Understanding pancreatitis: Causes, symptoms and treatment options

The pancreas is a long, flat gland that is found behind the stomach in the upper abdomen. Its role in the body is to produce enzymes that help digestion and hormones that help regulate the way your body processes sugar.

Pancreatitis is inflammation of the pancreas. It can occur as acute pancreatitis, meaning it appears suddenly and lasts for a few days. Some people develop chronic pancreatitis, which occurs over many years.

Mild cases of pancreatitis improve with treatment, but severe cases can cause life-threatening complications. Make an appointment with your doctor if you have acute onset or persistent abdominal pain.

Seek immediate medical help if your abdominal pain is so severe you can’t sit still or find a position that makes you more comfortable.

Symptoms of pancreatitis

Signs and symptoms of pancreatitis are different depending on whether it is acute or chronic.

Acute signs and symptoms include:

• Upper abdominal pain.
• Abdominal pain that radiates to your back.
• Tenderness when touching the abdomen.
• Fever.
• Rapid pulse.
• Nausea
• Vomiting

Chronic signs and symptoms include:

• Upper abdominal pain.
• Abdominal pain that feels worse after eating.
• Losing weight even when not exercising or on a diet.
• Oily and smelly stools (steatorrhea).

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Causes

Pancreatitis occurs when digestive enzymes become activated while still in the pancreas, irritating the cells of your pancreas and causing inflammation.

With repeated episodes 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. When the cause for pancreatitis is not found it is known as idiopathic pancreatitis.

Conditions that can lead to acute pancreatitis include:

• Gallstones.
• Alcoholism.
• Certain medications.
• High fat or triglyceride levels in the blood.
• High calcium in the blood.
• Pancreatic cancer.
• Abdominal surgery.
• Cystic fibrosis.
• Infection.
• Injury to the abdomen.
• Obesity.
• Trauma.
• Endoscopic retrograde cholangiopancreatography, a procedure to treat gallstones, also can lead to pancreatitis.

Risk factors

Factors that increase your risk of pancreatitis include:

• Excessive alcohol.
• Cigarette smoking. Smokers are three times more likely to develop chronic pancreatitis.
• Quitting smoking decreases your risk by about half.
• Obesity. You’re more likely to get pancreatitis if you’re obese.
• Diabetes. Having diabetes increases your risk of pancreatitis.
• Family history of pancreatitis.

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Complications

Pancreatitis can cause serious complications, including:

• Kidney failure.
• Breathing problems. Caused by low levels of oxygen in your blood.
• Infection. Acute pancreatitis can make your pancreas vulnerable to bacteria and infection.
• 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.
• Malnutrition. Both acute and chronic pancreatitis can cause your pancreas to produce fewer of the enzymes needed to process nutrients from. This can lead to malnutrition, diarrhoea and weight loss.
• Diabetes. Damage to insulin-producing cells in your pancreas from chronic pancreatitis can lead to diabetes.
• Pancreatic cancer. Longstanding inflammation in your pancreas caused by chronic pancreatitis is a risk factor for developing pancreatic cancer.

Treatment

Initial treatments in the hospital may include:

• Early eating. Eating as soon as you tolerate food helps heal the pancreas. As the inflammation lessens and pain symptoms improve, you should begin drinking clear liquids and eating bland foods. In time you can go back to your normal diet. If your pancreatitis symptoms persist and you still experience pain when eating, your doctor may recommend a feeding tube.

• Pain medications. Pancreatitis can cause severe pain. Your health care team will give you medication to 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 yourarm during your hospital stay.

Once your pancreatitis is under control, your health care team will evaluate and treat the underlying cause of your pancreatitis. Depending on the cause of your pancreatitis, treatment may include:

• ERCP procedure (Endoscopic retrograde cholangiopancreatography). It is a procedure 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 cholangiopancreatographyuses a long tube with a camera on the end to examine your pancreas and bile ducts.

• Gallbladder surgery. If gallstones caused your pancreatitis, your doctor will recommend surgery to remove your gallbladder.

• Pancreas procedures. Endoscopic procedures may be necessary to drain fluid or to remove diseased tissue.

Treatment for alcohol dependence:

• Drinking several drinks a day for years can cause pancreatitis. In this case your doctor may recommend an anti-addiction programme.

• Medication changes: If a medication is a cause of acute pancreatitis, your doctor may stop the medication and work with you to find alternative options.

• Enzymes to improve digestion. In chronic pancreatitis leading to diarrhoea or weight loss, pancreatic enzyme supplements can help your body process food.

• Diet changes. Your doctor may refer you to a dietitian to help plan low-fat meals high in nutrients.

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