Pancreatitis

Pancreatitis is inflammation of the pancreas. Inflammation is immune system activity that can cause swelling, pain, and changes in how an organ or tissues work.

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

Pancreatitis can be an acute condition. This means it appears suddenly and generally lasts a short time. Chronic pancreatitis is a long-term condition. The damage to the pancreas can get worse over time.

Acute pancreatitis may improve on its own. More-serious disease requires treatment in a hospital and can cause life-threatening complications.

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

• Pain in the upper belly.
• Pain in the upper belly that radiates to the back.
• Tenderness when touching the belly.
• Fever.
• Rapid pulse.
• Upset stomach.
• Vomiting.

Chronic pancreatitis signs and symptoms include:

• Pain in the upper belly.
• Belly pain that feels worse after eating.
• Losing weight without trying.
• Oily, smelly stools.

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 doctor 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.

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 the 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. The action can irritate, damage or destroy cells. This problem, in turn, leads to immune system responses that cause swelling and other events 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.
• Certain medicines.
• High triglyceride levels in the blood.
• High calcium levels in the blood.
• Pancreas cancer.
• Injuries from trauma or surgery.

Conditions that can lead to chronic pancreatitis include:

• Damage from repeated acute pancreatitis.
• Heavy alcohol use.
• Inherited genes linked to pancreatitis.
• High triglyceride levels in the blood.
• High calcium levels in the blood.

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

Factors that increase your risk of pancreatitis include:

• Excessive alcohol use. Research shows that having four or five drinks a day increases the risk of pancreatitis.
• Cigarette smoking. Compared with nonsmokers, smokers are on average three times more likely to develop chronic pancreatitis. Quitting smoking can decrease the risk.
• Obesity. People with a body mass index of 30 or higher are at increased risk of pancreatitis.
• Diabetes. Having diabetes increases the 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.

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 both acute and chronic pancreatitis, the pancreas may not produce enough enzymes for the digestive system. This can lead to malnutrition, diarrhea and weight loss.
• Diabetes. Diabetes can develop when chronic pancreatitis damages cells that produce insulin.
• Pancreatic cancer. Long-standing inflammation in the pancreas is a risk factor for cancer of the pancreas.

Your healthcare professional will ask you questions about your health history and symptoms, give you a general physical, and check for pain or tenderness in your belly.

Tests and procedures that may be used include the following.

• 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.
• Computerized tomography (CT) scan show gallstones and the extent of inflammation.
• Magnetic resonance imaging (MRI) to 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 digestive system. It can show inflammation, gallstones, cancer, and blockages in the pancreatic duct or bile duct.
• Stool tests can measure levels of fat that could suggest your digestive system isn't absorbing nutrients as it should.

Your doctor may recommend other tests, depending on your symptoms or other conditions you may have.

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

• Pain medicines. Pancreatitis can cause severe pain. Your healthcare team will give you medicines to help control the pain.
• Intravenous (IV) fluids. You will receive fluids through a vein in your arm to keep you hydrated.
• Nutrition. You will 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 a gallstone. 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 stone and clear the bile duct. ERCP may itself trigger acute pancreatitis, but research about risk factors have helped improve outcomes.
• 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 alcohol dependence. If excessive alcohol use has caused pancreatitis, a treatment program for alcohol addiction is recommended. Continuing to drink alcohol worsens pancreatitis and leads to serious complications.
• Changes in medicines. If a medicine is the likely cause of acute pancreatitis, your healthcare professional will work with you to find other options.

Additional treatments for chronic pancreatitis

Chronic pancreatitis may require additional treatments, including:

• Pain management. Chronic pancreatitis often causes severe, long-term pain. In addition to prescribing medicine, your healthcare professional will look 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. Taken with each meal, these enzyme supplements help your body break down and use the nutrients in food.
• Changes to your diet. Your doctor may refer you to a dietitian who can help you plan low-fat meals that are high in nutrients.

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 doctor for help. Your doctor 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 doctor for help. Medicines and counseling can help you quit smoking.
• Choose a low-fat diet. Choose a diet that limits fat and emphasizes 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.

Alternative therapies can't treat pancreatitis, but some may help you cope with the pain from chronic pancreatitis. These include:

• Meditation.
• Relaxation exercises.
• Yoga.
• Acupuncture.

You'll likely see your primary care professional first. You may be referred to a specialist in the digestive system called a gastroenterologist.

Because appointments can be brief, and because there's often a lot to discuss, it's a good idea to be well prepared. Here's some information to help you get ready and know what to expect from your doctor.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, vitamins, supplements or herbal remedies you're taking.
• Take a family member or friend along. Sometimes it can be difficult to keep track of all the information during an appointment. Someone going with you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Questions you may have at a first visit or follow-up visit after a diagnosis may include:

• What is likely causing my symptoms or condition?
• What are other possible causes for 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?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you several questions. Being ready to answer them may allow more time to cover points you want to address. Your doctor may ask:

• When did you first begin experiencing symptoms?
• Have your symptoms been off-and-on or constant?
• 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?
• Is there a family history of any pancreas disease?