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Pancreatitis

What is pancreatitis?

Key points

  1. Pancreatitis is pathologic swelling and inflammation of the pancreas, which is an organ that is important to digestion and the regulation of blood sugar.
  2. There are two types of pancreatitis: acute and chronic.
  3. Treatment for pancreatitis often involves hospitalization and a change in diet.

Pancreatitis is pathologic inflammation of the pancreas. Your pancreas resides behind your stomach. It secretes enzymes that help you digest food and also regulates how your body manages glucose.

Pancreatitis can come and go quickly, or it can be a chronic problem. Treatment will depend on whether your pancreatitis is acute or chronic.

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Types

What are the types of pancreatitis?

The onset of acute pancreatitis is often very sudden. The inflammation usually clears up within several days after treatment begins. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), around 210,000 American adults are admitted to the hospital for acute pancreatitis every year.

Gallstones are the most common cause of acute pancreatitis. Gallstones are small, solid masses that form from bile. A large enough gallstone can get stuck at the junction where the main pancreatic duct and the common bile duct come together to form another duct called the ampulla of Vater. These ducts empty into the duodenum, the first part of the small intestine.

The pancreatic duct carries digestive enzymes from the pancreas. The common bile duct carries bile or other biliary substances from the liver and gallbladder. When a gallstone gets stuck here, it can cause a backup of these substances. This can lead to inflammation in both the common bile duct and pancreas.

Chronic pancreatitis is an inflammation of the pancreas that occurs constantly over the long haul. People with chronic pancreatitis can have permanent damage to their pancreas. Scar tissue develops from this long-term inflammation.

Extensive scar tissue may cause your pancreas to stop making the normal amounts of digestive enzymes, or glucose-regulating hormones. As a result, you’re likely to have trouble digesting fats (which are needed to be able to absorb these enzymes), and you may develop diabetes.

Alcoholism is a common cause of both acute and chronic pancreatitis in adults. Long-term alcohol abuse is the most common cause of chronic pancreatitis in adults. Autoimmune and genetic diseases, such as cystic fibrosis, can also cause chronic pancreatitis in some people.

Symptoms

What are the symptoms of pancreatitis?

Most people who have acute or chronic pancreatitis experience middle-left upper abdominal pain as their primary symptom. Some people who have chronic pancreatitis may show inflammation on diagnostic imaging scans, but otherwise may show no symptoms.

Other symptoms of pancreatitis may include:

  • pain that wraps around the upper body and involves the back in a band-like pattern
  • indigestion
  • nausea or vomiting
  • abdominal tenderness
  • unintentional weight loss
  • bloating with a distended (swollen) abdomen
  • hiccups
  • fever

People who have chronic pancreatitis may also experience steatorrhea, which is fatty stools that give off a foul odor. Steatorrhea can be a sign of malabsorption. This means you’re not getting all of your essential nutrients from your diet because your pancreas doesn’t produce and secrete enough digestive enzymes to break down your food.

Pain associated with pancreatitis may last from a few minutes to several hours at a time. In severe cases, discomfort from chronic pancreatitis could become constant. Your pain is likely to increase after you eat or when you’re lying down. Try sitting up or leaning forward to make yourself more comfortable.

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Diagnosis

Diagnosing pancreatitis

Your doctor will likely use a combination of blood tests and imaging studies to make a diagnosis. If you have acute pancreatitis, you’ll have severe abdominal pain and blood tests may show a significant rise in your level of pancreatic enzymes.

Different types of ultrasound, MRI, and CT scans can reveal the anatomy of your pancreas, signs of inflammation, and information about the biliary and pancreatic ducts. A fecal fat test can also determine if your stools have fat content that’s higher than normal.

Treatment

Treating pancreatitis

Treatment for acute or chronic pancreatitis often involves hospitalization. The pancreas is a key contributor to your digestive processes and needs to rest to heal.

For this reason, you may receive specifically tailored fluids and nutrition intravenously (IV) or through a tube that goes from your nose directly into your stomach. This is called a nasogastric feeding tube.

Restarting an oral diet depends on your condition. Some people feel better after a couple of days. Other people need a week or two to heal sufficiently.

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 since their pancreas function has become compromised.

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’re getting the nutrients you need.

Surgery

Determining the underlying cause of your pancreatitis is part of the treatment process. If your doctor diagnoses gallstones or other blockages of the bile ducts, you may need surgery to correct these problems.

Lifestyle changes

Stop smoking tobacco and curb drinking alcohol in excess to help you heal more quickly and completely. Discuss these issues with your doctor if you need help.

Alternative techniques for pain control

You’ll probably be given IV painkiller medication in the hospital. However, alternative therapies may also help reduce pancreatitis pain. The Mayo Clinic suggests trying yoga, relaxation exercises such as deep breathing, and meditation if conventional treatments don’t reduce your pain. These alternative treatments focus on slow, measured movements that can take your mind off your discomfort.

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Complications

Complications and risks

Some people may develop complications. These complications are rare, but they’re more common in people with chronic pancreatitis:

  • kidney damage
  • pancreatic cancer
  • diabetes
  • malnutrition
  • pancreatic infections

People who have acute pancreatitis may also be at risk for developing breathing difficulties.

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Outlook

Long-term outlook

You can control pancreatitis with a healthy lifestyle and medical treatment when necessary. Organizations such as the National Pancreas Foundation can provide resources and support to help you live a full and healthy life with pancreatitis.

However, if any of your symptoms reappear, speak with your doctor as soon as possible.

  • Is it possible for acute pancreatitis to develop into chronic pancreatitis?
  • The mechanism of progression of acute to chronic pancreatitis is not completely understood, but research indicates that it most commonly occurs in patients with alcoholic pancreatitis.  Smoking appears to increase the risk of progression. The frequency and severity of acute episodes may also contribute to progression from acute to chronic. Approximately 45% of patients with acute alcoholic pancreatitis will progress to the chronic form. This can take between 1 to 20 years to occur.

    - Graham Rogers, MD
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