• Pancreatitis

    (Chronic Pancreatitis; Acute Pancreatitis)

    Definition

    Pancreatitis is a disease in which the pancreas becomes inflamed. The pancreas is a long, flat, pear-shaped organ located behind the stomach. It makes digestive enzymes and hormones, including insulin. In pancreatitis, the digestive enzymes attack the tissue that produces them.
    • Acute pancreatitis—occurs suddenly, with severe upper abdominal pain (This can be a serious, life-threatening illness if not treated.)
    • Chronic pancreatitis—a progressive disorder that can destroy the pancreas
    Pancreatitis
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    Causes

    Causes of pancreatitis include:

    Risk Factors

    A risk factor is something that increases your chance of getting a disease or condition. Risk factors for pancreatitis include:
    • Alcohol abuse
    • Family history of pancreatitis
    • Personal history of previous acute pancreatitis
    • Medicines, including:
      • Estrogens
      • Sulfonamides
      • Tetracyclines
      • Thiazides
    • Pancreatic cancer
    • Hyperlipidemia (excessive levels of fat in the blood)
    • Hypercalcemia (increased calcium in the blood)
    • Viral infections, such as mumps

    Symptoms

    Symptoms include:
      Severe pain in the center of the upper abdomen that:
      • Sometimes spreads into the upper back
      • Is often made worse by eating, walking, or lying down on your back
      • Is less severe in chronic pancreatitis, with a gradual onset that may be tolerable for weeks
    • Nausea and vomiting
    • Diarrhea
    • Fever
    • Jaundice (yellowing of the skin)
    • Shock—a severe change in the body's vital tasks (such as, rapid but weak pulse, rapid and shallow respiration, and low blood pressure) (in severe, acute cases)
    • Unexplained weight loss
    • Symptoms of diabetes :
      • Increased thirst
      • Increased urination
      • Fatigue

    Diagnosis

    The doctor will ask about your symptoms and medical history. Your doctor will ask how much alcohol you drink and what medicines you take. A physical exam will be done.
    Other tests may include:
    • Blood tests—to measure levels of certain digestive enzymes and check for obstructions and complications of pancreatitis (such as, diabetes, kidney failure, infection)
    • Abdominal ultrasound or abdominal CT scan—to look for gallstones and determine the level of pancreatic inflammation
    • Magnetic resonance cholangiopancreatography (MRCP)—a radiology test (MRI) that looks at the pancreas, pancreatic duct, and nearby bile ducts
    • ERCP—to examine the damage from pancreatitis and diagnose problems related to the pancreatic and biliary ducts

    Treatment

    Acute Pancreatitis

    Treatment for acute pancreatitis depends on the severity of the attack. Hospitalization may be necessary. The main goal is to rest the pancreas. In mild cases, this means you may not have food for 3-4 days. In severe cases, you may not be able to have food for 3-6 weeks. You will likely need strong pain medicine during this time.
    Treatment may also include:
    • IV fluids
    • IV nutrients if you are unable to eat for an extended period of time
    • Antibiotics if you have an infection
    • Surgery to drain excess fluid from the abdomen

    Chronic Pancreatitis

    The goals of treatment for chronic pancreatitis are to relieve pain and manage nutritional and metabolic problems. Specific steps include:
    • Strict avoidance of alcohol
    • Eating less fat
    • Taking pills containing pancreatic enzymes to help with digestion
    • Taking insulin to control blood sugar (if diabetes develops)
    • Eating smaller meals more frequently
    • Taking pain medicine if the pain becomes severe. You may want to see your doctor.
    Surgery and/or ERCP may be needed to:
    • Open a blocked pancreatic or biliary duct
    • Remove part (or rarely all) of the pancreas
    • Drain pancreatic cysts
    If you are diagnosed with pancreatitis, follow your doctor's instructions.
    If you are diagnosed with pancreatitis, follow your doctor's instructions.

    Prevention

    The best way to avoid pancreatitis is to limit your intake of alcohol to two drinks or less per day for men and one drink or less per day for women. If you have hyperlipidemia, restrict your intake of fat and follow your doctor’s treatment plan to lower your lipids. Get vaccinated against mumps.

    RESOURCES

    American Gastroenterological Association http://www.gastro.org

    National Institute of Diabetes and Digestive and Kidney Diseases http://www2.niddk.nih.gov

    National Pancreas Foundation http://www.pancreasfoundation.org

    CANADIAN RESOURCES

    Canadian Association of Gastroenterology http://www.cag-acg.org

    Health Canada http://www.hc-sc.gc.ca

    References

    Acute pancreatitis. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated September 26, 2012. Accessed October 16, 2012.

    Braganza JM, Lee SH, et al. Chronic pancreatitis. Lancet. 2011;377(9772):1184-1197.

    Chronic pancreatitis. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated September 5, 2012. Accessed October 16, 2012.

    Pancreatitis. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/pancreatitis/. Updated August 16, 2012. Accessed October 16, 2012.

    Revision Information

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