Pancreatitis – Acute and Chronic

Overview

  • What is the Pancreas?

    The pancreas is an organ within the abdomen behind the stomach. The pancreas has two main functions: it helps produce enzymes that aid in digestion and also secretes insulin that helps the body control blood sugar levels. Within the pancreas, there are specialized cells called acinar cells that are responsible for producing the digestive enzymes that help us break down fats and proteins. Also within the pancreas, there are specialized cells termed islets which make insulin and other hormones.

  • What is Pancreatitis?

    Acute pancreatitis is a condition characterized by abrupt inflammation of the pancreas characterized by swelling and at times even destruction of pancreatic tissue. The most common causes of acute pancreatitis are gallstones and excessive alcohol consumption. Other causes include smoking, high triglyceride levels, high calcium levels, certain medications, abdominal trauma, viral infections, structural anatomic anomalies and genetic abnormalities. Chronic pancreatitis occurs when there is irreversible scar tissue that forms in the pancreas as a result of ongoing inflammation. Chronic pancreatitis can lead to impaired digestion of food and diabetes mellitus. The most common causes of chronic pancreatitis are excessive consumption of alcohol, heavy smoking, and recurrent episodes of acute pancreatitis for any number of reasons including genetic mutations. However, the cause is unknown in nearly a third of patients, despite an extensive evaluation.

Acute Pancreatitis

The diagnosis of acute pancreatitis is made by a combination of symptoms, physical exam findings, and laboratory tests including amylase and lipase. If the diagnosis is uncertain, abdominal imaging studies such as a computed tomography (CT) scan may also be necessary.

  • What are the Symptoms of Acute Pancreatitis?

    • Gradual or sudden onset of severe pain in the upper abdomen that may radiate to the back and usually persists for several days.
    • Nausea and vomiting
    • Fever

    Chronic Pancreatitis

    Chronic pancreatitis is characterized by intermittent or constant upper abdominal pain. Other features of chronic pancreatitis include greasy or oily stool as well as difficult to control diabetes. The diagnosis of chronic pancreatitis is made by a combination of clinical symptoms and imaging studies such as abdominal CT scan, magnetic resonance imaging (MRI), endoscopic ultrasound (EUS) and/or endoscopic retrograde cholangiopancreatography (ERCP).

  • What are the Symptoms of Chronic Pancreatitis?

    • Recurrent abdominal pain (intermittent or constant)
    • Greasy or oily stools (steatorrhea)
    • Weight loss

    What Should I Do If I Think I Have Pancreatitis?

    If you are experiencing severe abdominal pain, call your doctor or go to the nearest emergency room. The doctor will take a medical history, perform a physical examination, and draw blood to tests for pancreatic enzymes (amylase and lipase). An ultrasound of the abdomen may be performed to exclude the presence of gallstones. Other abdominal imaging tests such as a CT scan or MRI may also be performed. Endoscopic procedures such as ERCP or EUS may also be warranted in some patients.

    Treatment

    • What is the Treatment for Pancreatitis?

      The principles for the treatment of acute pancreatitis are: 1) rest the pancreas by restricting oral intake of food; 2) administer intravenous fluids to maintain an adequate blood volume; and 3) pain medication. If alcohol is the cause of pancreatitis, strict abstinence from alcohol is recommended. Surgical removal of the gallbladder is indicated when the pancreatitis results from gallstones or gallbladder sludge. If the bile duct is blocked by a gallstone, an ERCP may be required to remove the gallstone.

      The most important goal in the treatment of chronic pancreatitis is to provide pain relief and prevent progression of disease. If pain is difficult to control, you may be referred to a chronic pain specialist. At times, relief of pain may require endoscopic, radiologic, or surgical treatment. If your pancreas is found to be unable to provide sufficient enzymes for adequate digestion, you may benefit from enzyme supplements. Also, if your blood sugar level is very high and not controlled by diet or oral medications, insulin may be required. It is important to avoid alcohol. Complete sessation of smoking is recommended as it is a risk factor for progression of chronic pancreatitis and pancreatic cancer. In a few select patients, there is also the option of surgically removing the pancreas to reduce pain and transplanting the islets from the pancreas into the liver to potentially prevent diabetes. Since chronic pancreatitis is also a risk factor for pancreatic cancer, you should speak to your provider about ways to help reduce your risk of developing pancreatic cancer.

    Prevention of Pancreatitis

    • Gallstone Pancreatitis – surgical removal of the gall bladder
    • Alcohol/tobacco induced Pancreatitis – strict abstinence from alcohol and/or tobacco
    • Drug Induced Pancreatitis – avoid offending medication
    • Hypertriglyceridemia – aggressive lipid-lowering agents
    • Avoidance of high fat foods, consuming diets rich in vegetables, and maintaining adequate fluid intake

    Terminology

    Bile – A secretion from the liver that assists in digesting fats.

    Biliary System – The ducts and tubes that collect and drain bile in to the intestine.

    CT Scan – Computerized tomography is a specialized radiologic test for imaging the pancreas and other intra-abdominal organs.

    ECRP (Endoscopic Retrograde Cholangiopancreatography) – A procedure utilizing a long, narrow, flexible tube called an endoscope that is introduced via the mouth into the small intestine to examine the pancreatic duct and bile ducts.

    EUS – An endoscopic test for imaging the pancreas and other intra-abdominal organs.

    Diabetes Mellitus – A condition characterized by an abnormally elevated blood sugar level. One cause is failure of the pancreas to secrete enough insulin when a patient has severe chronic pancreatitis.

    Endocrine – The portion of the gland that releases insulin directly into the blood stream.

    Exocrine – The portion of the gland that secretes pancreatic juice via the pancreatic duct into the small intestine.

    Inflammation – A response to tissue injury that results in redness, swelling, and pain.

    MRI – Magnetic resonance imaging is a radiologic test for imaging the pancreas and other intra-abdominal organs. It also visualizes the pancreatic and bile ducts.

    Pancreas – The pancreas is an organ within the abdomen that is responsible for digestion of food and control of blood sugar.

    Pancreatic duct – Drains pancreatic enzymes into the duodenum.

    Ultrasonography (Ultrasound) – A radiologic test for imaging the pancreas and other intra-abdominal organs. It is particularly useful in visualizing the liver and gall bladder.

    Author(s) and Publication Date(s)

    Vikesh K. Singh, MD, MSc, Pancreatitis Center, Division of Gastroenterology, Johns Hopkins Hospital and Bechien U. Wu, MD, MPH, Division of Gastroenterology, Kaiser Permanente Southern California – Updated December 2012.

    Peter A. Banks, MD, MACG, Brigham & Women's Hospital, Boston, MA – Updated April 2007.

    Peter A. Banks, MD, FACG and Saleem A. Desai, MD, Brigham & Women's Hospital, Boston, MA – Published October 2002.

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