Pancreatitis

Pancreatitis is inflammation of the pancreas, the large gland located behind the stomach. Pancreatitis can be acute, chronic, or recurrent.

• Acute pancreatitis is a sudden inflammation of the pancreas.
• People with chronic pancreatitis have ongoing inflammation of the pancreas that leads to permanent damage.

People with recurrent pancreatitis have repeated bouts of acute inflammation.

The main function of the pancreas is to produce digestive enzymes and hormones, such as insulin, that regulate blood sugar levels.

Most cases of pancreatitis are caused by overuse of alcohol.

Besides overuse of alcohol, other causes of pancreatitis include:

• Heredity — Hereditary chronic pancreatitis is a rare genetic disorder that predisposes a person to develop the disease, usually before age 20.
• Genetic causes — Mutations of the cystic fibrosis gene is the most widely recognized genetic cause.
• Blockage of the duct that drains digestive enzymes from the pancreas — If the enzymes don't drain properly, they can back up and damage the pancreas. Blockage can be caused by gallstones, scarring from prior surgery, tumors, or abnormalities of the pancreas or of the shape or location of the pancreatic duct. If the blockage is found early, surgery or a procedure called endoscopic retrograde cholangiopancreatography (ERCP) to relieve the blockage may help to prevent damage to the pancreas.
• Autoimmune pancreatitis — For unexplained reasons, some people develop antibodies that attack their own pancreas.
• Very high blood triglyceride levels.

Sometimes the underlying cause of chronic pancreatitis cannot be identified.

Acute pancreatitis 

In acute pancreatitis, enzymes that normally are released into the digestive tract stay within the pancreas and begin to damage it. The pancreas becomes swollen and inflamed. More enzymes are then released into the surrounding tissues and bloodstream.

As a result, digestion slows down and becomes painful. Other body functions can also be affected.

In some uncommon cases, a single, severe episode of acute pancreatitis can cause enough damage that the disease becomes chronic.

Chronic and recurrent pancreatitis 

The pancreas can become permanently damaged and scarred if attacks are severe, prolonged, or frequent.

Damage to the pancreas can cause problems with digestion, absorption of nutrients, and production of insulin. As a result, people with chronic pancreatitis can lose weight, experience diarrhea, become malnourished with vitamin deficiencies, or develop diabetes.

It usually takes several years for permanent changes and symptoms to occur. Similar to acute pancreatitis, most cases of pancreatitis are caused by overuse of alcohol.

Because only 5% to 10% of alcoholics develop chronic pancreatitis, there probably are other factors besides alcohol consumption that influence whether someone develops chronic pancreatitis. It is generally thought that people who continue to drink after one or more bouts of alcohol-related acute pancreatitis are more likely to develop chronic pancreatitis.

Symptoms

The most common symptom of acute pancreatitis is upper abdominal pain. It can range from tolerable to severe.

Once the pain begins, it quickly reaches its maximum intensity, often within 30 minutes. In alcohol-induced pancreatitis, the pain tends to begin one to three days after a binge.

It may be difficult to find a comfortable position. Bending over or lying on your side may reduce the pain. Eating usually makes the pain worse.

Other symptoms of acute pancreatitis include

• nausea and vomiting
• loss of appetite
• abdominal bloating.

In severe cases, fever, difficulty breathing, weakness, and shock may develop.

The symptoms of chronic pancreatitis are similar but usually less severe. The pain can occur daily or off and on, and can be mild or intense. As the disease gets worse and more of the pancreas is destroyed, pain may actually become less severe. During an attack, the pain often is made worse by drinking alcohol or eating a large meal high in fats.

Because a damaged pancreas can't produce important digestive enzymes, people with chronic pancreatitis may develop problems with digesting and absorbing food and nutrients. This can lead to weight loss, vitamin deficiencies, diarrhea, and greasy, foul-smelling stools. Over time, a damaged pancreas can also fail to produce enough insulin, which results in diabetes.

Diagnosis

Your doctor will diagnose acute pancreatitis based on

• your symptoms
• a physical examination
• blood tests that reveal high levels of two enzymes produced in the pancreas.

In some cases, a computed tomography (CT) scan may be done. The scan can identify any swelling of the pancreas and accumulation of fluid in the abdomen.

If gallstones are suspected, an ultrasound examination of the gallbladder may be performed.

There is no single test that can be used to diagnose chronic pancreatitis. If you have long-lasting abdominal pain or signs that your food is not being properly absorbed, such as weight loss or greasy stools, your doctor will ask you about alcohol use and other factors that increase your risk of chronic pancreatitis and other digestive problems.

The diagnosis of chronic pancreatitis can be made based upon

• typical symptoms
• imaging studies that show damage and scarring of the pancreas
• the absence of another medical problem, such as cancer, that would explain your symptoms and test results.

Expected Duration

Mild to moderate acute pancreatitis often goes away on its own within one week. But severe cases can last several weeks.

If significant damage is done to the pancreas in a single severe attack or several repeat attacks, chronic pancreatitis can develop.

Once the cells of the pancreas have been destroyed, they do not regenerate easily. For this reason, diabetes and any other problems associated with chronic pancreatitis require long-term treatment.

Some people with chronic pancreatitis also develop chronic pain. It is unclear why this happens, but once chronic pain develops, it tends to be long-lasting or even lifelong. Many patients require long-term medications for pain.

Prevention

Since most cases of pancreatitis are associated with alcohol use, the best way to prevent the problem is to avoid or limit alcohol use. Anyone who has had an episode of alcohol-related acute pancreatitis should stop drinking entirely to lower the possibility of developing chronic pancreatitis. People who have been diagnosed with chronic pancreatitis can prevent further damage by eliminating alcohol use.

Most first episodes of acute pancreatitis that are not related to alcohol use cannot be prevented. However, taking steps to prevent gallstones may help to prevent gallstone-related acute pancreatitis. To help prevent gallstones, maintain a normal weight and avoid rapid weight loss.

If the cause is gallstones, gallbladder surgery will usually be recommended to prevent future attacks.

Treatment

If you suspect you have acute pancreatitis, do not eat or drink anything until you see a doctor. Food and drink trigger the release of enzymes from the pancreas. This will make the pain worse.

Most people who develop pancreatitis are admitted to the hospital. They are treated with pain relievers and intravenous fluids.

You will not be allowed to eat or drink until your symptoms begin to improve. In most cases, nothing can be done to speed healing or shorten an episode. If the episode is prolonged, and a patient cannot eat for longer than a week, nutrition may be given intravenously. 

Because chronic pancreatitis cannot be cured, treatment is directed toward relieving pain, improving food absorption, and treating diabetes if it has developed. Pain management can be very challenging and require the help of a pain specialist.

Problems absorbing food, and the resulting vitamin deficiencies, can be helped by taking supplemental digestive enzymes in pill or capsule form. Your doctor also may recommend that you follow a low-carbohydrate, high-protein diet that also restricts some types of fats. Once digestive problems are treated, people often gain weight and their diarrhea improves.

Diabetes caused by chronic pancreatitis almost always requires treatment with insulin. 

When To Call A Professional

Call your doctor or proceed to urgent care if you have intense abdominal pain that lasts longer than 30 minutes, or persistent vomiting.

Make an appointment with your doctor if you have

• new severe abdominal pain
• repeated episodes of abdominal pain
• unexplained weight loss or diarrhea
• difficulty cutting back or stopping your alcohol use, especially if you have had a previous attack of acute pancreatitis.

Prognosis

In most cases, acute pancreatitis goes away on its own after a couple of days. People with severe pancreatitis may need to remain in the hospital for a week or longer. A small percentage of patients develop complications, such as an infected pancreas or bleeding inside the abdomen.

Pancreatitis caused by heavy drinking is likely to come back if drinking continues. Over time, permanent damage may be done to the pancreas.

Although chronic pancreatitis is an incurable condition, the severity, frequency, and type of symptoms can vary. Some people — especially those who quit drinking alcohol entirely — have very mild or occasional symptoms that are easily managed with medications. Other people — especially those who continue to drink alcohol — can have disabling, daily pain and may require frequent hospitalizations.

Lifestyle and home remedies

Once you leave the hospital, you can take steps to continue your recovery from pancreatitis, such as:

• Stop drinking alcohol. Even if alcohol was not deemed to be the cause of acute pancreatitis, it is prudent to stop drinking alcohol while recovering. If you're unable to stop drinking alcohol on your own, ask your doctor for help. Your doctor can refer you to local programs to help you stop drinking.
• Stop smoking. If you smoke, quit. If you don't smoke, don't start. If you can't quit on your own, ask your doctor for help. Medications and counseling can help you quit smoking.
• Choose a low-fat diet. Choose a diet that limits fat and emphasizes fresh fruits and vegetables, whole grains, and lean protein.
• Drink more fluids. Pancreatitis can cause dehydration, so drink more fluids throughout the day. It may help to keep a water bottle or glass of water with you.

Alternative medicine

Alternative therapies can't treat pancreatitis, but some alternative therapies may help you cope with the pain associated with pancreatitis.

People with chronic pancreatitis may experience constant pain that isn't easily controlled with medications. Using complementary and alternative medicine therapies along with medications prescribed by your doctor may help you feel more in control of your pain.

Examples of alternative therapies that may help you cope with pain include:

• Meditation
• Relaxation exercises
• Yoga
• Acupuncture

Preparing for an appointment

Start by seeing your family doctor or a general practitioner if you have any signs or symptoms that worry you. If your doctor suspects you may have pancreatitis, you may be referred to a doctor who specializes in the digestive system (gastroenterologist).

Because appointments can be brief, and because there's often a lot to discuss, it's a good idea to be well prepared. Here's some information to help you get ready and know what to expect from your doctor.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
• Note down any symptoms you're experiencing, even if they seem unrelated to the reason you have scheduled the appointment.
• Make a note of key personal information, including things like recent life changes, or major stresses.
• Make a list of all medications, as well as any vitamins or supplements, that you're taking.
• Take a family member or friend along. Sometimes it can be difficult to absorb all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down a list of questions to ask your doctor.

For pancreatitis, some basic questions to ask your doctor include:

• What is likely causing my symptoms or condition?
• What are other possible causes for my symptoms or condition?
• What kinds of tests do I need?
• Is my condition likely temporary or chronic?
• What is the best course of action?
• What are the alternatives to the primary approach that you're suggesting?
• I have other health conditions. How can I best manage pancreatitis along with these conditions?
• Are there any restrictions that I need to follow?
• Should I see a specialist? What will that cost, and will my insurance cover it?
• Is there a generic alternative to the medicine you're prescribing?
• Are there any brochures or other printed material that I can take with me? What websites do you recommend?
• What will determine whether I should plan for a follow-up visit?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may allow more time to cover points you want to address. Your doctor may ask:

• When did you first begin experiencing symptoms?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?
• Have you had these symptoms before?
• Have you been diagnosed with pancreatitis in the past?
• Do you drink alcohol? If so, how much and how often do you drink?
• Did you start any new medications before your symptoms began?
• Is there a family history of any pancreas disease?