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PancreatitisBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/pancreatitis/DS00371
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|Pancreatitis caused by gallstones|
Pancreatitis is inflammation in the pancreas. The pancreas is a long, flat gland that sits tucked behind the stomach in the upper abdomen. The pancreas produces enzymes that help digestion and hormones that help regulate the way your body processes sugar (glucose).
Pancreatitis can occur as acute pancreatitis — meaning it appears suddenly and lasts for days. Or pancreatitis can occur as chronic pancreatitis, which describes pancreatitis that occurs over many years.
Mild cases of pancreatitis may go away without treatment, but severe cases can cause life-threatening complications.
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Signs and symptoms of pancreatitis may vary, depending on which type you experience.
Acute pancreatitis signs and symptoms include:
- Upper abdominal pain
- Abdominal pain that radiates to your back
- Abdominal pain that feels worse after eating
- Tenderness when touching the abdomen
Chronic pancreatitis signs and symptoms include:
- Upper abdominal pain
- Losing weight without trying
- Oily, smelly stools (steatorrhea)
When to see a doctor
Make an appointment with your doctor if you have persistent abdominal pain. Seek immediate medical help if your abdominal pain is so severe that you can't sit still or find a position that makes you more comfortable.
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|Pancreatitis caused by gallstones|
What happens in pancreatitis
Pancreatitis occurs when digestive enzymes produced in your pancreas become activated while inside the pancreas, causing damage to the organ.
During normal digestion, the inactivated pancreatic enzymes move through ducts in your pancreas and travel to the small intestine, where the enzymes become activated and help with digestion. In pancreatitis, the enzymes become activated while still in the pancreas. This causes the enzymes to irritate the cells of your pancreas, causing inflammation and the signs and symptoms associated with pancreatitis.
With repeated bouts of acute pancreatitis, damage to the pancreas can occur and lead to chronic pancreatitis. Scar tissue may form in the pancreas, causing loss of function. A poorly functioning pancreas can cause digestion problems and diabetes.
Pancreatitis has many causes
A number of causes have been identified for acute pancreatitis and chronic pancreatitis, including:
- Abdominal surgery
- Certain medications
- Cigarette smoking
- Cystic fibrosis
- Endoscopic retrograde cholangiopancreatography (ERCP), when used to treat gallstones
- Family history of pancreatitis
- High calcium levels in the blood (hypercalcemia)
- High levels of parathyroid hormone in the blood (hyperparathyroidism)
- High triglyceride levels in the blood (hypertriglyceridemia)
- Injury to the abdomen
- Pancreatic cancer
Pancreatitis can cause serious complications, including:
- Breathing problems. Acute pancreatitis can cause chemical changes in your body that affect your lung function, causing the level of oxygen in your blood to fall to dangerously low levels.
- Diabetes. Damage to insulin-producing cells in your pancreas from chronic pancreatitis can lead to diabetes, a disease that affects the way your body uses blood sugar.
- Infection. Acute pancreatitis can make your pancreas vulnerable to bacteria and infection. Pancreatic infections are serious and require intensive treatment, such as surgery to remove the infected tissue.
- Kidney failure. Acute pancreatitis may cause kidney failure, which can be treated with dialysis if the kidney failure is severe and persistent.
- Malnutrition. Both acute and chronic pancreatitis can cause your pancreas to produce fewer of the enzymes that are needed to break down and process nutrients from the food you eat. This can lead to malnutrition, diarrhea and weight loss, even though you may be eating the same foods or the same amount of food.
- Pancreatic cancer. Long-standing inflammation in your pancreas caused by chronic pancreatitis is a risk factor for developing pancreatic cancer.
- Pseudocyst. Acute pancreatitis can cause fluid and debris to collect in cyst-like pockets in your pancreas. A large pseudocyst that ruptures can cause complications such as internal bleeding and infection.
Preparing for your appointment
Start by seeing your family doctor or a general practitioner if you have any signs or symptoms that worry you. If your doctor suspects you may have pancreatitis, you may be referred to a doctor who specializes in the digestive system (gastroenterologist).
Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared. Here's some information to help you get ready, and 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 for which you scheduled the appointment.
- Write down key personal information, including any major stresses or recent life changes.
- Make a list of all medications, as well as any vitamins or supplements, that you're taking.
- Take a family member or friend along. Sometimes it can be difficult to absorb all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
- Write down questions to ask your doctor.
Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important, in case time runs out. For pancreatitis, some basic questions to ask your doctor 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 these other health conditions. How can I best manage them together?
- Are there any restrictions that I need to follow?
- Should I see a specialist? What will that cost, and will my insurance cover it?
- Is there a generic alternative to the medicine you're prescribing?
- Are there any brochures or other printed material that I can take with me? What websites do you recommend?
- What will determine whether I should plan for a follow-up visit?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.
What to expect from your doctor
Your doctor is likely to ask you a number of 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 continuous, or occasional?
- How severe are your symptoms?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to 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 medications before your symptoms began?
Tests and diagnosis
Tests and procedures used to diagnose pancreatitis include:
- Blood tests to look for elevated levels of pancreatic enzymes
- Stool tests in chronic pancreatitis to measure levels of fat that could suggest your digestive system isn't absorbing nutrients adequately
- Computerized tomography (CT) scan to look for gallstones and assess the extent of pancreas inflammation
- Abdominal ultrasound to look for pancreas inflammation
- Endoscopic ultrasound to look for inflammation and blockages in the pancreatic duct or bile duct
- Magnetic resonance imaging (MRI) to look for abnormalities in the gallbladder, pancreas and ducts
Your doctor may recommend other tests, depending on your particular situation.
Treatments and drugs
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Treatment for pancreatitis usually requires hospitalization. Once your condition is stabilized in the hospital and inflammation in the pancreas is controlled, doctors can treat the underlying cause of your pancreatitis.
Hospitalization to stabilize pancreatitis
If you're experiencing pancreatitis, your doctor may admit you to the hospital for care. Initial treatments to help control the inflammation in your pancreas and make you more comfortable may include:
- Fasting. You'll stop eating for a couple of days in the hospital in order to give your pancreas a chance to recover. Once the inflammation in your pancreas is controlled, you may begin drinking clear liquids and eating bland foods. With time, you can go back to your normal diet. If your pancreatitis persists and you still experience pain when eating, your doctor may recommend a feeding tube to help you get nutrition.
- Pain medications. Pancreatitis can cause severe pain. Your health care team will give you medications to help control the pain.
- Intravenous (IV) fluids. As your body devotes energy and fluids to repairing your pancreas, you may become dehydrated. For this reason, you'll receive extra fluids through a vein in your arm during your hospital stay.
How long you stay in the hospital will depend on your situation. Some people recover quickly and others develop complications that require a longer hospitalization.
Treating the underlying cause of pancreatitis
Once your pancreatitis is brought under control, your health care team can treat the underlying cause of your pancreatitis. Treatment will depend on the cause of your pancreatitis, but examples of treatment may include:
- Procedures to remove bile duct obstructions. Pancreatitis caused by a narrowed or blocked bile duct may require procedures to open or widen the bile duct. A procedure called endoscopic retrograde cholangiopancreatography (ERCP) uses a long tube with a camera on the end to examine your pancreas and bile ducts. The tube is passed down your throat, and the camera sends pictures of your digestive system to a monitor. ERCP can aid in diagnosing problems in the bile duct and in making repairs.
- Gallbladder surgery. If gallstones caused your pancreatitis, your doctor may recommend surgery to remove your gallbladder (cholecystectomy).
- Pancreas surgery. Surgery may be necessary to drain fluid from your pancreas or to remove diseased tissue.
- Treatment for alcohol dependence. Drinking several drinks a day over many years can cause pancreatitis. If this is the cause of your pancreatitis, your doctor may recommend you enter a treatment program for alcohol addiction. Continuing to drink may worsen your pancreatitis and lead to serious complications.
Additional treatments for chronic pancreatitis
Chronic pancreatitis may require additional treatments, depending on your situation. Other treatments for chronic pancreatitis may include:
- Pain management. Chronic pancreatitis can cause persistent abdominal pain. Your doctor may recommend medications to control your pain and may refer you to a pain specialist. Severe pain may be relieved with surgery to block nerves that send pain signals from the pancreas to the brain.
- Enzymes to improve digestion. Pancreatic enzyme supplements can help your body breakdown and process the nutrients in the foods you eat. Pancreatic enzymes are taken in tablet form with each meal.
- 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.
Lifestyle and home remedies
Once you leave the hospital, you can take steps to continue your recovery from pancreatitis, such as:
- Stop drinking alcohol. 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 don't smoke, don't start. If you can't quit on your own, ask your doctor for help. Medications and counseling can help you quit smoking.
- Choose a low-fat diet. Choose a diet that emphasizes fresh fruits and vegetables, whole grains, and lean protein, and that limits fats.
- Drink more water. Pancreatitis can cause dehydration, so keep a water bottle or glass of water with you during the day to help you remember to drink more water.
Alternative therapies can't treat pancreatitis, but some alternative therapies may help you cope with the pain associated with pancreatitis. People with chronic pancreatitis may experience constant pain that isn't easily controlled with medications. Using complementary and alternative medicine therapies along with medications prescribed by your doctor may help you feel more in control of your pain.
Examples of alternative therapies that may help you cope with pain include:
- Relaxation exercises
Supplements for chronic pancreatitis pain
Some studies have found that vitamin and mineral supplements, such as vitamins A and C and selenium, may help reduce the need for pain medications in people with chronic pancreatitis. But more study is needed. If you're interested in trying vitamin and mineral supplements, discuss this with your doctor. Your doctor may be able to suggest what supplements and doses are safe for you to try.
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- Forsmark CE. Chronic pancreatitis. In: Feldman M, et al. Sleisenger & Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 9th ed. Philadelphia, Pa.: Saunders Elsevier; 2010. http://www.mdconsult.com/books/about.do?eid=4-u1.0-B978-1-4160-6189-2..X0001-7--TOP&isbn=978-1-4160-6189-2&about=true&uniqId=229935664-2192. Accessed Nov. 18, 2010.
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- Understanding pancreatitis. American Gastroenterological Association. http://www.gastro.org/patient-center/digestive-conditions/pancreatitis. Accessed Nov. 18, 2010.
- Sareen S, et al. Yoga: A tool for improving the quality of life in chronic pancreatitis. World Journal of Gastroenterology. 2007;13:391.
- Bhardwaj P, et al. A randomized controlled trial of antioxidant supplementation for pain relief in patients with chronic pancreatitis. Gastroenterology. 2009;136:149.