What is Pancreatitis?
In severe cases of pancreatitis, fluid and destroyed pancreatic tissue leak out of the ducts into the abdomen. This is called hemorrhagic pancreatitis. You may need to stay in hospital for pain medicines, intravenous fluids and antibiotics.
Doctors will check your blood and stools, and do imaging tests to see if the pancreas is damaged. They will also test for gallstones and a blockage of the bile and pancreatic ducts.
What is the pancreas?
The pancreas is an abdominal gland with both digestive (exocrine) and hormonal (endocrine) functions. The endocrine part of the pancreas secretes hormones into your bloodstream that control your blood sugar levels. The digestive part of the pancreas releases enzymes that help break down fats, proteins, and carbohydrates in food that you eat. The pancreas is located just behind your stomach, with the head of the pancreas (shown in pink below) overlying the pylorus and stomach and the tail stretching to touch the spleen (shown in yellow).
When you eat, the pancreas produces and releases digestive juices into your intestines to digest the foods you eat. These juices are made of water, bicarbonate, and enzymes that break down (digest) fats, proteins, and carbohydrates in food. The digestive enzymes secreted by the pancreas include proteolytic enzymes such as trypsin and chymotrypsin, which digest proteins; lipolytic enzymes, including phosphatase and esterase, which break down fats; and glycolytic enzymes, including amylase and lactase, which digest carbohydrates. The pancreas also secretes a protein called pancreatic polypeptide, which helps digest other proteins and protects the intestines from bacteria, yeast, and viruses.
A group of cells in the center of your pancreas – known as the islets of Langerhans – produce three different hormones that regulate your blood sugar levels. These ‘endocrine’ hormones are important for maintaining normal blood sugar levels, as well as controlling how much glucose (a type of sugar) is released from your liver into the bloodstream. Insulin lowers your blood glucose levels by helping your body store the glucose away in your fat, muscle, and liver cells for use as energy when needed.
Exocrine pancreatic insufficiency (EPI) occurs when your pancreas doesn’t make enough digestive enzymes to properly digest foods. It can be caused by chronic pancreatitis, gallstones in the bile duct, pancreatic cancer, recurrent pancreatitis, and other conditions such as cystic fibrosis, Shwachman-Diamond syndrome, and Crohn’s disease.
Symptoms
The pancreas is a small organ behind the stomach that releases enzymes into your small intestine to help digest food. It also produces hormones that control blood-sugar levels. Your body can have an attack on the pancreas (pancreatitis) if it mistakenly begins to digest itself, which causes inflammation in the pancreas. Inflammation can be sudden (acute) or develop over time (chronic). It may cause a pain in your back or abdomen. It can also produce fatty, oily stools (poo).
About 1 in 5 severe cases of acute pancreatitis result in the death of pancreatic tissue. In these cases, the symptoms of severe pain are more serious and usually require emergency treatment in a hospital. The most common causes of pancreatitis are heavy alcohol consumption and lumps of solid material (gallstones) in the gallbladder, an organ that sits next to the pancreas. Alcohol and gallstones can block the duct from your pancreas that normally allows digestive juices to enter your gut.
Pancreatitis can lead to complications that include abdominal pain, fat in the stool (polycystic ovaries), and a bacterial infection in the gallbladder called septic pancreatitis. In chronic pancreatitis, your body can’t make the enzymes needed for digestion, and you may have to pass fatty, foul-smelling stools.
A doctor will ask about your symptoms and do a physical exam. They will check for a painful area in your abdomen, and they may order an ultrasound or CT scan to confirm a diagnosis. These tests can detect the signs of pancreatitis, including a high level of 2 chemicals, lipase and amylase, that are released when your pancreas is damaged.
The most common treatments for pancreatitis are pain medicines and fluids to prevent dehydration. You might also need an IV line for fluids, insulin if you have diabetes, or antibiotics to treat an infection. In rare cases of pancreatitis, doctors might drain fluid collections (pseudocysts) from your pancreas with a procedure called percutaneous drainage. This involves inserting a thin, flexible tube down your throat and using tiny tools to remove the fluid. A doctor might also inject anesthetics into nerves near your pancreas to relieve pain.
Diagnosis
Acute pancreatitis is usually diagnosed by how severe your pain is and the results of a blood test. This test checks your levels of two digestive enzymes: amylase and lipase. If the test is high, it suggests your pancreas is damaged. Your doctor may also order an ultrasound, MRI, or CT scan of your pancreas to see the inflammation and find out what’s causing it. These tests can show if you have an infection or gallstones. They can also reveal other complications such as a pseudocyst or pancreatic cancer. A stool sample can tell whether you have fat malabsorption, which is common in chronic pancreatitis.
If the damage is severe, you might have signs of infection in your blood (septicemia). This happens because swelling cuts off the blood supply to parts of your pancreas. Without a blood supply, the tissue dies (necrosis). The bacteria that cause necrosis grow and can spread to other parts of your body, such as your lungs or bloodstream. You can also have a fever, low blood pressure, and yellowing of the skin or eyes (jaundice).
For pancreatitis caused by alcohol abuse or gallstones, your doctor will talk to you about how much you drink and eat and recommend changes to your lifestyle. In some cases, they might refer you to a specialist in your digestive system (gastroenterologist).
Chronic pancreatitis is more difficult to diagnose because the symptoms are often mild. Your doctor might recommend you have a procedure called endoscopic retrograde cholangiopancreatography (ERCP). In this test, your doctor inserts a long tube through your mouth into your stomach and then uses a camera to look for blockages in the duct that leads from the gallbladder to your pancreas. This can also help diagnose chronic pancreatitis and, if it’s caused by a gallstone, can remove the stone.
In severe attacks of acute pancreatitis, you might have to stay in the hospital for a few days and get fluids through a vein (intravenous, or IV) and pain medicine. You might also have to have your gallbladder removed if it’s the cause of the pancreatitis.
Treatment
Acute pancreatitis is usually very painful and needs to be treated in hospital. You will be given fluids through a vein (intravenous, or IV) and pain medicines. You may need a tube passed from your nose into your stomach (an NG tube, or nasogastric tube). This helps with vomiting and can give your digestive system rest so it can heal.
Your doctor will test your blood for the enzymes amylase and lipase to see if they’re high, which is a sign of pancreatitis. They may also use ultrasound, CT scans or MRI to get images of your pancreas and gallbladder. These can help diagnose the cause of the pancreatitis and find complications like cysts. They may also do a procedure called endoscopic retrograde cholangiopancreatography (ERCP) to remove a gallstone if they think this is the cause of the pancreatitis.
If you have a severe episode of pancreatitis, your doctor will need to keep you in hospital so the pancreas can rest and heal. You will be given fluids and nutrition through a vein (intravenous, called IV) or by mouth with a tube down your throat (an NG tube, or nasogastric). You might need a procedure where a tube is passed from your nose into your stomach to drain pancreatic juices if they’re too thick for the pancreatic duct. Your doctor will also check your heart, lungs and blood pressure.
One in 3 cases of acute pancreatitis is so serious that it causes so much swelling that the blood supply to parts of your pancreas is cut off (necrosis). This can cause infection in the bloodstream, which is a life-threatening emergency.
Chronic pancreatitis may be caused by a combination of things, including smoking, alcohol, and the use of certain drugs, like steroids and statins. It can also be hereditary or linked to inherited disorders that affect the way your body manages glucose. If you have repeated episodes of pancreatitis, your doctor might be able to predict which types of food will cause it by doing tests before each attack.
Treatment of chronic pancreatitis focuses on reducing your risk of having attacks by following a low-fat diet, not drinking alcohol or smoking, and taking painkillers as needed. They might also give you artificial digestion enzymes if your pancreas isn’t producing enough on its own.
