Pancreatitis

Overview

Pancreatitis is inflammation of the pancreas. Inflammation is the body's natural immune response to injury or irritation. It can lead to swelling, pain, and changes in how the pancreas works.

The pancreas is a long, flat gland that's tucked behind the stomach. The pancreas helps the body digest food and regulates blood sugar.

Pancreatitis can be an acute condition. This means it appears suddenly and can be mild or severe. Chronic pancreatitis is a long-term condition that does not heal or improve. The damage to the pancreas can get worse over time and cause permanent scarring.

Symptoms

Symptoms of pancreatitis may vary. Acute pancreatitis symptoms may include:

• Pain in the upper belly that may feel worse after eating.
• Pain in the upper belly that radiates to the back or shoulders.
• Tenderness when touching the belly.
• Fever.
• Fast heartbeat.
• Nausea and vomiting.
• Shortness of breath.

Chronic pancreatitis symptoms may include:

• Constant pain in the upper belly.
• Belly pain that feels worse after eating.
• Losing weight without trying.
• Diarrhea.
• Oily, smelly stools.
• Symptoms of diabetes mellitus, such as excessive thirst, hunger and urination.

Some people with chronic pancreatitis only develop symptoms after they get complications of the disease.

When to see a doctor

Make an appointment with your healthcare professional if you have sudden belly pain or belly pain that doesn't improve. Seek immediate medical help if your pain is so severe that you can't sit still or find a position that makes you more comfortable.

Causes

The pancreas has two major roles. It produces insulin, which helps the body manage and use sugars.

The pancreas also produces dietary juices, called enzymes, that help with digestion. The pancreas makes and stores "turned off" versions of these enzymes. After the pancreas sends the enzymes into the small intestine, they are "turned on" and break down proteins in the small intestine.

If the enzymes are turned on too soon, they can start acting like digestive juices inside the pancreas. This action can irritate, damage or destroy cells. This, in turn, leads to immune system responses that cause swelling and other actions that affect how the pancreas works.

Several conditions can lead to acute pancreatitis, including:

• Blockage in the bile duct caused by gallstones.
• Heavy alcohol use or cigarette smoking.
• Certain medicines.
• High triglyceride levels in the blood.
• High calcium levels in the blood.
• Pancreatic cancer.
• Injuries from endoscopy, trauma or surgery.

Conditions that can lead to chronic pancreatitis include:

• Heavy alcohol use or cigarette smoking.
• Damage from repeated acute pancreatitis.
• Inherited conditions of the pancreas.
• High triglyceride levels in the blood.
• Autoimmune condition of the pancreas.

Sometimes, a cause of pancreatitis is never found. This is known as idiopathic pancreatitis.

Risk factors

Factors that increase your risk of pancreatitis include:

• Being male. Males have a higher risk of developing pancreatitis than females.
• Race. People who are Black have a higher risk of developing pancreatitis than people who are white.
• Excessive alcohol use. People who consume more than four alcoholic drinks a day are at an increased risk of pancreatitis.
• Cigarette smoking. People who smoke cigarettes are three times more likely to develop pancreatitis than people who don't smoke. Quitting smoking can decrease the risk.
• Obesity. People with a body mass index of 30 or higher are at an increased risk of pancreatitis.
• Diabetes. People with diabetes have an increased risk of pancreatitis.
• Family history of pancreatitis. A number of genes have been linked to chronic pancreatitis. A family history of the disease is linked to an increased risk, especially when combined with other risk factors.
• Personal or family history of gallstones. People with a personal or family history of gallstones are at higher risk of pancreatitis.

Complications

Pancreatitis can cause serious complications, including:

• Kidney failure. Acute pancreatitis may result in the kidneys not filtering waste from the blood. Artificial filtering, called dialysis, may be needed for short-term or long-term treatment.
• Breathing problems. Acute pancreatitis can cause changes in how the lungs work, causing the level of oxygen in the blood to fall to dangerously low levels.
• Infection. Acute pancreatitis can make the pancreas vulnerable to infections. Pancreatic infections are serious and require intensive treatment such as surgery or other procedures to remove the infected tissue.
• Pseudocyst. Acute and chronic pancreatitis can cause fluid and debris to collect in a "pocket" in the pancreas, called a pseudocyst. A large pseudocyst that ruptures can cause complications such as internal bleeding and infection.
• Malnutrition. With chronic pancreatitis, the pancreas may not produce enough enzymes for the digestive system. This can lead to malnutrition, diarrhea and weight loss.
• Osteoporosis. Chronic pancreatitis that causes malnutrition can weaken the bones. This can lead to increased risk of fractures.
• Diabetes. Diabetes can develop when chronic pancreatitis damages cells that produce insulin.
• Pancreatic cancer. Long-standing inflammation in the pancreas can increase the risk of pancreatic cancer.

Prevention

Ways to prevent pancreatitis may include:

• Prevent or manage gallstones. Take steps to prevent gallstones by maintaining a healthy weight and eating a balanced diet. If you have a history of gallstones, your healthcare professional may recommend removing your gallbladder.
• Avoid alcohol and cigarettes. Drinking alcohol and smoking cigarettes increases the risk of pancreatitis.
• Avoid certain medicines. Some medicines increase the risk of pancreatitis. Talk with your healthcare professional about the medicines you take.
• Eat a balanced diet. Eat vegetables, fruit, whole grains and lean proteins. Avoid foods that are high in fat.
• Stay hydrated. Drinking enough water helps with digestion and gallbladder function.

Diagnosis

Pancreatitis diagnosis often begins with a review of your health history and symptoms. Your healthcare professional may do a physical exam to check for pain or tenderness in your belly.

Tests and procedures used to diagnose pancreatitis may include:

• Blood tests can give clues about how the immune system, pancreas and related organs are working.
• Ultrasound images can show gallstones in the gallbladder or inflammation of the pancreas.
• CT scan can show gallstones and the extent of inflammation.
• MRI can look for irregular tissues or structures in the gallbladder, pancreas and bile ducts.
• Endoscopic ultrasound is an ultrasound device on a small tube fed through the mouth and into the upper digestive system. It can show inflammation, gallstones, cancer, and blockages in the pancreatic duct or bile duct.
• Endoscopic retrograde cholangiopancreatography (ERCP) combines endoscopy and X-ray images to look at the bile and pancreatic ducts.
• Stool tests can measure levels of fat that could suggest your digestive system isn't absorbing nutrients as it should.
• Pancreatic function tests can be done on fluid collected from the pancreas during an endoscopy. This can show how well the pancreas is working.

Your healthcare professional may recommend other tests depending on your symptoms or other conditions you may have.

Treatment

There is no specific medicine to treat pancreatitis. Treatment begins with a hospital stay to manage symptoms and complications. This includes:

• Pain medicines. Pancreatitis can cause severe pain. Your healthcare team may give you medicines to help manage the pain.
• Intravenous (IV) fluids. You may receive fluids through a vein in your arm to keep you hydrated.
• Nutrition. You may begin eating again when you can do so without vomiting or pain. In some cases, a feeding tube is used.

When the symptoms and complications are under control, other treatments are used to treat underlying causes. These may include:

• Procedures to open bile ducts. A procedure called endoscopic retrograde cholangiopancreatography (ERCP) is used to locate and remove gallstones. A long tube with a camera is fed through the mouth and digestive system to the bile duct. This tube also is used to get tiny tools to the site to remove the stones and clear the bile duct. ERCP may trigger acute pancreatitis, so it may not be for everyone.
• Gallbladder surgery. If gallstones caused the pancreatitis, surgery to remove the gallbladder may be recommended. This procedure is called a cholecystectomy.
• Pancreas procedures. Procedures with an endoscopic camera and tools may be used to drain fluid from the pancreas or remove diseased tissue.
• Treatment for excessive alcohol use or cigarette smoking. If excessive alcohol use or cigarette smoking has caused pancreatitis, your healthcare professional may recommend a treatment program. Continuing to drink alcohol or smoke cigarettes worsens pancreatitis and leads to serious complications.
• Treatment for high triglyceride levels. If triglyceride levels are high, your healthcare professional may recommend medicines to lower the levels. Continuous high levels of triglycerides can cause pancreatitis to come back in the future.
• Changes in medicines. If a medicine is the likely cause of acute pancreatitis, your healthcare professional works with you to find other options.

Additional treatments for chronic pancreatitis

Chronic pancreatitis may need additional treatments, including:

• Pain management. Chronic pancreatitis often causes severe, long-term pain. In addition to prescribing medicine, your healthcare professional looks for causes or complications of chronic pancreatitis that cause pain. Treatments may include procedures to improve drainage from the pancreas or injections to block nerve signals from the pancreas to the brain. You may be referred to a pain specialist.
• Enzymes to improve digestion. When chronic pancreatitis causes diarrhea or weight loss, you may take pancreatic enzyme supplements. When taken with each meal, these enzyme supplements help your body break down and use the nutrients in food.
• Changes to your diet. Your healthcare professional may refer you to a dietitian who can help you plan meals that are high in nutrients.
• Surgery. Surgery may be used when chronic pancreatitis does not respond to other treatments. Surgery may involve bypassing the blocked pancreatic duct or, rarely, removing the pancreas.

Lifestyle and home remedies

Once you leave the hospital, you can take steps to continue your recovery from pancreatitis, such as:

• Stop drinking alcohol. Even if alcohol was not the likely cause of pancreatitis, it is best to stop drinking alcohol while recovering. If it was the expected cause, stop drinking. If you're unable to stop drinking alcohol on your own, ask your healthcare professional for help. They can refer you to local programs to help you stop drinking.
• Stop smoking. If you smoke, quit. If you can't quit on your own, ask your healthcare professional for help. Medicines and counseling can help you quit smoking.
• Choose a balanced diet. Choose a balanced diet that includes fresh fruits and vegetables, whole grains, and lean protein.
• Drink more fluids. Pancreatitis can cause dehydration, so drink more fluids throughout the day. It may help to keep a water bottle or glass of water with you.

Preparing for an appointment

If you're experiencing symptoms, you might start by seeing your primary healthcare professional. This person may refer you to a specialist in the digestive system, called a gastroenterologist.

What you can do

Here's some information to help you get ready for your appointment.

• Be aware of anything you need to do ahead of time. When you make an appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
• Write down symptoms you have, including any that may not seem related to the reason for which you scheduled the appointment.
• Write down important personal information, including major stresses or recent life changes.
• Make a list of all medicines, vitamins and supplements you're taking and the doses.
• Take a family member or friend along. It can be hard to remember all the information you get during an appointment. Someone who goes with you may remember something that you missed or forgot.
• Write down questions to ask your healthcare team.

For pancreatitis, some questions to ask might include:

• What is likely causing my symptoms or condition?
• What are other possible causes of my symptoms or condition?
• What kinds of tests do I need?
• Is my condition likely temporary or chronic?
• What is the best course of action?
• What are the alternatives to the primary approach that you're suggesting?
• I have other health conditions. How can I best manage pancreatitis along with these conditions?
• Should I see a specialist? How can I learn if my insurance covers a specialist?
• Is there a generic option for the medicine you're prescribing?
• Are there any brochures or other printed material that I can take with me? What websites do you recommend?
• Should I schedule a follow-up visit?

Don't hesitate to ask other questions.

What to expect from your doctor

Your healthcare professional is likely to ask you several questions, such as:

• When did you begin experiencing symptoms?
• Have your symptoms come and gone or stayed steady?
• How severe are your symptoms?
• Does anything improve your symptoms?
• Does anything worsen your symptoms?
• Have you had these symptoms before?
• Have you been diagnosed with pancreatitis in the past?
• Do you drink alcohol? If so, how much and how often do you drink?
• Did you start any new medicines before your symptoms began?
• Does anyone in your family have a history of any pancreas condition?