blood sugar may also result from severe acute pancreatitis.
Diagnosis of Acute Pancreatitis
Because the pancreas is located so deep in the body cavity, it can be hard to diagnose acute pancreatitis. Still, doctors can give a proper diagnosis using a combination of modern medical tools.
To diagnose acute pancreatitis, a doctor will look at your medical history and run an in-depth physical exam. In addition, a doctor will order a blood test. In the blood test, the doctor is looking for higher levels of digestive enzymes in the blood and changes to other chemicals in the body.
A doctor is likely also to use at least one of the following imaging tests:
- abdominal ultrasound - which uses sound waves to produce images of the pancreas, gallbladder, other organs, and gallstones if they are present
- computerized tomography (CT) scan - a type of three-dimensional x-ray image that can show gallstones or damage to the pancreas
- endoscopic ultrasound (EUS) - which involves sticking a tube down a patients throat, through the stomach, and into the small intestine in order to use sound waves to produce images of the pancreas and bile ducts
- magnetic resonance cholangiopancreatography (MCRP) - a type of magnetic resonance imaging (MRI) test in which dye is injected into a patient's veins to help show images of the pancreas, gallbladder, and pancreatic and bile ducts
Treatment of Acute Pancreatitis
Usually, people with acute pancreatitis need to stay in the hospital for a few days. During the hospital stay, patients are injected with fluids, given antibiotics, and treated with drugs to relieve pain. To let their pancreas rest, patients cannot eat or drink.
If pancreatitis does not go away within a few days, or if complications arise, a patient may need several weeks of nasogastric feeding - a process in which a tube is inserted through the nose, past the stomach, and into the stomach in order to provide food to patients.
After leaving the hospital, a patient should not smoke, drink alcohol, or eat fatty foods. In some cases, patients need more testing to determine the cause of their acute pancreatitis.
Other treatments for acute pancreatitis involve therapeutic endoscopic retrograde cholangiopancreatography (ERCP) - an imaging technique used to see the pancreas, gallbladder, and bile ducts. ERCP is used to treat complications of both acute and chronic pancreatitis.
Procedures that use ERCP include:
- sphincterotomy - a procedure in which a doctor uses a small wire on an endoscope (a long tube with a light and video camera) to make a small cut to widen the pancreatic and bile ducts
- gallstone removal - a process in which a doctor uses the endoscope to remove stones from the pancreatic and bile ducts
- stent placement - a procedure in which a straw-like tube is placed in the pancreatic or bile duct to keep the duct open
- balloon dilation - a procedure in which a small balloon is placed in the pancreatic or bile duct to stretch and keep the duct open
Complications of Acute Pancreatitis
Gallstones are the main complication of acute pancreatitis. If pancreatitis is mild, gallstones may be removed while the patient is still in the hospital. If pancreatitis is more severe, then gallstone removal using ERCP may need to be put off for at least a month so that the patient can fully recover.
Other complications of acute pancreatitis include:
- kidney failure
- pseudocysts - buildups of fluid and tissue debris that, if left untreated, can lead to heart, lung, and kidney problems
- breathing problems
- hypoxia - a condition in which body cells and tissues do not get enough oxygen
- lung failure
What is chronic pancreatitis?
While acute pancreatitis usually lasts for just a few days, the chronic form of pancreatitis lasts for years. In chronic pancreatitis, the pancreas does not heal. Over time, the condition gets worse, leading to permanent damage and serious complications.
Like acute pancreatitis, chronic pancreatitis happens when digestive juices damage the pancreas and surrounding tissues.
Chronic pancreatitis commonly develops in people between 30 and 40 years of age.
Causes of Chronic Pancreatitis
Heavy alcohol use is one of the most common causes of chronic pancreatitis. People who drink heavily over the years are putting themselves at risk of an acute attack of pancreatitis. It only takes one acute attack to damage the pancreatic duct and cause inflammation. As scar tissue develops, the pancreas is damaged over time.
Chronic pancreatitis can also be caused by:
- hereditary or genetic disorders of the pancreas, specifically caused by changes to the trypsinogen gene (PRSS1)
- cystic fibrosis - a genetic disease passed down through families that causes thick mucus to collect in the lungs, digestive tract, and other areas of the body
- hypercalcemia - too much calcium in the blood
- hyperlipidemia - too much fat in the blood
- hypertriglyceridemia - too much fat in the blood
- certain medications, including azathioprine (sold as Azasan and Imuran), sulfonamides, steroids, nonsteroidal anti-inflammatory drugs (NSAIDs), and antibiotics such as tetracycline (sold as Ala-Tet and Brodspec among others)
- autoimmune pancreatitis - a condition in which the immune system mistakenly attacks the healthy tissues of the pancreas
Symptoms of Chronic Pancreatitis
Like those with acute pancreatitis, people with chronic pancreatitis may experience abdominal pain. However, some patients do not feel any pain.
When patients do experience pain, it can get worse from eating or drinking. Over time, the pain can become constant and immobilizing.
As chronic pancreatitis progresses, the pain may go away. But this is not necessarily a good sign: the pancreas may have stopped making the damaging digestive enzymes.
Other symptoms of chronic pancreatitis include:
- abdominal tenderness
- fast heart rate
- rapid breathing
- oily stools (feces)
- weight loss
Diagnosis of Chronic Pancreatitis
Because symptoms are so similar, telling the difference between acute and chronic pancreatitis can be difficult.
To diagnose chronic pancreatitis, a doctor will run similar tests as those used in diagnosing acute pancreatitis. The doctor will look through a patient's medical history and run a thorough physical exam. Blood tests are likely to be used as well. However, in people with chronic pancreatitis, these blood tests sometimes come back with normal results.
In later or more advanced stages of the condition, a doctor may use blood, urine, and stool tests to diagnose and track the progression of chronic pancreatitis.
A doctor is also to use at least one of the imaging tests used to diagnose acute pancreatitis.
Treatment of Chronic Pancreatitis
Some of the treatments for chronic pancreatitis are similar to those used in treating acute pancreatitis. Patients may need to be hospitalized for help dealing with pain, hydration, and nutrition. If a patient continues losing weight, a doctor may suggest nasogastric feeding.
Over time, a patient's pancreas may lose the ability to produce digestive enzymes. In these cases, and when patients can eat a normal diet once again, a doctor may prescribe artificial enzymes to help the patient digest food.
A dietitian may also play a role in treatment for chronic pancreatitis. Dietitians can help patients plan a healthy, low-fat meal plan.
If you are diagnosed with chronic pancreatitis, you should avoid smoking and drinking alcoholic or caffeinated beverages.
Complications of Chronic Pancreatitis
If you have chronic pancreatitis and continue drinking large amounts of alcohol, you may have sudden attacks of intense abdominal pain.
Other complications of chronic pancreatitis include:
- narrowed or blocked ducts
- calcification of the pancreas - hardening of the pancreatic tissue caused by deposits of calcium salts
Cells in the pancreas - called beta cells - produce insulin, a hormone that manages blood sugar levels. When the pancreas can no longer produce insulin as the result of damage from pancreatitis, a patient can develop diabetes.
Kidney damage is another severe complication of chronic pancreatitis.
Who is at risk of pancreatitis?
A number of factors put people at risk for pancreatitis. These include:
- biliary tract disease - blockage of the biliary tract, usually by gallstones
- heavy alcohol use over time or binge drinking
- recent surgery - which can temporarily cut off blood supply to the pancreas, leading to tissue damage
- a family history of high triglycerides, or blood fats
In addition, African Americans have a higher risk of pancreatitis compared to Caucasians and Native Americans.