Dr. MJ Bazos MD,
Your pancreas is a large gland behind your
stomach and close to your duodenum. The pancreas secretes powerful digestive
enzymes that enter the small intestine through a duct. These enzymes help you
digest fats, proteins, and carbohydrates. The pancreas also releases the
hormones insulin and glucagon into the bloodstream. These hormones play an
important part in metabolizing sugar.
Pancreatitis is a rare disease in
which the pancreas becomes inflamed. Damage to the gland occurs when digestive
enzymes are activated and begin attacking the pancreas. In severe cases, there
may be bleeding into the gland, serious tissue damage, infection, and cysts.
Enzymes and toxins may enter the bloodstream and seriously injure organs, such
as the heart, lungs, and kidney.
are two forms of pancreatitis. The acute form occurs suddenly and may be a
severe, life-threatening illness with many complications. Usually, the patient
recovers completely. If injury to the pancreas continues, such as when a patient
persists in drinking alcohol, a chronic form of the disease may develop,
bringing severe pain and reduced functioning of the pancreas that affects
digestion and causes weight loss.
What Is Acute Pancreatitis?
An estimated 50,000 to 80,000 cases of
acute pancreatitis occur in the United States each year. This disease occurs
when the pancreas suddenly becomes inflamed and then gets better. Some patients
have more than one attack but recover fully after each one. Most cases of acute
pancreatitis are caused either by alcohol abuse or by gallstones. Other causes
may be use of prescribed drugs, trauma or surgery to the abdomen, or
abnormalities of the pancreas or intestine. In rare cases, the disease may
result from infections, such as mumps. In about 15% of cases, the cause is
What Are the Symptoms of
usually begins with pain in the upper abdomen that may last for a few days. The
pain is often severe. It may be constant pain, just in the abdomen, or it may
reach to the back and other areas. The pain may be sudden and intense, or it may
begin as a mild pain that is aggravated by eating and slowly grows worse. The
abdomen may be swollen and very tender. Other symptoms may include nausea,
vomiting, fever, and an increased pulse rate. The person often feels and looks
About 20% of cases are
severe. The patient may become dehydrated and have low blood pressure. Sometimes
the patient's heart, lungs, or kidneys fail. In the most severe cases, bleeding
can occur in the pancreas, leading to shock and sometimes death.
How Is Acute Pancreatitis
During acute attacks, high
levels of amylase (a digestive enzyme formed in the pancreas) are found in the
blood. Changes may also occur in blood levels of calcium, magnesium, sodium,
potassium, and bicarbonate. Patients may have high amounts of sugar and lipids
(fats) in their blood too. These changes help the doctor diagnose pancreatitis.
After the pancreas recovers, blood levels of these substances usually return to
What Is the Treatment for
The treatment a
patient receives depends on how bad the attack is. Unless complications occur,
acute pancreatitis usually gets better on its own, so treatment is supportive in
most cases. Usually the patient goes into the hospital. The doctor prescribes
fluids by vein to restore blood volume. The kidneys and lungs may be treated to
prevent failure of those organs. Other problems, such as cysts in the pancreas,
may need treatment too.
patient cannot control vomiting and needs to have a tube through the nose to the
stomach to remove fluid and air. In mild cases, the patient may not have food
for 3 or 4 days but is given fluids and pain relievers by vein. An acute attack
usually lasts only a few days, unless the ducts are blocked by gallstones. In
severe cases, the patient may be fed through the veins for 3 to 6 weeks while
the pancreas slowly heals.
may be given if signs of infection arise. Surgery may be needed if complications
such as infection, cysts, or bleeding occur. Attacks caused by gallstones may
require removal of the gallbladder or surgery of the bile duct. Surgery is
sometimes needed for the doctor to be able to exclude other abdominal problems
that can simulate pancreatitis or to treat acute pancreatitis. When there is
severe injury with death of tissue, an operation may be done to remove the dead
After all signs of acute
pancreatitis are gone, the doctor will determine the cause and try to prevent
future attacks. In some patients the cause of the attack is clear, but in others
further tests need to be done.
If the Patient Has Gallstones?
Ultrasound is used to detect
gallstones and sometimes can provide the doctor with an idea of how severe the
pancreatitis is. When gallstones are found, surgery is usually needed to remove
them. When they are removed depends on how severe the pancreatitis is. If it is
mild, the gallstones often can be removed within a week or so. In more severe
cases, the patient may wait a month or more, until he improves, before the
stones are removed. The CAT (computer axial tomography) scan may also be used to
find out what is happening in and around the pancreas and how severe the problem
is. This is important information that the doctor needs to determine when to
remove the gallstones.
gallstones are removed and inflammation subsides, the pancreas usually returns
to normal. Before patients leave the hospital, they are advised not to drink
alcohol and not to eat large meals.
What Is Chronic Pancreatitis?
Chronic pancreatitis usually follows
many years of alcohol abuse. It may develop after only one acute attack,
especially if there is damage to the ducts of the pancreas. In the early stages,
the doctor cannot always tell whether the patient has acute or chronic disease.
The symptoms may be the same. Damage to the pancreas from drinking alcohol may
cause no symptoms for many years, and then the patient suddenly has an attack of
pancreatitis. In more than 90% of adult patients, chronic pancreatitis appears
to be caused by alcoholism. This is more common in men than women and often
develops between 30 and 40 years of age. In other cases, pancreatitis may be
inherited. Scientists do not know why the inherited form occurs. Patients with
chronic pancreatitis tend to have three kinds of problems: pain, malabsorption
of food leading to weight loss, or diabetes.
Some patients do not have any pain but
most do. Pain may be constant in the back and abdomen, and for some patients,
the pain attacks are disabling. In some cases, the abdominal pain goes away as
the condition advances. Doctors think this happens because pancreatic enzymes
are no longer being made by the pancreas.
Patients with this disease often lose
weight, even when their appetite and eating habits are normal. This occurs
because the body does not secrete enough pancreatic enzymes to break down food,
so nutrients are not absorbed normally. Poor digestion leads to loss of fat,
protein, and sugar into the stool. Diabetes may also develop at this stage if
the insulin-producing cells of the pancreas (islet cells) have been damaged.
How Is Chronic Pancreatitis
Diagnosis may be difficult
but is aided by a number of new techniques. Pancreatic function tests help the
physician decide if the pancreas still can make enough digestive enzymes. The
doctor can see abnormalities in the pancreas using several techniques
(ultrasonic imaging, endoscopic retrograde cholangiopancreatography (ERCP), and
the CAT scan). In more advanced stages of the disease, when diabetes and
malabsorption (a problem due to lack of enzymes) occur, the doctor can use a
number of blood, urine, and stool tests to help in the diagnosis of chronic
pancreatitis and to monitor the progression of the disorder.
How Is Chronic Pancreatitis
The doctor treats chronic
pancreatitis by relieving pain and managing the nutritional and metabolic
problems. The patient can reduce the amount of fat and protein lost in stools by
cutting back on dietary fat and taking pills containing pancreatic enzymes. This
will result in better nutrition and weight gain. Sometimes insulin or other
drugs must be given to control the patient's blood sugar.
In some cases, surgery is needed to
relieve pain by draining an enlarged pancreatic duct. Sometimes, part or most of
the pancreas is removed in an attempt to relieve chronic pain.
Patients must stop drinking, adhere to
their prescribed diets, and take the proper medications in order to have fewer
and milder attacks.