Pancreatitis is inflammation of the pancreas, often due to gallstones or alcohol abuse. The pancreas is a gland that has an important role in digestion. Pancreatitis occurs when the digestive enzymes produced by the pancreas become active inside the pancreas and not in the small intestine as they would under normal circumstances. This causes damage to the pancreas.

There are two types of pancreatitis, acute and chronic. Acute cases occur over a short period of time and chronic cases occur over a longer time period. Both are serious conditions that can lead to complications, such as infection and respiratory failure.

The two leading causes of pancreatitis are alcohol abuse and gallstones (hard, stone-like masses that develop in the gallbladder or bile duct). However, there are many factors that may play a role in its development, such as increased levels of fats or calcium in the blood and heredity.

The most common symptom of pancreatitis is abdominal pain. Other symptoms may include nausea, vomiting and fever.

Pancreatitis may be diagnosed by a physician during a physical examination which includes a medical history and list of medications. Tests that may be performed include blood tests, x-rays and a computed axial tomography (CAT) scan.

Treatment of pancreatitis depends on the severity of the condition and its underlying causes. The focus of treatment, which typically requires hospitalization, is to support bodily functions, prevent complications, and relieve pain. Treatment may include pain medications, intravenous (I.V.) fluids and refraining from eating. When complications arise, they are treated separately. For example, patients who develop an infection are treated with antibiotics.

Pancreatitis is inflammation of the pancreas, which is most often caused by alcohol abuse or gallstones. It can be either acute (short term) or chronic (long term).

The pancreas is a long, flat organ located behind the stomach between the upper part of the small intestine (duodenum) and the spleen. It plays a key role in the digestive system. The pancreas has two primary functions:

• Secreting digestive enzymes into the small intestine through a tube called the pancreatic duct. These enzymes help the body digest fats, proteins and carbohydrates in food.
  
  
• Secreting the hormones insulin and glucagon into the bloodstream. The hormones help the body use glucose (sugar) found in food for energy.

Under normal circumstances, digestive enzymes do not begin working until they reach the small intestine. In patients with pancreatitis, however, the enzymes begin working in the pancreas and cause damage. One of the digestive enzymes, called trypsin, can cause tissue damage and bleeding. It can also cause swelling in the blood cells and blood vessels found inside the pancreas.

Pancreatitis can lead to a number of serious complications. They include:

• Infection. When the pancreas is damaged, it sometimes becomes infected with bacteria from the small intestine. Pancreatic infections can be fatal if not treated properly.
  
  
• Pseudocysts. Abnormal collections of fluid, dead tissue, enzymes and blood that can lead to a painful mass in the pancreas or an obstructed pancreatic duct.
  
  
• Abscess. Collection of pus that develops in or around the pancreas. Treatment involves drainage by catheter or surgery.
  
  
• Respiratory failure. Chemical changes that occur as a result of pancreatitis can impact lung function. This can result in hypoxia, a condition in which the level of oxygen in the blood becomes dangerously low.
  
  
• Kidney failure. Acute cases of pancreatitis can result in kidney failure.
  
  
• Shock. Potentially life-threatening condition that occurs when blood pressure is abnormally low and organs cannot function properly.

When pancreatitis occurs over a long period of time, it can lead to additional complications. These include:

• Bleeding. Persistent inflammation and damage to the blood vessels near the pancreas can cause bleeding.
  
  
• Malnutrition or weight loss. In severe cases, the pancreas stops producing digestive enzymes (exocrine failure). It may also lose its ability to produce insulin (endocrine failure). This causes malabsorption (poor absorption of nutrients by the small intestine) of food.
  
  
• Diabetes. Damage to the pancreas can impact insulin production and result in diabetes, a disease in which the body cannot produce enough insulin or does not use insulin properly.
  
  
• Pancreatic cancer. Chronic inflammation of the pancreas increases a patient’s risk of developing pancreatic cancer.

There are two types of pancreatitis. Either type can be severe or possibly life-threatening. Complications are possible with either type. They include:

• Acute pancreatitis. Occurs when pancreatitis develops suddenly and resolves itself after a short period of time. Patients can experience one attack or multiple attacks, but the pancreas returns to its normal state after the condition subsides. Most cases are caused by alcohol abuse or gallstones (hard, stone-like masses formed from substances in bile [such as cholesterol or bilirubin] that develop in the gallbladder or bile ducts). There are about 80,000 cases of acute pancreatitis each year in the United States. About 20 percent of those cases are severe, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
  

  

• Chronic pancreatitis. Acute cases of pancreatitis can develop into ones that last over a longer period of time. This occurs when the pancreas is scarred during an acute attack and cannot return to its normal state. Excessive alcohol consumption over many years causes 70 percent of chronic cases, which often develop between the ages of 30 and 40, according to the NIDDK. Chronic cases do not resolve and may result in damage to the pancreas, which can alter its normal structure and function. It may take many years of damage to the pancreas before signs and symptoms of the disease develop. Chronic pancreatitis is more common in men than women.

Alcohol abuse and gallstones are the two leading causes of pancreatitis. It is not fully understood how alcohol impacts the pancreas. However, scientists do know that it causes the premature release of digestive enzymes. It also impacts the small ducts that transport enzymes within the pancreas and causes digestive juices to leak into surrounding tissues and organs and damage them. Alcohol also causes the formation of protein plugs that can block parts of the pancreatic duct. An attack can occur from a few hours to several days after drinking alcohol.

Gallstones are hard, stone-like masses formed from substances in bile (e.g., cholesterol, bilirubin) that develop in the gallbladder or bile ducts. Gallstones can move from the gallbladder or bile ducts to the pancreatic duct and block the flow of digestive enzymes into the duodenum (upper part of the small intestine). As a result, the enzymes become active in the pancreas and cause damage.

Though alcohol and gallstones have been identified as causes of pancreatitis, scientists believe environmental and genetic factors may also play a role in development of the disease. Factors that may contribute to pancreatitis include:

• Increased level of substances in the blood. These may include triglycerides (fats) in the blood (hyperlipidemia) or calcium in the blood (hypercalcemia).
  
  
• Medications. Certain types of medications may contribute to pancreatitis, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and antibiotics. Common prescription medications like some loop diuretics (to reduce water in the body), HIV medications and chemotherapy drugs are also known to incite inflammation of the pancreas.
  
  
• Damage to the pancreas. This may result from abdominal surgery, trauma or other causes.
  
  
• Structural abnormalities. These may occur in the pancreas or bile duct.
  
  
• Infections. These can include hepatitis, Epstein-Barr virus and bacterial infections. The condition may also result from mumps, though this is rare.
  
  
• Heredity. This can include inherited conditions, such as cystic fibrosis.
  
  
• Endoscopic retrograde cholangiopancreatography (ERCP). A test that involves injecting a dye into the bile and pancreatic ducts. Acute pancreatitis develops in a small number of patients who undergo this procedure.
  
  
• Pancreatic cancer.
  
  
• Scorpion stings. People who have been stung by certain species of scorpions may develop pancreatitis.

In approximately 15 percent of cases, the cause of pancreatitis is unknown (idiopathic).

There are many factors that increase the risk of developing pancreatitis. Although long-term alcohol abuse is the primary risk factor for pancreatitis, only a small percentage of people with alcoholism develop pancreatitis. For this reason, scientists believe there are other factors that contribute to its development. They include:

• Gallbladder disease. This can result in the formation of gallstones, which are one of the primary causes of pancreatitis.
  
  
• Gender. More men than women develop pancreatitis. This may be because men are more likely to abuse alcohol.
  
  
• Ethnicity. Pancreatitis is more prevalent among black Americans than white Americans.
  
  
• Heredity. Abnormalities in genes and some inherited conditions, such as cystic fibrosis, may place a patient at a higher risk of developing pancreatitis.
  
  
• Exposure to toxins. The stress to the body from metabolizing cigarette smoke or pollution may strain the pancreas and contribute to pancreatitis.

The most common symptom of pancreatitis is abdominal pain in the upper abdomen that may radiate to the back. In acute cases, the pain occurs suddenly and may last for several days. In chronic cases, the pain may be intermittent or constant.

The pain may get worse after eating or drinking. Coughing, vigorous movement and deep breathing may also worsen the pain. Sitting upright, leaning forward or curling up into fetal position may ease the pain.

Other signs and symptoms of pancreatitis may include:

• Swollen or tender abdomen
• Nausea, vomiting or retching
• Fever
• Rapid pulse
• Few or no bowel sounds (ileus)
• Diarrhea

Signs and symptoms of chronic pancreatitis may also include:

• Jaundice (yellowing of the skin)
• Weight loss
• Greasy or oily stool (steatorrhea)
• Gas and bloating

The location of the pancreas makes diagnosing pancreatitis difficult. It may be diagnosed by a physician during a physical examination that includes a medical history and list of medications. Patients may also be referred to a gastroenterologist (a physician who specializes in the function and disorders of the gastrointestinal [GI] tract).

During a typical examination, a physician touches the abdomen and may use a stethoscope to listen for sounds in the intestines. A physician may ask a patient about patterns of alcohol use.

If a physician suspects that a patient has pancreatitis, blood tests may be performed. Blood tests can evaluate pancreatic function and may detect abnormalities such as:

• High levels of amylase and lipase, which are enzymes in the pancreas
  
  
• High levels of urinary trypsinogen-2
  
  
• High levels of white blood cells
  
  
• High levels of liver enzymes and bilirubin (substance formed from the breakdown of red blood cells)
  
  
• High blood sugar levels (hyperglycemia)
  
  
• Low calcium levels (hypocalcemia)

If a physician suspects that a patient has chronic pancreatitis, a stool test may also be performed. Patients often have elevated levels of fat in the stool because the fat is not digested and absorbed normally. A pancreatic function test may also be conducted. These tests measure the ability of the pancreas to secrete enzymes and other substances necessary for digestion.

Many cases of pancreatitis cannot be diagnosed with blood and stool tests alone. Imaging tests may be performed to detect abnormalities (such as gallstones) in the pancreas or pancreatic duct. These may include:

• X-rays. An image may be taken of the abdomen or chest on film paper or fluorescent screens. It is produced by using low doses of radiation.
  
  
• Ultrasound. An imaging technology that uses sound waves to produce images of the shape and outline of various tissues and organs of the body. An endoscopic ultrasound may be performed because it provides better images of the pancreas and pancreatic ducts than a standard ultrasound.
  
  
• Computed axial tomography (CAT) scan. A test that allows for multiple x-rays to be taken from different angles around the patient. It creates images of organs and bones within the body. This is the most important diagnostic test as it helps visualize the pancreas very well.
  
  
• Endoscopic retrograde cholangiopancreatography (ERCP). An endoscope (lighted tube) is inserted through the mouth to the small intestine. A dye is passed through a thin flexible tube (catheter) inside the endoscope before x-rays are taken. ERCP is usually performed stones are thought to be present in the common bile duct.
  
  
• Magnetic resonance cholangiopancreatography (MRCP). A test that uses magnetic resonance imaging to produce detailed images of the body.

Treatment of pancreatitis depends on the severity of the condition, its symptoms and its underlying cause. The focus of treatment is usually to support bodily functions, prevent complications and relieve pain. Treatment typically requires hospitalization.

Mild cases of pancreatitis usually resolve with minimal care, which may involve monitoring the condition, pain medications and intravenous (I.V.) fluids to prevent dehydration. Patients usually are not permitted to eat for a few days to allow the pancreas to rest.

Moderate to severe cases of pancreatitis are also treated with pain medications and I.V. fluids. Some patients may be fed through a tube placed into the middle part of the small intestine. After the pain subsides and bowel function returns to normal, patients may resume eating gradually. Some patients may be treated with medications that replace digestive enzymes to address malabsorption problems. These medications help restore normal digestion and promote weight gain.

Close monitoring is needed, particularly with moderate to severe cases, because pancreatitis can lead to serious complications that may require treatment. These complications include:

• Infection. Patients who develop an infection due to pancreatitis are treated with antibiotics.
  
  
• Hypoxia or lung failure. Patients with hypoxia (a deficiency of oxygen in the tissues) are treated by administering oxygen through a mask. Despite treatment, some patients develop lung failure and are placed on a respirator to help them breathe.
  
  
• Kidney failure. Kidney failure may require dialysis (artificial waste product removal from the blood) to maintain basic kidney function.
  
  
• Pseudocysts. These are collections of tissue, fluid, debris, pancreatic enzymes and blood. If pseudocysts are large enough to interfere with healing of the pancreas, they may be drained or surgically removed.
  
  
• Enlarged bile duct. Enlarged bile ducts may require drainage or, in severe cases, surgical removal.
  
  
• Necrosis. Some cases involve extensive damage and/or infection to the pancreas. In these cases, the dead tissue is surgically removed. This procedure is called a necrosectomy.
  
  
• Diabetes (condition in which the body does not produce enough insulin or does not use insulin properly). Patients who develop diabetes may require medication to control their blood sugar levels.

Cases of pancreatitis caused by gallstones often require surgery. Because cases caused by gallstones tend to recur, surgery often involves removal of the gallbladder (cholecystectomy).

Pancreatitis may not be preventable but there are methods to reduce some risk factors and prevent future attacks. They include:

• Avoiding excessive alcohol use. It is recommended that patients stop drinking alcohol, regardless of whether it contributed to the disease.
  
  
• Maintaining a healthy diet. A balanced diet of fruits, vegetables, complex carbohydrates, fiber, protein and limited fat can lower the risk for developing gallstones caused by high levels of blood fats.
  
  
• Eating smaller meals. Patients are often advised to eat smaller meals that are high in carbohydrates and low in fat. This may help minimize recurrence of the condition.
  
  
• Surgically removing the gallbladder. Pancreatitis caused by gallstones may be prevented by having the gallbladder surgically removed.
  
  
• Stop smoking. It is recommended that patients avoid smoking. The body’s attempt to metabolize cigarette smoke may place stress on the pancreas.

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions related to pancreatitis:

1. Do my symptoms suggest pancreatitis?
   
   
2. What methods will you use to determine if I have pancreatitis?
   
   
3. What type of pancreatitis do I have?
   
   
4. What may have caused me to develop pancreatitis?
   
   
5. Does this condition pose any danger to my overall health? What complications may I develop?
   
   
6. Aside from abdominal pain, what other symptoms of pancreatitis might I experience?
   
   
7. How do you intend to treat my pancreatitis?
   
   
8. Will a hospital stay be required to treat my pancreatitis?
   
   
9. What are some ways that I can prevent an attack in the future?
   
   
10. How many patients with pancreatitis have you treated?