Pancreas

Acute Pancreatitis

What is Acute Pancreatitis?

The pancreas is an organ located behind your stomach. It makes enzymes, which are special proteins that help digest your food. It also makes hormones that control the level of sugar in your bloodstream. Pancreatitis means inflammation of the pancreas. Acute pancreatitis means the inflammation develops quickly, over a few days or so. It often goes away completely and leaves no permanent damage. Sometimes it is serious.

What happens in Acute Pancreatitis?

The digestive chemicals (enzymes) that are made in the pancreas become activated and start to 'digest' parts of the pancreas. They are normally only activated after they reach the part of the gut just after the stomach (the duodenum). This leads to a range of chemical reactions that cause inflammation in the pancreas. How the above causes actually trigger this sequence of events is not clear.

1. In most cases (about 4 in 5), the inflammation is mild and settles within a week or so. Symptoms may be bad for a few days but then settle and the pancreas fully recovers.
2. In some cases (about 1 in 5) the inflammation quickly becomes severe. Parts of the pancreas and surrounding tissues may die (necrose). Pancreatic enzymes and chemicals may get into the bloodstream and cause inflammation and damage to other organs in the body. This can lead to shock, respiratory failure, kidney failure and other complications. This is a very serious situation which can be fatal.

What are the causes of Acute Pancreatitis?

Gallstones or alcohol cause more than 8 in 10 cases. Other causes are rare.

1. Gallstones – This is the most common cause . A gallstone can pass through the bile duct and out into part of the gut just after the stomach (the duodenum). This usually does not cause a problem. However, in some people a gallstone becomes stuck in the bile duct or where the bile duct and pancreatic duct open into the duodenum. This can affect the chemicals (enzymes) in the pancreatic duct (or even block them completely) and trigger a pancreatitis.
2. Alcohol - about a third of cases of acute pancreatitis are associated with alcohol, although the relationship is not clear. Few individuals who abuse alcohol go on to develop alcoholic pancreatitis. However, it seems that whilst alcohol itself does not damage the cells of the pancreas, it makes them more sensitive to damage from other causes such as smoking, high fat content in the blood or infections. Many patients with chronic alcoholic pancreatitis have a history of recurrent acute pancreatitis triggered by alcohol abuse.
3. High blood fat levels - hypertriglyceridaemia. This is reported to cause 1-4% of all cases of acute pancreatitis and up to 56% of pancreatitis cases during pregnancy.
4. Uncommon causes - include the following:
1. Viral infections (for example, the mumps virus, HIV).
2. A rare side-effect to some medicines.
3. Injury or surgery around the pancreas.
4. Infections with parasites (parasites are living things (organisms) that live within (or on) another organism).
5. High blood calcium levels.
6. Abnormal structure of the pancreas.
7. There is also a rare form of pancreatitis which can be inherited from a parent (hereditary).
5. Autoimmune - your own immune system attacks the pancreas. This can be associated with other autoimmune diseases - for example, Sjögren's syndrome and primary biliary cirrhosis.
6. Unknown - no cause is found in about 1 in 10 cases. However, a number of these cases are probably due to tiny gallstones or 'gallstone sludge' which passes through the bile duct but is too small to be seen on scans or other tests.

What are the symptoms of Acute Pancreatitis?

Pancreatitis can cause serious complications, including:

1. Pseudocyst. Acute pancreatitis can cause fluid and debris to collect in cystlike pockets in your pancreas. A large pseudocyst that ruptures can cause complications such as internal bleeding and infection.
2. 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.
3. Kidney failure. Acute pancreatitis may cause kidney failure, which can be treated with dialysis if the kidney failure is severe and persistent.
4. 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.

What is the treatment of Acute Pancreatitis?

The treatment depends on how bad your attack of acute pancreatitis is. There is no specific treatment that will take the inflammation away. However, in most cases the pancreatitis settles over a few days, although symptoms can get worse before they get better.

1. Strong painkillers by injection are usually needed to ease the pain.
2. A tube may occasionally also be passed down your nose into your stomach (nasogastric tube) to suck out the fluid from your stomach. This can be useful if you are being sick (vomiting) a lot.
3. A nasogastric tube may also be passed into the stomach to feed you, as you will not be able to eat properly.
4. A 'drip' is needed to give fluid into your body until symptoms settle.
5. A catheter - a thin tube going into your bladder to drain urine - is likely to be inserted so the doctors can monitor accurately the amount of urine you are passing.

Less commonly, complications develop and the situation can become very serious. Other treatments that may then be needed include the following:

1. Intensive care treatment. If you have a severe attack of pancreatitis then you will be monitored very closely in the intensive care unit.
2. A procedure to remove a blocked gallstone if this is found to be the cause.
3. Antibiotics if the pancreas or surrounding tissue becomes infected.
4. Surgery is sometimes needed to remove infected or damaged tissue.

How to prevent recurrent attacks of Acute Pancreatitis?

An attack of acute pancreatitis may be a one-off event. However, if there is an underlying cause, then it may happen again (recur) unless the cause is corrected. One of the following may be relevant to prevent a recurrence, depending on the cause:

1. An operation to remove your gallbladder is usually advised if a gallstone was the cause.
2. Alcohol-related concerns:
1. You should not drink alcohol for at least several months after a bout of acute pancreatitis, even if alcohol was not the cause of your pancreatitis.
2. If alcohol is the cause of pancreatitis, you should stop drinking alcohol altogether.

A high blood fat level (hyperlipidaemia) is sometimes the cause. This may need treating with medication.

A side-effect from some medication is a rare cause of acute pancreatitis. A change in your medication may be needed if this is your cause of pancreatitis.

Chronic Pancreatitis

What is Chronic Pancreatitis?

Chronic pancreatitis is an inflammation of your pancreas that doesn’t improve over time.

The pancreas is an organ located behind your stomach. It makes enzymes, which are special proteins that help digest your food. It also makes hormones that control the level of sugar in your bloodstream.

Pancreatitis occurs when your pancreas becomes inflamed. Pancreatitis is considered acute when the inflammation comes on suddenly and only lasts for a short period of time. It’s considered chronic when it keeps coming back or when the inflammation doesn’t heal for months or years.

Chronic pancreatitis can lead to permanent scarring and damage. Calcium stones and cysts may develop in your pancreas, which can block the duct, or tube, that carries digestive enzymes and juices to your stomach. The blockage may lower the levels of pancreatic enzymes and hormones, which will make it harder for your body to digest food and regulate your blood sugar. This can cause serious health problems, including malnutrition and diabetes.

What are the causes of Chronic Pancreatitis?

There are numerous different causes of chronic pancreatitis. The most common cause is long-term alcohol abuse. Approximately 70 percent of cases are linked to alcohol consumption.

Other causes include:

1. autoimmune disease, which occurs when your body mistakenly attacks your healthy cells and tissues
2. a narrow pancreatic duct, which is the tube that carries enzymes from the pancreas to the small intestine
3. a blockage of the pancreatic duct by either gallstones or pancreatic stones
4. cystic fibrosis, which is a hereditary disease that causes mucus to build up in your lungs
5. genetics
6. high blood levels of calcium, which is called hypercalcemia
7. a high level of triglyceride fats in your blood, which is called hypertriglyceridemia

What Are the Symptoms of Chronic Pancreatitis?

At first, you may not notice any symptoms. Changes in your pancreas can become quite advanced before you begin to feel unwell. When symptoms occur, they may include:

1. pain in your upper abdomen
2. diarrhea
3. fatty stools, which are loose, pale, and don’t flush away easily
4. nausea and vomiting
5. shortness of breath
6. unexplained weight loss
7. excessive thirst and fatigue

You may experience more severe symptoms as the disease progresses, such as:

1. pancreatic fluids in your abdomen
2. jaundice, which is characterized by a yellowish discoloration in your eyes and skin
3. internal bleeding
4. intestinal blockage

Painful episodes can last for hours or even days. Some people find that eating or drinking can make their pain worse. As the disease progresses, the pain may become constant.

What are possible complications of chronic pancreatitis?

Chronic pancreatitis damages the insulin-producing cells of the pancreas. This may cause these complications:

1. Calcification of the pancreas. This means the pancreatic tissue hardens from deposits of calcium salts.
2. Long-term (chronic) pain
3. Diabetes
4. Gallstones
5. Kidney failure
6. Buildup of fluid and tissue debris (pseudocysts)
7. Pancreatic cancer
8. Acute flare-ups that keep coming back

How Is Chronic Pancreatitis Treated?

Treatment for chronic pancreatitis focuses on reducing your pain and improving your digestive function. The damage to your pancreas can’t be undone, but with the proper care, you should be able to manage many of your symptoms. Treatment for pancreatitis can include medication, endoscopic therapies, or surgery.

Medications

1. pain medication
2. artificial digestive enzymes if your enzyme levels are too low to digest food normally
3. insulin if you have diabetes
4. steroids if you have autoimmune pancreatitis, which occurs when your body’s immune system attacks your pancreas

Endoscopy

Some treatments use an endoscope to reduce pain and get rid of blockages. An endoscope is a long, flexible tube that your doctor inserts through your mouth. It allows your doctor to remove pancreatic stones, place small tubes called stents to improve flow, and close leaks.

Surgery

Surgery is indicated if you have severe pain that isn’t responding to medication. Surgery may also be used to unblock your pancreatic duct, drain cysts, or to widen it if it’s too narrow.

It’s important to avoid alcohol after you’ve been diagnosed with chronic pancreatitis, even if alcohol wasn’t the cause of your illness. You should also avoid smoking because it can increase your risk of developing pancreatic cancer. You may need to limit the amount of fat in your diet and take vitamins.