Pancreatitis

Pancreatitis is a disease in which the pancreas becomes inflamed. It occurs when digestive enzymes, attack the pancreas instead of breaking down food in the small intestine.

Pancreatitis may be either acute or chronic. Acute pancreatitis usually involves a single attack in which the pancreas becomes inflamed and then returns to normal. Chronic pancreatitis is characterized by ongoing inflammation and can result in permanent damage to the pancreas and its function.

Risk Factors

Gallstones are the number-one risk factor for acute pancreatitis, while alcoholism is a significant risk factor for chronic pancreatitis.

Other risk factors include gall bladder conditions, family history of pancreatitis, certain medications, injury to the abdomen, cigarette smoking and ulcers.

Symptoms of Possible Pancreatitis

The following are the most common symptoms of possible pancreatitis. However, each individual may experience symptoms differently.

• Severe abdominal pain in the upper abdomen that radiates to the back and sometimes to the chest
• Nausea
• Vomiting
• Rapid pulse rate
• Fever
• Swelling in the upper abdomen
• Ascites (fluid build-up in the abdominal cavity)
• Dropping blood pressure
• Mild jaundice (yellowing of the skin and eyes)

Causes

Heavy alcohol use or gallstones cause the majority of cases of pancreatitis. Less common causes include certain medications, infections, trauma, metabolic disorders and surgery. In about 10 to 15 percent of acute pancreatitis cases, the cause is unknown. Very rarely, pancreatitis is caused by genetics (hereditary pancreatitis).

Detection and Diagnosis

When making a diagnosis, the doctor checks for signs of jaundice, weakness, emaciation, diarrhea and/or foul-smelling stool. Patients with a family history of pancreatitis, a history of alcohol abuse or several bouts of severe abdominal pain should be tested for chronic pancreatitis. The doctor will use one or more of the following tests:

• Blood tests: This can identify abnormalities associated with chronic pancreatitis and help rule out acute inflammation.
• Stool test: This measures fat content in the feces. Chronic pancreatitis often causes excess fat in the stool because fat isn’t digested and absorbed normally by the small intestine.
• Ultrasound: Endoscopic ultrasound may provide images of the pancreas and of bile and pancreatic ducts superior to those produced by standard ultrasound. Doctors thread a thin, flexible tube (endoscope) containing a small ultrasound device through the stomach. The device then generates a detailed image on a computer screen.
• X-ray of bile and pancreatic ducts: In a procedure called endoscopic retrograde cholangiopancreatography, doctors gently thread an endoscope down the throat and through the stomach to the opening of the bile and pancreatic ducts in the duodenum. A dye passed through a thin, flexible tube (catheter) inside the endoscope allows X-ray images of the ducts to be taken.
• Pancreatic function test: This test may be conducted if a patient has lost weight or the doctor suspects a malabsorption problem. Several tests exist, but all measure the ability of the pancreas to secrete enzymes or other substances necessary for digestion.

Treatment

• Acute pancreatitis—An acute attack of pancreatitis usually lasts only a few days, unless there are complications. Treatment for acute pancreatitis commonly includes intravenous (IV) fluids, antibiotics and pain medications. An acute attack of pancreatitis caused by gallstones may require removal of the gallbladder or endoscopic surgery of the bile duct. After the gallstones are removed and the inflammation subsides, the pancreas usually returns to normal.
• Chronic pancreatitis—Doctors may try to relieve the patient’s pain and improve the nutritional and metabolic problems that result from loss of pancreatic function. Treatment for chronic pancreatitis may involve IV fluids, pain medication, a nutritious diet low in fat and enzyme supplements. Surgery may help relieve abdominal pain, restore drainage of pancreatic secretions, treat chronic pancreatitis caused by blockage of the pancreatic duct, or reduce the frequency of attacks.
• Gallbladder surgery—If gallstones are the cause of pancreatitis, a doctor may recommend surgery to remove the gallbladder (cholecystectomy).
• Pancreas surgery—Surgery may be necessary to drain fluid from your pancreas or to remove diseased tissue.

Treatment for Alcohol Dependence

If alcoholism is the cause of pancreatitis, a doctor may recommend a treatment program for alcohol addiction.

Prevention

Because most cases of pancreatitis are caused by alcohol abuse, prevention is directed at responsible drinking or no drinking at all.