Pancreatitis

What is Pancreas?

The pancreas is a large gland located in the abdominal cavity, behind the stomach and next to the upper part of the small intestine (the duodenum). The pancreas has two main functions:

1. It produces powerful pancreatic enzymes and releases them into the small intestine to aid in the digestion of carbohydrates, proteins, and fats.
2. It releases the hormones insulin and glucagon into the bloodstream. These hormones are involved in glucose metabolism, regulating how the body stores and uses food for energy.

What is Pancreatitis?

Pancreatitis is a rare disease in which the pancreas becomes inflamed. The destruction of the pancreas occurs when the pancreatic enzymes are activated and begin to attack the pancreas itself.

In very severe cases, pancreatitis can lead to bleeding within the gland, severe tissue damage, infection, and the formation of cysts. Severe pancreatitis can also cause damage if the enzymes and toxins are released into the bloodstream, which can harm other vital organs such as the heart, lungs, and kidneys.

Pancreatitis develops gradually and tends to worsen over time. There are two forms of pancreatitis: acute and chronic.

• Acute pancreatitis is a sudden inflammation of the pancreas that occurs over a short period. In more than 80% of cases, acute pancreatitis is caused by gallstones or alcohol abuse. Other causes include medications, high triglyceride levels, and very rarely, infections, trauma, metabolic disorders, and surgical procedures.

In about 10-15% of cases, the cause of acute pancreatitis is unknown. The severity of acute pancreatitis can range from mild abdominal discomfort to a severe, life-threatening condition. However, the majority of patients with acute pancreatitis (more than 80%) recover fully after receiving appropriate treatment.

• Chronic pancreatitis pancreatitis often follows an episode of acute pancreatitis and results from ongoing inflammation of the pancreas. Chronic pancreatitis can be caused by alcohol abuse or smoking. It can also result from metabolic disorders. Very rarely, patients may have chronic pancreatitis due to a family history (hereditary pancreatitis). Patients with chronic pancreatitis may experience intense pain and loss of pancreatic function, leading to digestive abnormalities and blood sugar issues.

What are the Symptoms of Pancreatitis?

Most patients with acute pancreatitis experience pain in the upper abdomen that radiates to the back. Patients may describe this as a “dull sensation” that worsens primarily with eating and gradually intensifies. Their abdomen may be swollen. Patients may also experience nausea, vomiting, fever, and an increased heart rate.

Symptoms of chronic pancreatitis may include:

• Continuous pain that radiates to the back. In some patients, the pain may decrease.
• Poor food absorption, leading to weight loss. Patients may lose weight even when their appetite and dietary habits are normal. This poor absorption occurs because the body does not secrete enough pancreatic enzymes to break down food properly.
• Diabetes (elevated blood sugar levels) may develop if the cells of the pancreas that produce insulin are destroyed.

How is Pancreatitis Diagnosed?

Acute pancreatitis is suspected when a patient has the aforementioned symptoms and risk factors such as alcohol abuse or gallstones. Confirmation of pancreatitis is achieved by measuring the levels of two pancreatic enzymes in the blood, amylase and lipase. Elevated levels of these two enzymes strongly indicate acute pancreatitis. As the patient recovers, the levels of pancreatic enzymes decrease to normal.

Chronic pancreatitis is suspected when a patient has the symptoms mentioned above and risk factors such as alcohol abuse. Diagnosis can be challenging, but techniques such as pancreatic function tests and imaging of the pancreas contribute to the assessment. In more advanced stages of the disease, when poor absorption or diabetes is present, the doctor may use blood, urine, and stool tests to monitor the progression of the disease.

Diagnostic tests include:

• Pancreatic function tests, which measure whether the pancreas produces appropriate levels of pancreatic enzymes.
• Glucose tolerance tests to measure damage to the insulin-producing cells of the pancreas.
• Ultrasound, which can produce images of the pancreas to look for potential abnormalities.
• CT scans, which can produce images of the pancreas to detect abnormalities.
• ERCP (endoscopic retrograde cholangiopancreatography), a test that shows the size and shape of the pancreas and its connection to the intestine.
• Endoscopic ultrasound, a test in which images of the pancreas are obtained from inside the stomach and intestine using sound waves.

How is Pancreatitis Treated?

Patients with acute pancreatitis are hospitalized and primarily receive intravenous fluids and pain medications. In up to 20% of patients, pancreatitis can be severe, requiring admission to the intensive care unit (ICU). In the ICU, the patient is closely monitored, as pancreatitis can cause damage to the heart, lungs, or kidneys. Some cases of severe pancreatitis may lead to death of pancreatic tissue, and surgery may be necessary to remove the damaged tissue.

Acute pancreatitis typically lasts only a few days unless it is caused by gallstones. Acute pancreatitis caused by gallstones may require the removal of the gallbladder or endoscopic retrograde cholangiopancreatography (ERCP) to remove the stones from the bile duct.

Surgery can be performed laparoscopically as a “minimally invasive” procedure. During laparoscopic surgery, five or six small (5 to 10 mm) incisions are made in the abdominal wall. The laparoscope and surgical instruments are inserted through these incisions. The surgeon is guided by the laparoscope, which transmits images of the internal organs to a monitor. The advantages of laparoscopic surgery include smaller incisions, reduced risk of infection, less pain, smaller scars, and faster recovery.

Surgical intervention is determined by the severity of pancreatitis. Once gallstones are removed and inflammation subsides, the pancreas typically returns to normal.

Chronic pancreatitis can be somewhat difficult to treat. Doctors primarily aim to relieve the patient’s pain and improve the nutritional and metabolic issues arising from the loss of pancreatic function. Patients are generally given pancreatic enzymes and insulin, as these substances are not secreted or released by the pancreas. Pancreatic enzymes are prescribed pills that must be taken before meals to aid in nutrient absorption. A low-fat diet may also be helpful.

Surgery may be necessary to relieve abdominal pain, restore the flow of pancreatic secretions, treat chronic pancreatitis caused by pancreatic duct obstruction, or to reduce the frequency of episodes.

Patients should stop drinking alcoholic beverages, follow their doctor’s and dietician’s dietary recommendations, and take the appropriate medications to have fewer and milder episodes of pancreatitis.

Can Pancreatitis be Prevented?

When the cause is identified, further episodes can be prevented by removing the underlying cause (for example, gallbladder removal). Since alcohol and smoking are risk factors for pancreatitis, patients are advised to completely avoid smoking and alcohol consumption. If alcohol abuse is a concern, talk to your doctor about being referred to an alcohol treatment center. Additionally, you may benefit from support groups and smoking cessation clinics.

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