Definition

Pancreatitis is a disease in which the pancreas becomes inflamed. The pancreas is a long, flattened, pear-shaped organ located behind the stomach. It makes digestive enzymes and hormones including insulin. In pancreatitis, the digestive enzymes attack the tissue that produces them.

Acute pancreatitis—occurs suddenly, with severe upper abdominal pain (This can be a serious, life-threatening illness if not treated.)

Chronic pancreatitis—a progressive disorder that can destroy the pancreas

	Pancreatitis
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Causes

Causes include:

• Alcohol abuse (most common cause)
• Gallstones and other obstructions of the bile ducts
• Surgery or trauma to the pancreas
• Certain medications
• Unknown causes (approximately 15% of cases)
• Elevated blood triglyceride levels (hypertriglyceridemia)
• Infections (bacterial, viral, fungal, or parasitic)
• HIV infection
• Congenitally abnormal pancreas duct (pancrease divisum)
• Complication of ERCP (endoscopic retrograde cholangiopancreatography)

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

• Alcohol abuse
• Family history of pancreatitis
• Personal history of acute pancreatitis
• Medications including:
  • Estrogens
  • Sulfonamides
  • Tetracyclines
  • Thiazides
• Pancreatic cancer
• Hyperlipidemia (excessive levels of fat in the blood)
• Hypercalcemia (increased calcium in the blood)
• Viral infections, such as mumps

Symptoms

Symptoms include:

• Severe pain in the center of the upper abdomen that:
  • Sometimes spreads into the upper back
  • Is often made worse by eating, walking, or lying down on your back
  • Is less severe in chronic pancreatitis, with a gradual onset that may be tolerable for weeks
• Nausea and vomiting
• Diarrhea
• Fever
• Jaundice (yellowing of the skin)
• Shock —a severe change in the body's vital processes (eg, rapid but weak pulse, rapid and shallow respiration, and low blood pressure) (in severe, acute cases)
• Unexplained weight loss
• Symptoms of diabetes :
  • Increased thirst
  • Increased urination
  • Fatigue

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. There will be specific questions about how much alcohol you drink and what medications you take.

Other tests may include:

• Blood tests—to measure levels of certain digestive enzymes and check for biliary obstruction and complications of pancreatitis (eg, diabetes, kidney failure , infection)
• Abdominal ultrasound or abdominal CT scan —to look for gallstones and determine the extent of pancreatic inflammation
• Magnetic resonance cholangiopancreatography (MRCP)—a radiology test ( MRI ) that looks at the pancreas, pancreatic duct, and nearby bile ducts
• Endoscopic retrograde cholangiopancreatography (ERCP) —a lighted instrument passed through the mouth and into the pancreatic ducts to examine the damage from pancreatitis and diagnose ailments related to the pancreatic and biliary ducts

Treatment

Acute Pancreatitis

Treatment for acute pancreatitis depends on the severity of the attack. Hospitalization may be necessary. The main goal is to rest the pancreas. In mild cases, this means you may not have food for 3 to 4 days. In severe cases, you may not be able to have food for 3-6 weeks. You will likely need strong pain medication during this time.

Treatment may also include:

• Intravenous (IV) fluids
• IV nutrients if you are unable to eat for an extended period of time
• Antibiotics if you have an infection
• Surgery to drain the fluid building up in the abdomen

Chronic Pancreatitis

The goals of treatment for chronic pancreatitis are to relieve pain and manage nutritional and metabolic problems. Specific steps include:

• Strict avoidance of alcohol
• Eating less fat
• Taking pills containing pancreatic enzymes to help with digestion
• Taking insulin to control blood sugar (if diabetes develops)
• Eating smaller meals more frequently

Surgery and/or ERCP may be needed to:

• Open a blocked pancreatic or biliary duct
• Remove part (or rarely all) of the pancreas
• Drain pancreatic cysts

Prevention

The best way to avoid pancreatitis is to limit your intake of alcohol to two drinks or less per day for men and one drink or less per day for women. If you have hyperlipidemia, restrict your intake of fat and follow your doctor’s treatment plan to lower your lipids.

RESOURCES:

American Gastroenterological Association
http://www.gastro.org

National Institute of Diabetes and Digestive and Kidney Diseases
http://diabetes.niddk.nih.gov

The National Pancreas Foundation
http://www.pancreasfoundation.org

CANADIAN RESOURCES:

BC Health Guide
http://www.bchealthguide.org/

Canadian Association of Gastroenterology
http://www.cag-acg.org/default.aspx

References:

American Gastroenterological Association website. Available at: http://www.gastro.org/ .

Feldman, Scharschmidt BF, Sleisenger MH, Fordtran JS, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease . 7th ed. Saunders: 2002.

National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://diabetes.niddk.nih.gov/ .

The National Pancreas Foundation website. Available at: http://www.pancreasfoundation.org .

Tadataka Y, Alpers DH, Kaplowitz N, Laine L, Owyang C, Powell DW. Textbook of Gastroenterology . 4th ed. Lippincott Williams and Wilkins; 2003.

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