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PANCREATITIS National Digestive Diseases Information Clearing House Pancreatitis is an inflammation of the pancreas. The pancreas is a large gland behind the stomach and close to the duodenum. The duodenum is the upper part of the small intestine. The pancreas secretes digestive enzymes into the small intestine through a tube called pancreatic duct. These enzymes help digest fats, proteins and carbohydrates in food. The pancreas also releases the hormones insulin and glucagons into the blood stream. These hormones help the body use the glucose it derives from food for energy. Normally, digestive enzymes do not become active until they reach the small intestine, where they begin digesting food. But if these enzymes become active inside the pancreas, they start “digesting” it. Acute pancreatitis occurs suddenly and lasts for a short period of time and usually resolves. Chronic pancreatitis does not resolve itself and results in a slow destruction of the pancreas. Either form can cause serious complications. In severe cases, bleeding, tissue damage, and infection may occur. Cysts, which are fluid-filled sacs of tissue, may also develop. And enzymes and toxins may enter the bloodstreams, injuring the heart, lungs, and kidneys, or other organs. Acute Pancreatitis Some people have more than one attack and recover completely after each, but acute pancreatititis can be a severe, life threating illness with many complications. About 80,000 cases occur in the United States each year; some 20 percent of them are severe. Acute pancreatitis is usually caused by drinking too much alcohol or by gallstones. A gallstone can block the pancreatic duct, trapping digestive enzymes in the pancreas causing pancreatitis. Some prescription drugs, pancreatic or intestinal abnormalities, abdominal trauma, such as mumps, and in about15 percent of the cases, the cause is unknown. Symptoms Acute pancreatitis usually begins with pain in the upper abdomen that may last for a few days. The pain may be severe and may become—just in the abdomen—or it may reach to the back and other areas. It may sudden and intense or begin as a mild pain that gets worse when food is eaten. Someone with acute pancraetitis often looks and feels very sick. Other symptoms may include
Severe cases may cause dehydration and low blood pressure. The heart, lungs, or kidneys may fail. If bleeding occurs in the pancreas, shock and sometimes-even death follow. Diagnosis Besides asking about a person’s medical history and doing a physical exam, a doctor will order a blood test to diagnose acute pancreatitis. During acute attacks, the blood contains at least three times more amylase are digestive enzymes formed in the pancreas. Changes may also occur in blood levels of glucose, calcium, magnesium, sodium, potassium, and bicarbonate. After the pancreas improves, these levels usually return to normal. A doctor may also order an abdominal ultrasound to look for gallstones and a CAT (computerized axial tomography) scan to look for inflammation or destruction of the pancreas. CAT scans are also useful in locating pseudocysts. (See the section on pancreatitis). Treatment Treatment depends on how bad the attack is. If no complications in the form of kidney failure or lung problems occur, acute pancreatitis usually improves on its own. Treatment is designed to support to vital functions and prevent complications. A hospital stay will be necessary so that fluids can be replenished intravenously. Acute pancreatitis can also cause breathing problems. Many people develop hypoxia, which means that cells and tissues are not receiving oxygen. Doctors treat hypoxia by giving oxygen through a facemask. Despite treatment, some people still experience lung failure and require a ventilator. If pancreatic cysts occur and are considered large enough to interfere with the pancreas’s healing, your doctor may drain or surgically remove the cysts. Sometimes a person cannot stop vomiting and needs to have a tube placed in the stomach to remove fluid and air. In mild cases, a person may not eat for 3 or 4 days and instead may receive fluids and pain relievers through an IV (intravenous) line. Unless gallstones block the pancreatic duct, an acute attack usually lasts only a few days. In severe cases, a person may be fed intravenously for 3 to 6 weeks while the pancreas slowly heals. This process is called total parenteral nutrition. However, for mild cases of the disease, total parenteral nutrition offers no benefit.
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