Pancreatitis: Symptoms, Diagnosis and Treatment

Pancreatitis is a medical term used for the inflammation of the pancreas. Pancreas is a leaf-like gland present behind the stomach in the upper abdomen. The pancreas produces hormones like insulin to control blood sugar and digestive juices that help in the digestion of food in the intestine. These enzymes digest the pancreas to cause inflammation which can be acute or chronic. Pancreatitis occurs in adults but the incidence in children is increasing. About 275,000 people get hospitalized due to acute pancreatitis and 86,000 people due to chronic pancreatitis in the U.S. every year.

Type of Pancreatitis

• Acute pancreatitis: Acute pancreatitis is a short-term condition in which patient’s symptoms appear suddenly and last for some days.
• Chronic pancreatitis: It develop over years slowly damaging your pancreas. The functional pancreatic tissue becomes scarred and loses its functions.

Sign and Symptoms of Pancreatitis

These depend upon the type of pancreatitis you are suffering from but both types of patients feel pain in upper abdomen that spreads to the back. But they may feel pain in different ways:

Acute Pancreatitis

• Onset of pain can be slow or sudden
• Pain may spread to the back
• Pain can be mild or severe in nature
• Pain in abdomen on touching (tenderness)
• Fever
• Rapid heart beating
• Nausea and vomiting

Chronic Pancreatitis

• Pain in upper abdomen but some people don’t experience any pain
• Unintentional weight loss
• Steatorrhea (pale coloured, greasy and smelly stools)

Causes of Pancreatitis

 When the pancreatic enzymes become activated in the pancreas itself causing digestion of its own cells, this results in inflammation. Repeated episodes of this acute pancreatitis lead to chronic pancreatitis. Conditions causing pancreatitis are:

• Gallstones – most common cause of acute pancreatitis
• Trauma or surgery causing injury to the pancreas
• Alcoholism – most common cause of chronic pancreatitis
• Genetic disorders of pancreas – family history can be present
• Certain medications
• Infections
• Pancreatic cancer
• Hypercalcemia (high levels of calcium in blood)
• Hypertriglyceridemia (high level of lipids in blood)
• Idiopathic – where physician is not able to find any reason of pancreatitis

Complications of Pancreatitis

 These arise due to diminished function of pancreas and damage to surrounding structures as

• Malnutrition – Both acute and chronic pancreatitis results in less enzyme production. So, food is not digested properly. This can lead to diarrhoea, weight loss and malnutrition
• Diabetes – pancreatic cell also produces insulin. Damage to them can lead to diabetes mellitus
• Pseudocyst – Fluid and debris formed during digestion in acute pancreatitis collect in cyst like pockets called as pseudocyst. Their rupture causes internal bleeding and infection
• Dehydration, bleeding, infection
• Breathing problem
• Heart, lung or kidney failure
• Pancreatic cancer

Risk factors for Pancreatitis

• Gender – men have higher chances than female
• Race – African Americans are more susceptible to pancreatitis
• Family history of gallstones or pancreatitis

Diagnosis of Pancreatitis

 Your doctor will ask you some question related to your medical history, conduct a physical exam and medical test to find the cause of your constipation

• Medical history

• Physical examination

• Laboratory test

Blood test: Your blood sample is tested for

Elevated level of pancreatic enzymes like lipases or amylases

Level of blood glucose, lipids

Signs of inflammation or infection

Stool test: To check for steatorrhea (fat malabsorption)

• Imaging tests

Ultrasound – It is the safest and cheapest imaging technique which can be used to find gallstones

CT scan – It uses x-rays to create pictures of gallbladder, pancreas and bile ducts to look for inflammation or stones

MRI – It is similar to CT scan bit it doesn’t uses X-rays

Treatment of Pancreatitis

The goal of treatment is to provide supportive care to the patient and then treating the underlying cause if any

Supportive care: The patient is suffering from pain, dehydration or infection. So, initial supportive treatment includes

• Pain medication – to relieve the pain
• Fasting – patient is kept on fasting to reduce the load on pancreas meanwhile pancreas get some time to heal
• IV fluids and nutrition – rehydrate the patient and provide energy to recover
• Antibiotics – to fight off infection if present.

Mild cased of acute pancreatitis with no underlying disease can be treated with the supportive care and rest.

Treating underlying cause:

• Surgery to remove gallbladder – if the underlying cause of pancreatitis is gallstones.
• Removing bile duct obstruction – pancreatitis occurring due to narrowing of the pancreatic or bile duct can be treated by a procedure called ERCP (Endoscopic Retrograde Cholangiopancreatography) which uses endoscopy and x-rays to remove the blocking material.

Additional treatment of chronic pancreatitis: Depending upon the conditions of the patients, chronic pancreatitis may require

• Enzyme pills – your doctor may give you enzyme containing pills which can help you with digestion.
• Treatment of complications – Complications such as diabetes, pseudocyst, or any other require specific treatment.
• Pancreatic surgery – if your pancreas is severely damage and not responding to other treatment then your doctor will recommend you for the removal of whole pancreas but they transplant the insulin producing islet part to liver so that patient do not develop diabetes.

Prognosis of Pancreatitis

 Patients having acute pancreatitis can recover completely despite being a life-threatening condition in some people. About 5% of acute pancreatitis becomes chronic. Patients having chronic pancreatitis are at three time more risk of developing pancreatic cancer than general population.

References:

• Forsmark CE, Vege SS, Wilcox CM. Acute pancreatitis. The New England Journal of Medicine.2016; 375(20):1972–1981.
• Ketwaroo GA, Freedman SD, Sheth, SG. Approach to patients with suspected chronic pancreatitis: a comprehensive review. Pancreas. 2015;44(2):173–180.