Inflammation of the Pancreas

Inflammation of the pancreas or pancreatitis is one of the common health problems. Pancreas is a large, flat gland located just behind the stomach adjacent to duodenum (upper part of the small intestine) in the upper abdomen. Secretion of digestive enzymes into the small intestine through the pancreatic duct is the main pancreas function. These enzymes are essential for the digestion of proteins, fats and carbohydrates. It also produces the hormones insulin and glucagon. These hormones play an important role in maintaining the blood glucose levels. Deficiency of insulin can increase the blood sugar levels, leading to diabetes. Inflammation of the pancreas or pancreatitis is caused by various reasons. There are two forms of pancreatitis such as acute pancreatitis and chronic pancreatitis. Let’s understand in detail about the causes, symptoms and treatment of acute and chronic pancreatitis.

Types of Pancreatitis

Inflammation of the pancreas may be acute (sudden and short-term) or chronic (long-term and ongoing). Acute pancreatitis causes severe inflammation of the pancreas and lasts for a short period of time. In most cases, acute pancreatitis results from alcoholism or gallstones. It may be mild causing abdominal discomfort or severe causing life-threatening conditions such as tissue damage, bleeding and infection. About 80,000 people are diagnosed with acute pancreatitis in the United States.

Chronic pancreatitis usually follows the episodes of acute pancreatitis. It results from damage of pancreas by the digestive enzymes, causing pain and scarring. The main cause of chronic pancreatitis is prolonged alcohol abuse. Read on to know more about the causes of pancreatitis.

Causes of Pancreatitis

The two main causes of pancreatitis, i.e. formation of gallstones and alcoholism, account for about 80-90% of cases. Pancreatitis from alcoholism occurs due to long-term intake of alcoholic drinks. Formation of gallstones in the gallbladder can cause blockage in the pancreatic duct, which leads to accumulation of digestive juices within the pancreas, thus resulting in inflammation of the pancreas. During the normal digestion process, pancreatic enzymes in the inactive form are released to the small intestine through the pancreatic duct. They become active in the small intestine. In case of pancreatitis, the enzymes become active within the pancreas and begin to digest the pancreatic tissues; this process is known as autodigestion. This can cause irritation of pancreatic cells, leading to inflammation of the pancreas. Pancreatitis may occur due to different reasons, depending on whether it is acute or chronic.

Acute Pancreatitis: Acute pancreatitis occurs suddenly and in most cases, it is severe. The major causes of acute pancreatitis are gallstones, gallbladder disease and alcoholism. It is also caused by common bile duct surgical procedures, traumatic injury, abnormal structure of the pancreas, genetic factors, hypertriglyceridemia (high lipid levels in the blood) and certain medications such as corticosteroids, estrogens and thiazide diuretics. Certain viral and bacterial infections such as mumps, mycoplasma pneumonia and coxsackie B can also contribute to acute pancreatitis. In children, acute pancreatitis is usually associated with cystic fibrosis, mumps, abdominal trauma, Reye syndrome, Kawasaki disease and Hemolytic-uremic syndrome.

Chronic Pancreatitis: Acute pancreatitis is typically followed by chronic pancreatitis. It causes scarring and inflammation of the pancreatic tissues. It also interferes with the production of digestive enzymes and insulin. Most often, chronic pancreatitis is caused by alcohol abuse over a prolonged period of time. Some other conditions that can lead to chronic pancreatitis are chronic narrowing or blockage of the pancreatic duct due to trauma or formation of pseudocysts, hyperparathyroidism and hyperlipidemia. Chronic pancreatitis is more common in men than in women.

Symptoms of Pancreatitis

Abdominal pain that starts suddenly or gradually in the upper abdomen is one of the main symptoms of pancreatitis. The signs and symptoms vary according to the type of pancreatitis.

Acute Pancreatitis: Acute pancreatitis causes severe and persistent pain the upper abdomen. It may spread to the back or below the left shoulder blade. Pain may worsen with lying on the back or after eating high fat content foods or drinking alcohol. Some other symptoms of acute pancreatitis are nausea, vomiting, fever, rapid pulse, sweating and swollen and tender abdomen. Acute pancreatitis can also cause indigestion, gaseous abdominal fullness, swollen abdomen, hiccups, clay-colored stools and skin rash. In some severe cases of acute pancreatitis, there may be dehydration, fatigue, lethargy, headache, low blood pressure, renal failure or heart failure.

Chronic Pancreatitis: In case of chronic pancreatitis, some people may experience pain in the upper abdomen, while some may not. Pain occurs gradually, is continuous and may last from a few hours to some days. Pain may worsen after eating and drinking. Some other symptoms of chronic pancreatitis are vomiting, nausea, indigestion, digestive problems, smelly and fatty stools (steatorrhea) and unintentional weight loss. Weight loss is most often in chronic pancreatitis, because pancreatic enzymes are not secreted in adequate amounts to break down the food. It can interfere with normal absorption of the nutrients. Due to poor digestion, there may be excretion of proteins, sugars and fats into the stool. Thus, the body is deprived of essential nutrients, which results in weight loss.

Complications of Pancreatitis

If left untreated, both acute and chronic pancreatitis can cause some severe complications. Acute pancreatitis can cause breathing problems due to certain chemical changes in the body. This can affect lung function. There is an increased risk of bacterial infection in the pancreas due to acute pancreatitis. Acute pancreatitis can also cause accumulation of fluid and debris within the pancreas, leading to formation of a large pseudocyst. If this pseudocyst ruptures, it may result in infection and internal bleeding.

Chronic pancreatitis can cause damage to islet cells that produce insulin in the pancreas. This may result in increased blood sugar levels, leading to diabetes. Chronic pancreatitis is considered as a risk factor for pancreatic cancer. Both acute and chronic pancreatitis can lead to malnutrition and weight loss due to inadequate digestion of food and malabsorption of nutrients.

Diagnosis of Pancreatitis

Pancreatitis is diagnosed on the basis of findings of physical examination, imaging tests and certain laboratory investigations such as blood tests and stool tests. There are different diagnostic criteria for acute and chronic pancreatitis.

Acute Pancreatitis: In physical examination, the physician checks for fever, low blood pressure, rapid breathing rate and rapid heart rate. Certain blood tests are performed to detect the levels of serum amylase and lipase as well as urine amylase. Amylase and lipase are the digestive enzymes produced in the pancreas. The levels of amylase and lipase are increased in acute pancreatitis. Some other blood tests such as complete blood count, determination of blood glucose and serum calcium are also performed. Imaging tests such as abdominal CT scan, MRI scan and ultrasound are performed to detect gallstones and damage to pancreatic cells.

Chronic Pancreatitis: Diagnosis of chronic pancreatitis involves certain tests such as fecal fat test and blood tests such as determination of serum amylase, lipase and trypsinogen. Imaging tests such as abdominal CT scan, ultarsound and endoscopic retrograde cholangiopancreatography (ERCP) are carried out to detect inflammation or calcium deposits in the pancreas. Exploratory laparotomy can be done for the confirmation of pancreatitis.

Treatment of Pancreatitis

Since pancreatitis can cause life-threatening complications, it usually needs immediate medical attention and hospitalization. The treatment of pancreatitis is aimed at relieving pain, reducing stimulation of the pancreas, preventing indigestion and replacing the fluids by intravenous infusion. Once inflammation in the pancreas is controlled and patient’s condition is stabilized, then the treatment is given to cure the underlying cause of pancreatitis.

When diagnosis of pancreatitis is confirmed, immediate hospitalization is recommended. Initial treatments are given to control the inflammation. Patient is asked to stop eating for a couple of days. Analgesics are given in order to relieve abdominal pain. Due to loss of fluids, the patient may suffer from dehydration which is countered with intravenous fluids. Once inflammation is controlled, patient diet is gradually shifted to liquids and bland foods. Normal diet can be started after recovery. Patients are advised to add adequate amounts of calcium and vitamins in their diet.

Once pancreatitis is controlled, the physician starts the treatment for underlying causes. The treatment option depends upon the cause of pancreatitis. If pancreatitis is caused by gallstones, then cholecystectomy (gallbladder surgery) is recommended to remove the gallbladder. If pancreatitis is caused by narrowing or blockage of the bile duct, then a surgical procedure called endoscopic retrograde cholangiopancreatography (ERCP) is performed in order to widen or open the bile duct. Pancreas surgery is recommended to remove the affected pancreatic tissues or to drain fluids from the pancreas. Since alcoholism and alcohol abuse is the main cause of pancreatitis, a treatment program for alcohol addition is very essential. If intake of alcoholic drinks is continued, then it can worsen the pancreatitis, leading to serious complications.

Additional treatment is required for the treatment of chronic pancreatitis. It includes pain management with pain relievers, pancreatic enzyme supplements to improve digestion and certain changes in diet such as low-fat meals.

There are some alternative treatments for pancreatitis. Certain therapies such as meditation, yoga and relaxation techniques can help to cope with abdominal pain. Mineral and vitamin supplements such as vitamin C, vitamin A and selenium can help to reduce the pain of chronic pancreatitis.

In order to prevent this serious health condition, you should have a nutritious, healthy diet that contains low-fat foods and high amounts of whole grains, fresh vegetables and fruits. You can minimize the risk of pancreatitis, by giving up unhealthy habits such as drinking alcohol and smoking.