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Pancreatitis is an inflammation of the pancreas. It may be caused by a number of factors, including gallstones, alcohol, certain medications, a serious viral or bacterial infection, trauma to the abdomen, high triglyceride levels, or high blood calcium levels. There are two types of pancreatitis:
Acute pancreatitis is a short-term, sudden inflammation which usually resolves with intensive treatment. It can be a severe, life-threatening condition. There are about 80,000 cases each year in the US, of which 20% are severe. Acute pancreatitis occurs more frequently in men than women, and may be caused by gallstones, alcohol intake or medication.
Chronic pancreatitis is a disease process that occurs over a longer period of time, and which does not resolve itself without treatment. It can slowly destroy the pancreas, causing, in severe cases bleeding, infection and tissue damage, as well as pseudocysts – fluid accumulation and tissue debris. In acute pancreatitis, enzymes and toxins can flood the bloodstream, causing injury to major organs including lungs, kidneys, and heart. Chronic pancreatitis may occur if acute pancreatitis is not resolved.
Symptoms of Pancreatitis
Acute pancreatitis often begins with pain in the upper abdomen which continues for a few days, and which is severe and constant. The pain may remain in the abdomen or it can move to the back and elsewhere in the body. It may be sudden and intense, or it may begin as mild and worsen when eating. It may cause swelling of the abdomen, and cause nausea, vomiting, fever, clammy skin, and a rapid pulse. Patients may have a mass or abdominal hardness or tenderness. Abscesses or pseudocysts (abnormal deposits of tissue or fluid) sometimes form in the pancreas weeks after onset. In the acute phase, blood pressure may drop, dehydration may occur, and breathing may become difficult. Major organs – lungs, kidneys and heart – may fail. If the pancreas bleeds, shock and death may occur.
Chronic pancreatitis' symptoms usually develop over a period of time. Periods of abdominal pain may occur or worsen when eating or drinking, and may become severe, constant, and disabling. Pain may actually lessen over time as the pancreas stops secreting enzymes and insulin, and diabetes may then develop. Nausea, vomiting, weight loss, and fatty or pale stools are also symptoms of chronic pancreatitis.
Risk Factors for Pancreatitis
Gallstones are a major risk factor for acute pancreatitis; and alcoholism is a major cause of chronic pancreatitis, especially for men. Other causes include a blocked or narrowed pancreatic duct due to injury, or pseudocysts. Genetic factors (heredity), congenital conditions, cystic fibrosis, high levels of calcium in the blood (hypercalcemia), high levels of blood cholesterol and triglycerides, certain drugs, and some autoimmune conditions also increase the risk.
Diagnosis of Pancreatitis
If your doctor suspects acute pancreatitis, he or she may perform an ultrasound, a noninvasive imaging test that uses sound waves, or computed tomography (CT or CAT) scan, also a noninvasive test which uses a type of x-ray, and an endoscopic retrograde cholangiopancreatography (ERCP) to determine if gallstones are the cause, and to determine the severity.
If chronic pancreatitis is a possibility, a pancreatic function test (an endoscopic test), endoscopic ultrasound (EUS), a CT scan, and endoscopic retrograde cholangiopancreatography (ERCP) may be performed. Blood, urine and stool tests can also help diagnose and monitor this condition in advanced cases.
Endoscopic Retrograde Choangiopancreatography (ERCP)
An endoscopic retrograde choangiopancreatography (ERCP) is used to diagnose disorders of the duct systems of the gallbladder, liver, and pancreas. In this procedure, which takes about an hour, patients, who fast for 12 hours before the test, are given a sedative and a local anesthetic for the throat, either a spray or gargle, after which the physician places an endoscope into the esophagus and guides it into the stomach, and the duodenum – the top of the small intestine. The endoscope is a narrow, flexible tube equipped with a light and a camera. Side-effects of this procedure include a mild sore throat, pancreatic inflammation, and, rarely, bleeding if a duct is opened or tear in the intestinal wall occurs.
Endoscopic Ultrasound (EUS)
An endoscopic ultrasound (EUS) – similar to the ERCP but which uses an ultrasound probe placed within the endoscope and cholangioscopy (a type of x-ray) – can also provide a very detailed view of the pancreas, thereby increasing the accuracy of ERCP.
Pancreatic Function Test
A pancreatic function test, also an endoscopic procedure, may also be done to test secretin function. Secretin is a hormone produced by the small intestine that stimulates the pancreas.
Treatment for Pancreatitis
In acute pancreatitis, reducing the flow of pancreatic enzymes by not eating or drinking is necessary, while patients receive intravenous fluids and pain relief. Oxygen may be given, and sometimes a ventilator is needed. In severe cases, if vomiting is uncontrollable, a tube is placed in the stomach to remove fluid and air. If an infection occurs, antibiotics are given, and surgery may be needed to treat bleeding if it occurs. If the kidneys fail, patients will receive dialysis to remove toxins from the blood. When gallstones are a cause of pancreatitis, surgery is usually needed to remove them.
For chronic pancreatitis, our physicians will treat the pain and design a diet that is high in carbohydrates, low in fat and in which alcohol is prohibited. They will prescribe pancreatic enzymes to be taken with meals if the pancreas is not producing sufficient amounts. Insulin may also be prescribed if the pancreas is not producing enough due to injury, and surgery may be indicated to remove a damaged section of the pancreas.
Additionally, our doctors use islet cell transplants as a treatment for pancreatitis. You can learn more about this treatment on our islet cell transplant page.