Gastroenterology & Hepatology

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Division of Gastroenterology & Hepatology

Pancreatitis

The pancreas is a gland that sits behind the stomach and spans across the belly.  It is larger than your gallbladder, but smaller than the liver.  The pancreas plays a key role in the digestive system.  Specifically, the pancreas:

  • Secretes digestive juices (enzymes and a substance called sodium bicarbonate) into the small intestine
  • Produces the hormones, including insulin and glucagon, that control your body's ability to use sugar

The digestive juices enter the pancreatic duct, which is a small tube that drains into the small intestine. The digestive juices split the fats, proteins, and carbohydrates into small molecules that can easily be absorbed.

 

What is Pancreatitis?

Pancreatitis is inflammation, or irritation of the pancreas.  This condition usually begins as a sudden episode known as acute pancreatitis, and in some cases, may result in long term damage after severe and/or recurrent attacks, known as chronic pancreatitis.  When the pancreas becomes inflamed, the digestive enzymes attack the pancreas itself.  One of these enzymes, called trypsin, can cause tissue damage and bleeding, and can cause the pancreas cells and blood vessels to swell.  In chronic pancreatitis, scar tissue replaces the normal pancreas tissue and the pancreas may eventually stop producing the enzymes that are necessary for your body to breakdown food and absorb nutrients.  When chronic pancreatitis is advanced, the pancreas can also lose its ability to make insulin resulting in diabetes. The main symptom of chronic pancreatitis, however, is severe abdominal pain.

There are two types of pancreatitis:

Acute pancreatitis: Sudden damage to the pancreas causes it to swell, resulting in pain. It is most often caused by gallstones or alcohol abuse, although there are many other causes as well.  When gallstones pass through the bile duct, they may become stuck at the bottom, blocking both the bile duct and pancreatic duct. This causes enzymes to build up in the pancreas as they cannot drain, resulting in damage to the pancreas.  In the case of alcohol, the pancreas may be sensitive to the toxic effect of alcohol.  An attack may occur anywhere from a few hours to one or two days after drinking alcohol.  The amount of alcohol needed to cause acute pancreatitis will vary from person to person.  Other less common causes of acute pancreatitis are: excessive levels of fat particles known as triglycerides in the blood (hypertriglyceridemia), medications, surgery, genetics, tumor of the pancreas, and idiopathic (unknown cause).  Acute pancreatitis affects about 80,000 Americans every year. Acute pancreatitis usually has a brief course of 2-5 days requiring hospitalization, but it can be severe enough to require a lengthy hospitalization and may even be life threatening.

Chronic pancreatitis: This occurs when repeated and/or severe damage to the pancreas results in extensive scar tissue that replaces the normal pancreas tissue. This condition is usually due to years of excessive alcohol consumption, but may also develop from other causes, including a hereditary gene defect. Rarely, it can lead to pancreatic cancer.

 

What are the Symptoms of Pancreatitis?

Acute pancreatitis:

  • A sudden severe pain in the center part of the upper abdomen goes through to your back; this pain may get worse when you eat and builds to a persistent pain
  • Nausea and vomiting
  • Jaundice (a yellowing of the skin and eyes) due to blockage of the bile duct from the inflamed pancreas

Chronic pancreatitis (not all of these symptoms have to be present):

  • Steady, gnawing upper abdominal pain that may radiate to the back. Tends to be always present.
  • Loose, oily stools that are hard to flush and smell odd.
  • Jaundice (a yellowing of the skin and eyes) due to blockage of the bile duct from the inflamed pancreas
  • New onset of diabetes
  • Weight loss

 

What Should I Do If I Think I Have Pancreatitis?

If your abdominal pain lasts more than 30 minutes call your doctor or go to the emergency room.  Your doctor will take a medical history, ask you about your drinking history, and draw blood to check for pancreatitis.  Imaging of the pancreas with an ultrasound, CT, or MRI may be obtained. The optimal management of severe acute pancreatitis often involves monitoring by specialists that may not be available in every hospital but is offered at Froedtert Hospital. In addition, for chronic pancreatitis, you may require a 48-72hr stool collection to check for poor absorption of fat, and you may require a special type of endoscopy known as endoscopic ultrasound.  This combines ultrasound technology with an endoscope to allow your doctor to examine your pancreas internally for subtle changes.

If you have unexplained weight loss that lasts more than a few weeks, call your doctor.  This could be a warning sign. 

 

What is the treatment for Pancreatitis?

Your doctor will focus treatment on your nutritional and metabolic needs and on relieving your pain.  Mild pain can be treated with analgesics (pain medication).  If the cause of acute pancreatitis is gallstones, you may have to have your gallbladder removed to prevent further attacks.  If the bile duct is enlarged, you may need an ERCP (endoscopic retrograde cholangiopancreatography) to drain it.  An ERCP is a way your doctor can examine your pancreas, pancreatic duct, the common bile duct, and/or sphincter of Oddi (see ERCP page).  It involves passage of a long narrow tube called an endoscope used to put x-ray contrast dye into the bile and pancreas ducats.  In severe cases, surgery will be required to drain the pancreatic duct or to remove part of the pancreas.

 

What Hope for the Future?

If their condition was caused by drinking, they will have a positive outcome if they stop drinking and continue follow-up treatment.

While pancreatitis is still not fully understood, there are some steps you can take to prevent pancreatitis from occurring again:

  • Make sure that your doctor reviews and monitors all your medications because some prescription medications may cause pancreatitis.
  • Stop smoking
  • Stop drinking alcohol (or limit drinking if pancreatitis was not caused by alcohol)
  • Low fat diet
  • In some cases, pancreatic enzyme pills may be helpful

 

 

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Page Updated 09/17/2014