Understanding Pancreatitis

~ by Jo Jordan

Pancreatitis is an inflammatory condition that occurs when pancreatic digestive enzymes become active inside the pancreas before they have a chance to reach the small intestine. As a result, the enzymes attack the pancreas rather than the food they are designed to break down.

 

Why Is a Healthy Pancreas So Vital?

An integral component of the digestive system, the pancreas secretes the digestive enzymes that help digest fats, proteins, and carbohydrates. It also releases insulin and glucagon, hormones that assist the body in using the glucose it derives from food for energy.

 

Acute Pancreatitis

Acute pancreatitis occurs suddenly, lasts just a few days, and is normally resolved with simple dietary changes. Approximately 80,000 acute pancreatitis cases occur in the United States each year, with about twenty percent of them being classified as severe.1

Some sufferers experience more than one acute attack from which they completely recover. Acute pancreatitis, however, can be extremely serious, has far-reaching ramifications, including breathing problems and fatality.

 

Chronic Pancreatitis

Chronic pancreatitis develops gradually and persists over many years. It does not resolve itself, but instead leads to scarring, and the eventual destruction of the pancreas and nearby tissues.

 

Signs and Symptoms of Pancreatitis

Sufferers of both acute and chronic pancreatitis may experience mild to severe abdominal pain, often with nausea, vomiting, and fever.

The onset of acute pancreatitis is usually sudden, and is marked by a few days of mild to severe pain in the upper abdomen. The pain may be constant, and can eventually radiate to the back and other areas; it may increase in intensity when food or alcohol is ingested.

Other symptoms include a sickly complexion, a swollen and/or tender abdomen, and a rapid pulse. In severe cases, dehydration and low blood pressure can occur.

Chronic pancreatitis can take several years to exhibit signs and/or symptoms, and some people never experience pain. Most, however, have intermittent abdominal pain and, as with acute pancreatitis, it worsens when they eat or drink, and can eventually spread to the back and/or become constant.

The abdominal pain sometimes ends when – it is believed – the pancreas stops making digestive enzymes. Other symptoms include weight loss, fatty and/or foul-smelling stools, and diabetes. Chronic pancreatitis can also lead to malnutrition, drug addiction, and pancreatic cancer.

Both acute and chronic pancreatitis can lead to serious, long-term complications. Bleeding, infection, abscesses, and tissue damage may occur, and pseudocysts – a result of fluid and tissue debris build-up – can develop.

In addition, enzymes and toxins may enter the bloodstream; the heart, kidneys, lungs, and/or other organs may fail. If bleeding occurs in the pancreas, shock and death may result.2

Hereditary pancreatitis is marked by its presence in two or more family members within the same generation. While the genetic defect that causes the disease is present at birth, symptoms do not normally present themselves until the second decade of life. In fact, hereditary pancreatitis may not be diagnosed until early adulthood. In most cases, attacks (as described in acute pancreatitis, above) progress into chronic pancreatitis.

 

Causes and Risk Factors for Pancreatitis

While the cause of pancreatitis is often excessive alcohol consumption and/or gallstones, there are many other contributing factors, and it is likely a combination of issues that leads to onset:

  • Abdominal trauma
  • Bacterial infections
  • Blockage of pancreatic duct due to trauma or pseudocysts
  • Certain autoimmune conditions
  • Congenital conditions such as pancreas divisum
  • Cystic fibrosis
  • Ethnicity – black Americans are more likely to develop acute pancreatitis than white Americans
  • Gallbladder disease
  • Gender – men are more likely to develop pancreatitis than women
  • Gene abnormalities
  • Genetic mutations – abnormalities in one or more genes may predispose an individual to pancreatitis
  • Heredity
  • High levels of blood fats
  • High levels of calcium in the blood
  • Pancreatic cancer
  • Some medications, including corticosteroids and nonsteroidal anti-inflammatory drugs, blood pressure lowering drugs, antibiotics, and medications that suppress the immune system
  • Structural abnormalities of the pancreas or the common bile duct
  • Surgery, usually of the abdomen
  • Unknown causes
  • Viral infections, including the mumps, hepatitis, and Epstein-Barr virus

 

Diagnosing Pancreatitis

It can be difficult to diagnose pancreatitis, especially the chronic variety. In addition to a medical history and physical examination, various tests are used to secure an accurate diagnosis.

To diagnose acute pancreatitis, the following tools are used:3

  • Elevated levels of the pancreatic enzymes, amylase, and lipase
  • Elevated liver enzymes and bilirubin
  • Elevated white blood cell count
  • High blood sugar (hyperglycemia)
  • Levels of bicarbonate, glucose, magnesium, potassium, and sodium
  • Low calcium level

In addition, an ultrasound, endoscopic retrograde cholangiopancreatography (ERCP), or a computerized axial tomography (CAT) scan of the abdomen may be used to examine the pancreas and check for gallstones, a duct problem, pseudocysts, or inflammation and/or destruction of the gland. An X-ray of the abdomen and chest is used to rule out other possible causes of the symptoms being experienced.

To diagnose chronic pancreatitis, the following tools are used:

  • Blood tests
  • Urine tests
  • Stool tests
  • Ultrasound
  • X-rays of bile and pancreatic ducts

If malabsorption or weight loss has been an issue, a pancreatic function test may be required to measure the gland’s ability to secrete a sufficient supply of enzymes or other substances necessary for digestion.

 

Treating Pancreatitis

The specific treatment regimen for pancreatitis depends partially on the cause, which is why testing to determine what is responsible for bringing on the disease is vital.

Treatment is designed to maintain and support bodily functions, and prevent complications. It involves pain relief; limiting oral intake (especially fat restriction) through the implementation of a feeding tube to avoid stimulating the pancreas, and steer clear of infection caused by bowel flora; ensuring that adequate fluids and salts are received intravenously; and monitoring for various complications associated with the disease.

Acute pancreatitis treatment can include antibiotics, intravenous fluids, oxygen, and/or surgery. A hospital stay is generally required in order to replace bodily fluids intravenously. If pancreatic pseudocysts are involved, and they are relatively large, it may be necessary to surgically remove or drain them. Sometimes surgery is necessary to remove gallstones, the gallbladder, or part of the pancreas itself.

Treatment for chronic pancreatitis involves pain relief, and the implementation of a high-carbohydrate, low-fat diet, and pancreatic enzyme supplements to be taken with meals to help with digestion and weight loss.

Enzyme therapy can be helpful in treating malabsorption problems. In addition, potent pancreatic enzymes for pain are effective for some people. Enzyme therapy increases the levels of enzymes in the duodenum, which in turn decreases the secretion of enzymes by the pancreas, reducing secretion pressure — and in turn the pain — within the pancreas.4

Sometimes insulin or other drug treatments are needed in order to control diabetes and blood glucose issues. It may also be necessary to assist in alcohol and/or drug dependency.

 

Reducing the Number of Pancreatitis Attacks and Minimizing Symptoms

While most people with acute pancreatitis recover completely, chronic pancreatitis is associated with lifelong symptoms such as pain and malabsorption. In both cases, it is crucial to do whatever is possible to care for your pancreas.

  • Avoid alcohol
  • Drink plenty of fluids
  • Eat smaller meals
  • Implement a high-carbohydrate diet
  • Limit dietary fat
  • Use safe methods to control pain