Pancreatitis is a painful inflammation of your pancreas. It’s a stomachache like you’ve never had before. The pain in your upper abdomen bores through to your back. Lying flat causes your abdomen to hurt even more, so to relieve the pain, you double over. Pain like this, which may last for many hours to days is typical.
The pancreas is a long, flat gland that lies horizontally behind your stomach. The head of the pancreas rests against the upper part of the small intestine (duodenum), and its tail reaches toward your spleen.
The pancreas has two main functions:
- Its cells produce digestive juices and enzymes that help break down fats, carbohydrates and proteins (pancreatic exocrine function). Once produced, these juices and enzymes are then transported through a small duct that opens into your duodenum.
- It secretes the hormones insulin and glucagon into your bloodstream, along with somatostatin, another hormone that helps regulate their function. The primary role of insulin and glucagon is to regulate the metabolism of carbohydrates and to control the level of sugar in your blood.
When inflammation develops in the pancreas, these functions are disrupted. The inflammation can be acute or chronic. Most cases are mild to moderate, but in about 20 percent of cases, symptoms can be severe. Acute pancreatitis requires immediate medical care to avoid complications that can be fatal.
Pancreatitis Signs and Symptoms
Acute
Acute cases come on suddenly when digestive enzymes produced in the pancreas remain there and become active, irritating and inflaming delicate pancreatic tissues. Normally, digestive enzymes are transported to the duodenum, and become active there.
The main symptom is mild to severe pain in your upper abdomen that often radiates to your back and, occasionally, your chest. It can persist for hours or days without relief. Drinking alcohol or eating may worsen the pain. Many people bend forward or curl up in a fetal position because these positions seem to relieve the pain.
People with severe inflammation often feel and look very sick, and they frequently experience nausea and vomiting. Other signs and symptoms may include a high fever, difficulty breathing and abdominal bruises from internal bleeding.
Chronic
Chronic pancreatitis differs in that the inflammation happens over time, often many years. This disease is usually less obvious, and in its early stages, its signs and symptoms can be difficult to recognize. Some people with chronic pancreatitis have no pain. Others have intermittent periods of mild to moderate abdominal pain. The pain may be sharp and last for a few hours, or it may be a continuous dull ache that lasts for weeks. In addition to pain, you may experience nausea and vomiting, fever, bloating and gas. Drinking alcohol or eating can make the symptoms worse.
Unlike acute pancreatitis, which may improve spontaneously without long-term complications, chronic disease results in permanent damage. As the inflammation persists, it slowly destroys the pancreas. The organ is less able to secrete the enzymes and hormones needed for proper digestion. This leads to poor absorption (malabsorption) of nutrients, particularly fat, causing weight loss and passage of fat-containing stools that are loose, malodorous and oily in appearance. Eventually, the cells that produce insulin are impaired, causing diabetes.
Unfortunately, warnings of malabsorption and diabetes often don’t appear until the inflammation is advanced.
Causes
The two most common known causes are excessive alcohol use and gallstones. In some cases the cause is unknown.
Alcohol
Heavy alcohol use over many years is a leading cause of chronic pancreatitis. Excessive alcohol may also cause an acute attack. Why some people get the disease while most don’t is uncertain. It’s also unclear how alcohol damages the pancreas. One theory is that excessive alcohol leads to protein plugs — precursors to small stones — that form in the pancreas and block parts of the pancreatic duct. Another theory is that alcohol directly injures pancreatic tissues.
Gallstones
A leading cause of acute pancreatitis is gallstones. Sometimes these stones migrate out of the gallbladder through the common bile duct, which merges with the pancreatic duct near the entrance to the duodenum. At this junction, gallstones can lodge in or near the pancreatic duct and block the flow of pancreatic juices into the duodenum. Digestive enzymes become active in the pancreas instead of in the digestive tract, causing acute pancreatitis.
Less common causes
- Calcium deposits or stones that can block the pancreatic or common bile duct
- Increased levels of blood fats (triglycerides) or of calcium in the blood (hypercalcemia)
- Structural abnormalities of the pancreas, abdominal trauma or major surgery
- Bacterial or viral infection, such as the mumps
Occasionally, a complication of acute pancreatitis, such as narrowing of the pancreatic duct, can lead to a chronic case. Sometimes, young adults with cystic fibrosis and associated gene abnormalities develop episodes of chronic pancreatitis. Some people are born with a hereditary form of the disease that can cause attacks in childhood or adolescence.
Prevention
- Avoid excessive alcohol use.
Overuse of alcohol is the No. 1 cause of chronic pancreatitis and a contributing factor in many acute attacks. - Limit fat.
Eating a high-fat diet can result in high blood fat levels. Work with your doctor and a dietitian to plan a healthy diet.
Treatment by Type
Acute
Severe acute pancreatitis usually requires a hospital stay. If you have complications, you may be admitted to the intensive care unit. Treatment goals include controlling the pain, allowing the pancreas to rest and restoring a normal balance of pancreatic juices. Because the pancreas goes into action whenever you eat, you won’t be able to eat or drink for a few days. Instead, you’ll receive fluids and nutrition through a vein (intravenously).
If the cause of your attack is gallstones blocking the pancreatic duct, your doctor may recommend a procedure to remove the stones. You may eventually need surgery to remove the gallbladder if gallstones continue to pose problems. If alcohol is the cause, treatment may include therapy to stop drinking alcohol.
Mild cases generally improve in a week or less. Moderate to severe cases take longer.
Chronic
Your main goal is to control pain and treat malabsorption problems.
- Pain relief.
Unlike acute, in which the pain often disappears within a few days to weeks, chronic pancreatitis pain can linger. Persistent pain can be the biggest challenge of chronic. In addition to taking conventional pain relievers, you may receive a prescription for pancreatic enzymes. Enzyme therapy works by increasing the levels of enzymes in the duodenum, which in turn decreases the secretion of enzymes by the pancreas. This is thought to reduce secretion pressure, and hence, pain, within the pancreas. For severe pain that can’t be controlled, treatment options include surgery to remove damaged tissue or procedures to block pain signals or deaden those nerves transmitting the pain. - Enzyme therapy for malabsorption.
Enzyme supplements taken with each meal, such as pancrelipase (Cotazym, Pancrease, Viokase), can treat malabsorption problems caused by the pancreas by replacing those digestive enzymes that the pancreas isn’t secreting, helping to restore normal digestion.
Treating diabetes
Chronic pancreatitis can cause diabetes mellitus in some people. Treatment usually involves maintaining a healthy diet and getting regular exercise. Some people also need insulin injections. Consult your doctor to talk with you about how to manage diabetes, recognize symptoms of high and low blood sugar and prevent complications.
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