Pancreatitis Causes, Symptoms, Diagnosis, Treatment, Prevention

Pancreatitis Causes, Symptoms, Diagnosis, Treatment, Prevention


What is pancreatitis?


Pancreatitis simply means inflammation of the pancreas. Located in the upper part of the abdomen, behind the stomach, the pancreas plays an important role in digestion. The pancreas is a gland, producing two main types of substances: digestive juices and digestive hormones.

Digestive juices include enzymes and bicarbonate. They travel through a small tube called the pancreatic duct that connects the pancreas to the small intestine to the small intestine (duodenum).

Pancreatitis Causes, Symptoms, Diagnosis, Treatment, Prevention
Pancreatitis


There, the enzymes help in the break down of proteins and fats in the foods that you eat to permit the nutrients to be absorbed. 

The bicarbonate neutralizes stomach acid.

Digestive hormones, mainly insulin and glucagon, are released into the bloodstream. They control the body's blood sugar level, a major source of energy, and are an important role in the cause of diabetes.
Inflammation of the pancreas has various causes. Once the gland becomes inflamed, the condition can progress to swelling of the gland and surrounding blood vessels, bleeding, infection, and damage to the gland. There, digestive juices become trapped and start "digesting" the pancreas itself. If this damage persists, the gland may not be able to carry out normal functions.

Pancreatitis may be acute (new, short-term) or chronic (ongoing, long-term). Either type can be very severe, even life-threatening. Either type can have serious complications.

Acute pancreatitis usually begins soon after the damage to the pancreas begins. Attacks are typically very mild, but about 20% of them are very severe. An attack lasts for a short time and usually resolves completely as the pancreas returns to its normal state. Some people have only one attack, whereas other people have more than one attack, but the pancreas always returns to its normal state. 

Chronic pancreatitis begins as acute pancreatitis. If the pancreas becomes scarred during the attack of acute pancreatitis, it cannot return to its normal state. The damage to the gland continues, worsening over time.
About 80,000 cases of acute pancreatitis occur in the United States each year. Pancreatitis can occur in people of all ages, although it is very rare in children. Pancreatitis occurs in men and women, although chronic pancreatitis is more common in men than in women.

Causes of pancreatitis


The most common causes of pancreatitis are:

  • having gallstones (small pebble-like stones made of hardened bile) in your bile duct
Other causes include:

  • certain medicines, such as sodium valproate, azathioprine, furosemide and corticosteroids
  • abdominal injuries
  • a tumour in your pancreas
  • damage caused by surgery or endoscopy
  • a viral infection, such as mumps or the Epstein-Barr virus
  • increased calcium or fat levels in your blood
  • pancreas divisum – being born with ducts in your pancreas that don't function properly
  • genetics – you may inherit a faulty gene from your parents (this is called hereditary pancreatitis)
  • inflammation of the blood vessels in your pancreas or reduced blood flow to your pancreas
Acute pancreatitis can become chronic if pancreatic tissue is destroyed and scarring develops, or if the underlying cause, for example, drinking alcohol to excess, has not been managed. In some people who develop chronic pancreatitis, the cause isn’t known.

Symptoms of pancreatitis


Acute pancreatitis can be a life-threatening illness with severe complications. Symptoms come on suddenly or develop over a few days, and may be worse after eating. Although the pain may be mild at first, it can become severe and may last continuously for a few days. Symptoms include:

  • severe pain in your upper abdomen (tummy)
  • loss of appetite
  • feeling sick and vomiting
  • a temperature higher than 37.5°C
  • a swollen abdomen
  • a rapid pulse
If acute pancreatitis is very severe, it may also lead to dehydration and a drop in blood pressure.

If the inflammation is severe or recurrent, your pancreas can be permanently damaged, leading to chronic pancreatitis. Symptoms of chronic pancreatitis are similar to those for acute pancreatitis, but the pain is likely to be less severe and you won’t have a fever. Additional symptoms of chronic pancreatitis include:

  • pale-coloured, oily faeces
  • weight loss (even though you’re eating normally) and tiredness
These symptoms aren't always caused by pancreatitis but if you have them, see your GP. You may need to seek urgent medical attention if your symptoms are severe. 

How Is Pancreatitis Diagnosed?


Pancreatitis is primarily suspected when a person reports symptoms of pancreatitis and also has risk factors such as heavy alcohol use or gallstone disease. To confirm acute pancreatitis, the doctor measures levels in the blood of the two digestive enzymes, amylase and lipase. High levels of these two enzymes strongly suggest acute pancreatitis.

Diagnosis can be difficult but is aided by a number of techniques such as pancreatic function tests and radiographic imaging of the pancreas. In more advanced stages of the disease, when malabsorption or diabetes is present, blood, urine, and stool tests will confirm the progression.

Diagnostic tests for pancreatitis include:

  • Pancreatic function test, to determine if the pancreas is producing the appropriate levels of digestive enzymes
  • Glucose tolerance test to measure damage to the cells in the pancreas that make insulin
  • Ultrasound, which can produce images of the pancreas so that abnormalities may be detected
  • CT scan (computed tomography scan), which can produce images of the pancreas so that abnormalities may be detected
  • ERCP (endoscopic retrograde cholangiopancreatography) to look at the pancreatic and bile ducts using contrast and X-rays
  • Endoscopic ultrasound (EUS) and biopsy, an exam in which a fine needle is inserted into a localized abnormality of the pancreas to remove a small tissue sample for study.

Pancreatitis Medical Treatment


Medical treatment is usually focused on relieving symptoms and preventing further aggravation to the pancreas. Certain complications of either acute pancreatitis or chronic pancreatitis may require surgery or a blood transfusion.

Acute Pancreatitis Treatment


In acute pancreatitis, the choice of treatment is based on the severity of the attack. If no complications are present, care usually focuses on relieving symptoms and supporting body functions so that the pancreas can recover.

Most people who are having an attack of acute pancreatitis are admitted to the hospital.
  • Those people who are having trouble breathing are given oxygen.
  • An IV (intravenous) line is started, usually in the arm. The IV line is used to give medications and fluids. The fluids replace water lost from vomiting or from the inability to take in fluids, helping the person to feel better.
  • If needed, medications for pain and nausea are prescribed.
  • Antibiotics are given if the health care practitioner suspects an infection may be present.
  • No food or liquid should be taken by mouth for a few days. This is called bowel rest. By refraining from food or liquid intake, the intestinal tract and pancreas are given a chance to start healing.
  • Some people may need a nasogastric (NG) tube. The thin, flexible plastic tube is inserted through the nose and down into the stomach to suck out the stomach juices. This suction of the stomach juices rests the intestine further, helping the pancreas recover.
  • If the attack lasts longer than a few days, nutritional supplements are administered through an IV line.

Chronic Pancreatitis Treatment


In chronic pancreatitis, treatment focuses on relieving pain and avoiding further aggravation to the pancreas. Another focus is to maximize a person's ability to eat and digest food.

  • Unless people have severe complications or a very severe episode, they probably do not have to stay in the hospital.
  • Medication is prescribed for severe pain.
  • A high carbohydrate, low fat diet; and eating smaller more frequent meals help prevent aggravating the pancreas. If a person has trouble with this diet, pancreatic enzymes in pill form may be given to help digest the food.
  • People diagnosed with chronic pancreatitis are strongly advised to stop drinking alcohol.
  • If the pancreas does not produce sufficient insulin, the body needs to regulate its blood sugar, and insulin injections may be necessary.

Diet


A low-fat, healthy diet plays a major role in recovering from pancreatitis. People with chronic pancreatitis, in particular, need to be careful about the amount of fat they consume because their pancreas function has become compromised.

You should eat small meals throughout the day to put minimal stress on your digestive system. Stick to low-fat dairy and other foods and drink lots of fluids to stay hydrated. Your doctor might also give you vitamin supplements to ensure that you are getting the nutrients you need.

Prevention of pancreatitis


For most people, self-care alone is not enough to treat pancreatitis. People may be able to make themselves more comfortable during an attack, but they will most likely continue to have attacks until treatment is received for the underlying cause of the symptoms. If symptoms are mild, people might try the following preventive measures:

Stop all alcohol consumption. 

Adopt a liquid diet consisting of foods such as broth, gelatin, and soups. These simple foods may allow the inflammation process to get better. 

Over-the-counter pain medications may also help. Avoid pain medications that can affect the liver such as acetaminophen (Tylenol and others). In individuals with pancreatitis due to alcohol use, the liver is usually also affected by the alcohol.

Pancreatitis in Children


Chronic pancreatitis is rare in children. Trauma to the pancreas and hereditary pancreatitis are two known causes of childhood pancreatitis. Children with cystic fibrosis, a progressive, disabling, and incurable lung disease, may also have pancreatitis. But more often the cause is not known.

Living with pancreatitis


If you have a bout of acute pancreatitis or are diagnosed with chronic pancreatitis, you will need to make lifestyle changes to help manage your condition and prevent further attacks.

Your doctor will suggest you drink sensibly and eat a low-fat diet – a dietitian can help you to plan an appropriate diet. You may also need to take vitamin and enzyme supplements. If you have developed diabetes, your doctor will tell you about changes that you may need to make to your diet and how to measure your blood sugar.

Points To Remember


  • Pancreatitis begins when the digestive enzymes become active inside the pancreas and start "digesting" it.
  • Pancreatitis has two forms: acute and chronic.
  • Pancreatitis is often caused by gallstones or by alcohol abuse.
  • Symptoms of acute pancreatitis include pain in the abdomen, nausea, vomiting, fever, and a rapid pulse.
  • Treatment for acute pancreatitis can include intravenous fluids, oxygen, antibiotics, or surgery.
  • Acute pancreatitis becomes chronic when pancreatic tissue is destroyed and scarring develops.
  • Treatment for chronic pancreatitis includes easing the pain; eating a high-carbohydrate, low-fat diet; and taking enzyme supplements. Surgery is sometimes needed as well.