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Health Encyclopedia - Diseases and Conditions

Pancreatitis

Definition of Pancreatitis
Description of Pancreatitis
Causes and Risk Factors of Pancreatitis
Symptoms of Pancreatitis
Diagnosis of Pancreatitis
Treatment of Pancreatitis
What Questions To Ask Your Doctor About Pancreatitis

Definition of Pancreatitis

Pancreatitis is the inflammation of the pancreas (a large gland situated behind the stomach that is responsible for secreting digestive enzymes).

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Description of Pancreatitis

The pancreas secretes enzymes, alkaline material (sodium bicarbonate) and hormones (insulin and glucagon) into the small intestine through a duct. Inflammation of the pancreas is thought to occur when digestive enzymes attack, destroy and digest the pancreatic tissues. This process is called autodigestion.

Autodigestion causes swelling, hemorrhage and damage to the blood vessels. In addition to digesting pancreatic tissue, it is believed that the enzymes (especially trypsin) set off a chain reaction by activating other enzymes, thus increasing the number enzymes eating away the tissue. There are two forms of pancreatitis - acute pancreatitis and chronic pancreatitis.

Acute pancreatitis occurs when the pancreas suddenly becomes inflamed and then becomes better without damage to the pancreas. Chronic pancreatitis develops over a period of years and causes permanent damage to the pancreas.

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Causes and Risk Factors of Pancreatitis

The major causes of acute pancreatitis are gallstones (lumps of solid material found in the gallbladder) and alcohol abuse (in 80 percent of all cases). Other factors include increased triglyceride or calcium level in the blood, viral or bacterial infections, medications (especially estrogens, corticosteroids, thiazide diuretics, acetaminophen or tetracycline), pancreatic surgery, pancreatic injury, peptic ulcers and medical conditions, such as Reye's syndrome, cystic fibrosis and vasculitis.

The major cause of chronic pancreatitis is alcohol abuse (in 90 percent of all cases). In the other 10 percent of all cases, chronic pancreatitis is a result of hemochromatosis (excess iron in the body) or heredity. In October 1996, researchers from the University of Pittsburgh Medical Center identified the gene, trypsinogen, as the basis for hereditary pancreatitis.

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Symptoms of Pancreatitis

Patients with acute pancreatitis may have one or several attacks. These attacks last from one to several days, and may include the following symptoms:

abdominal pain in the upper abdomen which may include and be accompanied by

increases in severity and may last for several days
may be constant and localized, or radiate to the back and other areas
may be swollen and extremely tender, and sometimes a lump can appear in the area
may be worse when lying flat on the back
may be worse by eating or drinking (within minutes following meals), especially greasy foods or foods with a high fat content
may be worse after drinking alcohol
nausea
vomiting
low-grade fever
increased pulse rate
jaundice (yellowing of the skin)
pleurisy (inflammation of the pleura - the membrane lining the lungs and chest cavity)
shortness of breath
dizziness
weakness
sweating
anxiety.

In the most severe cases, bleeding may occur in the pancreas, leading to shock and often to death.

People affected with chronic pancreatitis may have no symptoms for many years and then a sudden attack of pancreatitis, which may include the following symptoms:

abdominal pain that is intense and lasting, and that may radiate to the back and chest
symptoms of malabsorption (the impaired absorption of nutrients, vitamins or minerals from the diet by the lining of the small intestine) including diarrhea, weight loss and malnutrition
fever
excessively foul, bulky stools
nausea
vomiting
weight loss
clammy skin
abdominal swelling
onset of diabetes
A pattern of acute pancreatitis may appear periodically over the years. A person with chronic pancreatitis may have recurrent attacks of acute pain along with persistent pain. Unlike acute pancreatitis, the pain may be constant and daily, indefinite or occasional, intermittent or absent altogether.

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Diagnosis of Pancreatitis

Acute and chronic pancreatitis is diagnosed on the basis of symptoms and blood tests (elevated amylase, lipase levels, glucose, serum calcium and CBC - complete blood count), ultrasonography, CT scan or a special x-ray study (called endoscopic retrograde cholangiopancreatography - ECRP) may be used to inspect the pancreatic ducts. The technique is performed by inserting an endoscope (a flexible, lighted, tube-like instrument) through the mouth and stomach into the duodenum. In the duodenum are openings to the common bile and main pancreatic ducts. A special device is inserted through this opening, and x-ray contrast material is injected. Obstructions, tumors and characteristic ductal patterns associated with chronic pancreatitis can be seen on the x-ray films that are obtained in this study.

An additional laboratory test for chronic pancreatitis is done using a sample of fecal matter. Patients with chronic pancreatitis often have a high fat content in their feces because the fat is not being absorbed by the intestine.

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Treatment of Pancreatitis

Unless complications occur, acute pancreatitis usually gets better on its own, so treatment is supportive in most cases. The patient is usually hospitalized from three to 16 days, depending on the severity of the attack. The hospital treatment is aimed at relieving the pain and reducing stomach secretions, which can stimulate the pancreas. To allow the pancreas to rest, eating and drinking are replaced by intravenous feeding, and stomach acids are suctioned through the nose. Antibodies (for infection), MS Contin (drug for pain), Valium (for restlessness and agitation) may also be included in the treatment if deemed appropriate. Surgery may be needed if complications, such as gallstones, infection, tissue damage, bleeding or cysts occur.

Most cases of acute pancreatitis will improve within three to seven days with conservative therapy. During convalescence, a low-fat, high-protein diet should be followed, and antacids may be prescribed. The therapy for chronic pancreatitis usually centers on two problems: pain and malabsorption. These problems can be solved with medication, diet and surgery.

Medication

If the person is experiencing intermittent pain, the doctor may prescribe an analgesic or a narcotic-based pain reliever. If malabsorption is present, the doctor will recommend pancreatic replacement therapy. This therapy requires the person take an enzyme preparation at every meal. This therapy supplements the insufficient quantities of enzymes secreted by the pancreas, as well as helps to normalize digestion and maintain adequate nutritional status. Generally, eight (8) tablets with meals are prescribed (two after eating a few bites, four during the meal, and two at completion of the meal) Note: Diabetes may develop with chronic pancreatitis and thus, insulin or other drugs must be given to control the blood sugar.

Diet

First and foremost, avoid any alcohol. Continued use will only lead to increased damage and possible death. Additionally, doctors will recommend a diet low in fat (no more than two teaspoons of fat daily, including the fat used in cooking). Please ask the doctor for a list of do's and don'ts foods.

Surgery

In some cases, surgery is needed to relieve pain by draining an enlarged pancreatic duct, removing the damaged pancreatic tissue or deadening the nerves that are transmitting the pain.

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