The most common cause of acute pancreatitis is the presence of gallstones which are small, pebble-like structures made of hardened bile that cause inflammation in the pancreas as they pass through the common bile duct. Chronic, heavy alcohol abuse is also another common cause. Acute pancreatitis can occur within hours or as long as two days after consuming alcohol.
Other causes of acute pancreatitis include abdominal trauma, reactions to certain medications, infections, tumors and genetic abnormalities of the pancreas.
Chronic pancreatitis, similar to acute pancreatitis, occurs when digestive enzymes attack the pancreas and nearby tissues causing episodes of pain. This condition usually affects people who are between 30 and 40 years of age. The most common cause of chronic pancreatitis is many years of alcohol abuse. The chronic type of pancreatitis can be triggered by one acute attack that damages the pancreatic duct. This damaged duct causes the pancreas to become inflamed.
Other causes of chronic pancreatitis include hereditary disorders of the pancreas, cystic fibrosis, hypercalcemia (high levels of calcium in the blood), hyperlipidemia or hypertriglyceridemia (high levels of blood fats), reactions to certain medications, particular autoimmune conditions and some unknown causes which researchers still have not grown to fully understand.
Acute pancreatitis usually begins with gradual or sudden pain in the upper abdomen region which sometimes extends through the back. This pain may be mild at first and worsen after eating. The pain is often severe and may become more constant and last several days. The individual with the condition usually looks and feels very ill and requires immediate medical attention.
Other symptoms of acute pancreatitis include:
- A swollen or tender abdomen
- Nausea and vomiting
- Fever
- Rapid pulse
Severe and ignored acute pancreatitis may cause dehydration and low blood pressure. The heart, lungs and even kidneys can fail. If bleeding occurs in the pancreas, shock and even death may follow. If you experience any or a combination of the symptoms, seek medical help immediately.
Chronic pancreatitis brings upper abdominal pain, although some people have no pain at all. This pain may also spread to the back and feel worse after eating or drinking. It may become constant and disabling to the individual. In some cases of chronic pancreatitis, this abdominal pain goes away while the condition worsens internally, most likely because the pancreas is no longer making digestive enzymes.
Other symptoms of chronic pancreatitis include:
- Nausea
- Vomiting
- Weight Loss
- Diarrhea
- Oily Stools
People living with chronic pancreatitis often lose weight, even when appetite and eating habits are regular. The weight loss occurs because the body is not secreting enough pancreatic enzymes to digest food properly so nutrients are not absorbed through food normally. Poor digestion leads to malnutrition due to excretion of fat in the stool.
Getting medical treatment for acute pancreatitis is essential. Acute pancreatitis can develop into various complications if left untreated or ignored. Gallstones that cause acute pancreatitis require surgical removal of the stones and of the gallbladder. If an infection develops, surgery may be necessary in order to drain the infected area as well as explore the source of the bleeding to rule out conditions that resemble pancreatitis or even to remove damaged pancreatic tissue.
Pseudocysts, accumulations of fluid and tissue debris, may develop in the pancreas and if left untreated could allow enzymes and toxins to enter the bloodstream. These toxins would affect the heart, lungs, kidneys and other organs. The condition can also lead to kidney failure which would then require dialysis or a kidney transplant to cure.
In rare cases, acute pancreatitis can cause breathing problems. Hypoxia can develop, which is a condition that occurs when the body cells and tissues do not get enough oxygen. Some with this complication may experience lung failure and require a transplant.
I am experiencing symptoms of pancreatitis but do not abuse alcohol. Am I still at risk for the condition?
- Yes, ultimately while heavy alcohol consumption and abuse is a fundamental cause of acute and chronic pancreatitis, it is not the only cause. Especially in the case of acute pancreatitis, there are multiple causes which could explain the onset of symptoms. Other causes include abdominal trauma, reactions to certain medications, infections, tumors and genetic abnormalities. Even if you are not a drinker, if you identify or suspect you may identify with one of these factors, seek medical attention immediately for pancreatitis testing.
Is there research being conducted to learn more?
- Yes, The National Institute of Diabetes and Digestive and Kidney Diseases’ Division of Digestive Diseases and Nutrition supports basic and clinical research into gastrointestinal diseases, including potential causes of pancreatitis as well as cell injury in the gastrointestinal tract. Also, researchers are currently studying the genetics of hereditary pancreatitis including risk factors such as cystic fibrosis. For information on current studies, visit www.ClinicalTrials.gov.
The pancreas is a glandular organ located in the abdomen that creates digestive juices which contain necessary enzymes that aid in the digestion process. These enzymes join with bile, a liquid produced in the liver and stored in the gallbladder, to help break down and digest food. The pancreas also releases the hormones insulin and glucagon into the bloodstream. These hormones help to regulate the level of glucose (blood sugar) present in the bloodstream at any given time.
Pancreatitis occurs when pancreas becomes inflamed. Typically, digestive enzymes secreted by the pancreas do not become active until they reach the small intestine. However, when the pancreas is inflamed, the enzymes within it attack and damage the tissues which produce them.
Pancreatitis can either be acute or chronic. Both forms are serious and can lead to complications such as bleeding, infection and permanent tissue damage.
Acute pancreatitis is inflammation of the pancreas that occurs suddenly and will usually resolve in a few days with proper treatment. Each year, about 210,000 people in the United States are admitted to hospitals with acute pancreatitis. Chronic pancreatitis is inflammation of the pancreas that does not heal or improve, instead this condition is progressive and worsens over time, leading to permanent damage.
Both acute and chronic pancreatitis occur more often in men than in women. Pancreatitis is rare in children although trauma to the pancreas and hereditary pancreatitis are two known causes of childhood pancreatitis. Children with cystic fibrosis, a progressive lung disease without cure, may be at risk for developing pancreatitis.
Treatment for acute pancreatitis requires a in a hospital for IV fluids, antibiotics and medication to help in relieving pain. The individual will not be allowed to eat or drink so that the pancreas can rest and take a break from working to digest substances. Unless further complications arise, the condition usually goes away with treatment in a few days. In more severe cases, the patient may need nasogastic feeding when a special liquid is given in a long, thin tube inserted through the nose and throat into the stomach. After treatment, the patient should not smoke, drink alcohol or eat fatty meals.
Therapeutic Endoscopic Retrograde Cholangiopancreatography (ERCP) can be used in the treatment of both acute and chronic pancreatitis. ERCP is a technique used to view the pancreas, gallbladder and tile ducts in order to treat complications of the condition such as gallstones, narrowing or blockage of the pancreatic duct or bile ducts, leaks in the bile ducts and accumulations of fluid and tissue debris. After lightly sedating the patient, medication is given to numb the throat and the doctor inserts an endoscope with a small camera, into the mouth, throat, stomach and into the small intestine. The doctor then inserts dye to more clearly see the pancreas, bile ducts and gallbladder.
The following procedures can be performed using the ERCP:
- Sphincterotomy: Using a small wire on the endoscope, the doctor then finds the muscle surrounding the pancreatic or bile duct and makes a tiny cut to enlarge the duct opening. When a pseudocyst is present, the duct is drained.
- Gallstone Removal: The endoscope is used to remove stones built up in the pancreatic and bile ducts with a tiny basket. This procedure can be performed with a sphincterotomy.
- Stent Placement: The doctor places a tiny piece of plastic or metal which resembles a straw in a narrowed pancreatic or bile duct to widen it as well as keep it open.
- Balloon Dilatation: Certain endoscopes can be used that come with a small ballon which the doctor uses to dilate or stretch narrowed pancreatic or bile duct. A temporary stent then may be placed there in order to keep the duct open for a few months.
Treatment for chronic pancreatitis may require hospitalization as well for pain management, IV hydration and nutritional support. Once a normal diet is resumed, your doctor may prescribe synthetic pancreatic enzymes if the pancreas is still unable to secrete enzymes on its own. These enzymes should be taken with every meal and will help the individual digest food and regain some weight which has been lost. The next step in treatment is to begin incorporating a healthy diet low in fat in small, frequent meals.
In addition, those living with chronic pancreatitis should not drink alcohol or smoke and limit their caffeine consumption. They should make sure to drink plenty of fluids as well.
Living with acute or chronic pancreatitis can be incredibly disrupted as the pain is severe and often disabling. Once you experience one or more symptoms, seek medical treatment immediately in order to avoid further risk. The condition takes vigilance and a quick response time.
A diagnosis of acute or chronic pancreatitis can also be the indicator you may need in order to make a necessary lifestyle change to improve your health. Because the main cause of chronic pancreatitis is continued and substantial alcohol abuse, this could be the wake up call required to quit smoking and consuming alcohol. To make the transition easier, ask your family to participate in your new lifestyle and make sure your office and home space are free of these temptations.
Your doctor may recommend seeing a nutritionist which could provide much help and guidance to assist you in regaining your health. Start a diet that is low in fats and eat smaller and more frequent meals throughout the day. Talk to your nutritionist or dietitian and work together to form a meal plan which could make following this regimen easier to stick to. Drink plenty of liquids and limit your intake of caffeine.
The pain an individual may feel while suffering from acute pancreatitis will most likely drive them to seek medical help on their own. If you are experiencing any of the symptoms of acute or chronic pancreatitis, seek medical help as soon as possible to avoid complications and further internal risk.
Your doctor will conduct a physical examination, including a blood test. With acute pancreatitis, the blood contains at least three times the normal amount of amylase and lipase, which are two digestive enzymes normally found within the pancreas.
However, sometimes diagnosing acute pancreatitis can be difficult as the pancreas is located deep in the abdomen, making testing tough. There are tests available for easier diagnosis:
- Abdominal ultrasound: Sound waves are sent toward the location of the pancreas through a handheld device that is glided over the abdomen. These sound waves proceed to bounce off the pancreas, gallbladder, liver and other internal organs making a sonogram from electrical impulses. If gallstones are causing inflammation the sound waves will show their location.
- CT scan: This noninvasive x-ray can be utilized to show gallstones and the extent of damage to the pancreas.
- Endoscopic ultrasound (EUS): A solution is sprayed to numb the patient’s throat followed by a doctor inserting an endoscope, a thin flexible lighted tube, down the throat and into the small intestine. An ultrasound is used to produce sound waves creating visual images of the pancreas and bile ducts in order to asses damage.
- Magnetic resonance cholangiopancreatography (MRCP): A MRCP uses magnetic resonance imagine which produces cross-section images of parts of the body. After being lightly sedated, the patient lies in a cylinder-like tube while the technician injects a dye into the patient’s veins. This helps to show the doctor the pancreas, gallbladder and pancreatic and bile ducts.
Chronic pancreatitis can sometimes be confused with acute pancreatitis as the symptoms are similar for both. Blood testing will not work in the case of chronic pancreatitis as the enzymes sometimes appear normal even when the individual has the condition. When the condition is more progressed and severe, malabsorption and diabetes can occur which may be when the doctor orders blood, urine and stool tests to help in diagnosing the condition and monitor its progression.
In the case of chronic pancreatitis, the doctor may use tests used in the diagnosis of acute pancreatitis such as an abdominal ultrasound, CT scan, EUS and MRCP.