Pancreatitis

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Pancreatitis is inflammation in the pancreas. The pancreas is a long, flat gland that sits tucked behind the stomach in the upper abdomen. The pancreas produces enzymes that help digestion and hormones that help regulate the way your body processes sugar (glucose).

Pancreatitis can occur as acute pancreatitis — meaning it appears suddenly and lasts for days. Or pancreatitis can occur as chronic pancreatitis, which is pancreatitis that occurs over many years.

Mild cases of pancreatitis may go away without treatment, but severe cases can cause life-threatening complications.

hronic pancreatitis is a long-term progressive inflammatory disease of the pancreas that leads to permanent breakdown of the structure and function of the pancreas.

The pancreas is a gland organ that is located in the abdomen, behind the stomach and below the ribcage. It specializes in producing important enzymes and hormones that help break down and digest foods. It also makes insulin to moderate the levels of sugar in the blood.

The most common cause is long-term alcohol abuse – it is thought to account for between 70 and 80 percentTrusted Source of all cases.

Chronic pancreatitis results in over 122,000 visits to a doctor and 56,000 hospitalizations annually in the United States.

Significantly more men than women are affected.

Pancreatitis is a disease in which your pancreas becomes inflamed.

The pancreas is a large gland behind your stomach and next to your small intestine. Your pancreas does two main things:

• It releases powerful digestive enzymes into your small intestine to help you digest food.
• It releases insulin and glucagon into your bloodstream. These hormones help your body control how it uses food for energy.

Types of Pancreatitis

The two forms of pancreatitis are acute and chronic.

• Acute pancreatitis is sudden inflammation that lasts a short time. It can range from mild discomfort to a severe, life-threatening illness. Most people with acute pancreatitis recover completely after getting the right treatment. In severe cases, acute pancreatitis can cause bleeding, serious tissue damage, infection, and cysts. Severe pancreatitis can also harm other vital organs such as the heart, lungs, and kidneys.
• Chronic pancreatitis is long-lasting inflammation. It most often happens after an episode of acute pancreatitis. Another top cause is drinking lots of alcohol for a long period of time. Damage to your pancreas from heavy alcohol use may not cause symptoms for many years, but then you may suddenly have severe pancreatitis symptoms.

Causes

Pancreatitis occurs when digestive enzymes become activated while still in the pancreas, irritating the cells of your pancreas and causing inflammation.

With repeated bouts of acute pancreatitis, damage to the pancreas can occur and lead to chronic pancreatitis. Scar tissue may form in the pancreas, causing loss of function. A poorly functioning pancreas can cause digestion problems and diabetes.

Conditions that can lead to pancreatitis include:

• Abdominal surgery
• Alcoholism
• Certain medications
• Cystic fibrosis
• Gallstones
• High calcium levels in the blood (hypercalcemia), which may be caused by an overactive parathyroid gland (hyperparathyroidism)
• High triglyceride levels in the blood (hypertriglyceridemia)
• Infection
• Injury to the abdomen
• Obesity
• Pancreatic cancer

Endoscopic retrograde cholangiopancreatography (ERCP), a procedure used to treat gallstones, also can lead to pancreatitis.

Sometimes, a cause for pancreatitis is never found.

Pancreatitis Symptoms

Symptoms of acute pancreatitis

• Fever
• Higher heart rate
• Nausea and vomiting
• Swollen and tender belly
• Pain in the upper part of your belly that goes into your back. Eating may make it worse, especially foods high in fat.

Symptoms of chronic pancreatitis

The symptoms of chronic pancreatitis are similar to those of acute pancreatitis. But you may also have:

• Constant pain in your upper belly that radiates to your back. This pain may be disabling.
• Diarrhea and weight loss because your pancreas isn’t releasing enough enzymes to break down food
• Upset stomach and vomiting

When to see a doctor

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Make an appointment with your doctor if you have persistent abdominal pain. Seek immediate medical help if your abdominal pain is so severe that you can’t sit still or find a position that makes you more comfortable.

Diagnosis

There are no reliable tests to diagnose chronic pancreatitis. A doctor will suspect the disease because of the patient’s symptoms, history of repeated acute pancreatitis flare-ups, or alcohol abuse.

Blood tests may be useful in checking the blood glucose levels, which may be elevated.

Blood tests for elevated levels of amylase and lipase are not reliable at this stage. Amylase and lipase blood levels rise during the first couple of days of pancreatitis, and then settle back to normal after five to seven days. A patient with chronic pancreatitis would have had the disease for much longer.

Doctors need to have a good look at the pancreas in order to diagnose the disease properly. This will most likely involve:

• An ultrasound scan: High frequency sound waves create an image on a monitor of the pancreas and its surroundings.
• A CT scan: X-rays are used to take many pictures of the same area from several angles, which are then placed together to produce a 3-D image. The scan will reveal changes of chronic pancreatitis.
• Magnetic resonance cholangiopancreatography (MRCP) scan: This scan shows the bile and pancreatic ducts more clearly than a CT scan.
• An endoscopic retrograde cholangio-pancreatography (ERCP) scan: An endoscope is inserted into the digestive system. The doctor uses ultrasound to guide the endoscope through.

Patients with chronic pancreatitis have an elevated risk of developing pancreatic cancer. If symptoms worsen, especially the narrowing of the pancreatic duct, doctors may suspect cancer. If so, they will order a CT scan, MRI scan, or endoscopic study.

Complications-

There are several ways in which chronic pancreatitis can develop and become more harmful to a person’s wellbeing.

Stress, anxiety, and depression

The disease may have an effect on the patient’s psychological and emotional well being. Constant or recurring pain, which is often severe, may cause distress, anxiety, irritability, stress, and depression.

It is important for patients to tell their doctors if they are emotionally or psychologically affected. If there is a support group in your area, being able to talk to people who share the same condition may help you feel less isolated and more able to cope.

Pseudocyst

This is a collection of tissue, fluid, debris, pancreatic enzymes, and blood in the abdomen, caused by leakage of digestive fluids escaping from a faulty pancreatic duct.

Pseudocysts do not usually cause any health problems. However, sometimes they can become infected, cause blockage to part of the intestine, or rupture and cause internal bleeding. If this happens, the cyst will have to be surgically drained.

Pancreatic cancer

Even though pancreatic cancer is more common among patients with chronic pancreatitis, the risk is only 1 in 500.

Risk factors

Factors that increase your risk of pancreatitis include:

• Excessive alcohol consumption. Research shows that heavy alcohol users (people who consume four to five drinks a day) are at increased risk of pancreatitis.
• Cigarette smoking. Smokers are on average three times more likely to develop chronic pancreatitis, compared with nonsmokers. The good news is quitting smoking decreases your risk by about half
• Obesity. You’re more likely to get pancreatitis if you’re obese.
• Family history of pancreatitis. The role of genetics is becoming increasingly recognized in chronic pancreatitis. If you have family members with the condition, your odds increase — especially when combined with other risk factors.

Prevention

Patients with acute pancreatitis significantly reduce their risk of developing chronic pancreatitis if they give up drinking alcohol. This is especially the case for patients who drink heavily and regularly.

Treatment

The following treatments are commonly recommended for chronic pancreatitis.

Lifestyle changes

People with chronic pancreatitis will need to undergo some lifestyle changes. These will include:

• Stopping alcohol consumption: Giving up drinking will help prevent further damage to the pancreas. It will also contribute significantly towards relieving the pain. Some people may need professional help to quit alcohol.
• Stopping tobacco use: Smoking is not a cause of pancreatitis, but it can accelerate the progression of the disease.

Pain management

Treatment should not only focus on helping ease the pain symptoms, but also depression which is a common consequence of long-term pain.

Doctors will usually use a step-by-step approach, in which mild painkillers are prescribed, gradually becoming stronger until pain becomes manageable.

Insulin

The pancreas may stop producing insulin if the damage is extensive. The individual is likely to have developed diabetes type 1.

Regular insulin treatment will become part of the treatment for the rest of the person’s life. Diabetes type 1 caused by chronic pancreatitis involves injections, not tablets, because most likely the digestive system will not be able to break them down.

Surgery

Severe chronic pain sometimes does not respond to painkilling medications. The ducts in the pancreas may have become blocked, causing an accumulation of digestive juices which puts pressure on them, causing intense pain. Another cause of chronic and intense pain could be inflammation of the head of the pancreas.

Several forms of surgery may be recommended to treat more severe cases.

Endoscopic surgery

A narrow, hollow, flexible tube called an endoscope is inserted into the digestive system, guided by ultrasound. A device with a tiny, deflated balloon at the end is threaded through the endoscope. When it reaches the duct, the balloon is inflated, thus widening the duct. A stent is placed to stop the duct from narrowing back.

Pancreas resection

The head of the pancreas is surgically removed. This not only relieves the pain caused by inflammation irritating the nerve endings, but it also reduces pressure on the ducts. Three main techniques are used for pancreas resection:

• The Beger procedure: This involves resection of the inflamed pancreatic head with careful sparing of the duodenum, the rest of the pancreas is reconnected to the intestines.
• The Frey procedure: This is used when the doctor believes pain is being caused by both inflammation of the head of the pancreas as well as the blocked ducts. The Frey procedure adds a longitudinal duct decompression to the pancreatic head resection – the head of the pancreas is surgically removed, and the ducts are decompressed by connecting them directly to the intestines.
• Pylorus-sparing pancreaticoduodenectomy (PPPD): The gallbladder, ducts, and the head of the pancreas are all surgically removed. This is only done in very severe cases of intense chronic pain where the head of the pancreas is inflamed, and the ducts are also blocked. This is the most effective procedure for reducing pain and conserving pancreas function. However, it has the highest risk of infection and internal bleeding.

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