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Inflammation of the Pancreas

Inflammation of the Pancreas

The pancreas is one of the most important organs of the digestive system. Inflammation of the pancreas, referred to as pancreatitis, is a common digestive disease.
Reshma Jirage
Last Updated: May 30, 2018
In order to prevent this serious health condition, you should have a nutritious, healthy diet that contains low-fat foods and high amounts of whole grains, fresh vegetables and fruits. You can minimize the risk of pancreatitis by giving up unhealthy habits such as drinking alcohol and smoking.

Inflammation of the pancreas or pancreatitis is one of the common health problems related to the body's digestive function. The pancreas is a large, flat gland located just behind the stomach, placed adjacent to the duodenum (upper part of the small intestine), in the upper abdomen. Secretion of the enzyme trypsin into the pancreas, instead of the small intestine, is the chief trigger that leads to pancreatic inflammation. There are two forms of pancreatitis such as acute pancreatitis and chronic pancreatitis.

Types of Pancreatitis
Pancreatitis may be acute (sudden and short-term) or chronic (long-term and ongoing). Acute pancreatitis manifests as severe inflammation of the pancreas and lasts for a short period. In most cases, acute pancreatitis results from alcoholism or gallstones. It may be mild, causing abdominal discomfort or severe, causing life-threatening conditions such as tissue damage, bleeding and infection.

Chronic pancreatitis usually follows the episodes of acute pancreatitis and results from damage to the pancreas by digestive enzymes, causing pain and scarring. The main cause of chronic pancreatitis is prolonged alcohol abuse.

Causes Leading to Pancreas Inflammation
The two main causes of pancreatitis, the formation of gallstones and alcoholism, account for about 80-90% of cases. Pancreatitis from alcoholism occurs due to long-term intake of alcoholic drinks. Formation of gallstones in the gallbladder can cause blockage in the pancreatic duct, which leads to the accumulation of digestive juices within the pancreas, resulting in irritation and inflammation. During the normal digestion process, pancreatic enzymes, in an inactive form, are released to the small intestine through the pancreatic duct. They become active in the small intestine. In case of pancreatitis, the enzymes become active within the pancreas and begin to digest the pancreatic tissues. This process is known as auto-digestion. This can cause irritation of pancreatic cells, leading to inflammation of the pancreas. Pancreatitis may occur due to different reasons, depending on whether it is acute or chronic.

Acute Pancreatitis: Acute pancreatitis occurs suddenly and in most cases, it is severe.
  • The major causes of acute pancreatitis are gallstones, gallbladder disease and alcoholism.
  • It is also caused by common bile duct surgical procedures, traumatic injury, abnormal structure of the pancreas, genetic factors, hypertriglyceridemia (high lipid levels in the blood),etc.
  • Certain medication, such as corticosteroids, estrogen and thiazide diuretics, are also known to be causative agents.
  • Certain viral and bacterial infections such as mumps, mycoplasma pneumonia and coxsackie B can also contribute to acute pancreatitis.
  • In children, acute pancreatitis is usually associated with cystic fibrosis, mumps, abdominal trauma, Reye's syndrome, Kawasaki disease and Hemolytic-uremic syndrome.
Chronic Pancreatitis: Acute pancreatitis, when experienced for a long time, takes the form of chronic pancreatitis. It causes scarring and inflammation of the pancreatic tissues. It also interferes with the production of digestive enzymes and insulin.
  • Most often, chronic pancreatitis is caused by alcohol abuse over a prolonged period.
  • Some other conditions that can lead to chronic pancreatitis are chronic narrowing or blockage of the pancreatic duct due to trauma or formation of pseudocysts, hyperparathyroidism and hyperlipidemia.

Indications of Acute and Chronic Pacreatitis

Abdominal pain, that starts suddenly or gradually in the upper abdomen, is one of the main symptoms of pancreatitis. The signs and symptoms vary according to the type of pancreatitis.

Acute Pancreatitis: Acute pancreatitis causes severe and persistent pain the upper abdomen. It may spread to the back or below the left shoulder blade. Pain may worsen with lying on the back or after eating fatty food or drinking alcohol. Some other symptoms of acute pancreatitis are:
  • Nausea
  • Vomiting
  • Fever
  • Rapid pulse
  • Sweating
  • Swollen and tender abdomen
  • Indigestion
  • Gaseous abdominal fullness
  • Hiccups
  • Clay-colored stools
  • Skin rash
  • Dehydration
  • Fatigue
  • Lethargy
  • Headache
  • Low blood pressure
  • Renal failure
  • Heart failure
Chronic Pancreatitis: In case of chronic pancreatitis, some people may experience pain in the upper abdomen, while some may not. Pain occurs gradually, is continuous and may last from a few hours to some days. Pain may worsen after eating and drinking. Some other symptoms of chronic pancreatitis are:
  • Vomiting
  • Nausea
  • Indigestion
  • Digestive problems
  • Smelly and fatty stools (steatorrhea)
  • Unintentional weight loss
Weight loss is most often seen in people suffering from chronic pancreatitis, because pancreatic enzymes are not secreted in adequate amounts to break down the food. It can interfere with the normal absorption of the nutrients. Due to poor digestion, there may be excretion of proteins, sugars and fats into the stool. Thus, the body is deprived of essential nutrients, which results in weight loss.

Pancreatitis is diagnosed on the basis of the findings of a physical examination, imaging tests and certain laboratory investigations such as blood tests and stool tests. There are different diagnostic criteria for acute and chronic pancreatitis.

Acute Pancreatitis:
  • In a physical examination, the physician checks for fever, low blood pressure, rapid breathing rate and rapid heart rate.
  • Certain blood tests are performed to detect the levels of serum amylase and lipase as well as urine amylase. Amylase and lipase are the digestive enzymes produced in the pancreas. The levels of amylase and lipase are increased in acute pancreatitis.
  • Some other blood tests such as complete blood count, determination of blood glucose and serum calcium are also performed.
  • Imaging tests such as abdominal CT scan, MRI scan and ultrasound are performed to detect gallstones and damage to pancreatic cells.
Chronic Pancreatitis:
  • Diagnosis of chronic pancreatitis involves certain tests such as fecal fat test and blood tests such as determination of serum amylase, lipase and trypsinogen.
  • Imaging tests such as abdominal CT scan, ultrasound and endoscopic retrograde cholangiopancreatography (ERCP) are carried out to detect inflammation or calcium deposits in the pancreas.
  • Exploratory laparotomy can be done for the confirmation of pancreatitis.

Treatment and Management
Since pancreatitis can cause life-threatening complications, it usually needs immediate medical attention. The treatment is aimed at relieving pain, reducing stimulation of the pancreas, managing indigestion, and replacing the fluids by intravenous infusion. Once the inflammation in the pancreas is controlled and patient's condition is stabilized, treatment to cure the underlying cause of pancreatitis is administered.
  • When diagnosis of pancreatitis is confirmed, immediate hospitalization is usually recommended.
  • Initial treatments are given to control the inflammation.
  • The patient is asked to stop eating for a couple of days.
  • Analgesics are given in order to relieve abdominal pain.
  • Due to loss of fluids, the patient may suffer from dehydration, which is countered with intravenous fluids.
  • Once the inflammation is controlled, the patient's diet is gradually shifted to liquids and bland foods.
  • Normal diet can be started after recovery. Patients are advised to add adequate amounts of calcium and vitamins in their diet.
Once pancreatitis is controlled, the physician starts the treatment for underlying causes. The treatment option depends upon the cause of pancreatitis.
  • If pancreatitis is caused by gallstones, then cholecystectomy (gallbladder surgery) is recommended.
  • If pancreatitis is caused by narrowing or blockage of the bile duct, then a surgical procedure, called endoscopic retrograde cholangiopancreatography (ERCP), is performed in order to widen or open the bile duct.
  • Pancreas surgery is recommended to remove the affected pancreatic tissues or to drain fluids from the pancreas.
  • Since alcoholism and alcohol abuse is the main cause of pancreatitis, a treatment program for alcohol addiction is very essential. If intake of alcoholic drinks is continued, it can worsen the condition, leading to serious complications.

Possible Complications If Neglected
If left untreated, both acute and chronic pancreatitis can cause some severe complications. Acute pancreatitis can have the following complications:-
  • Breathing problems due to certain chemical changes in the body. This can affect the functioning of the lungs.
  • There is an increased risk of bacterial infection in the pancreas due to acute pancreatitis.
  • Acute pancreatitis can also cause accumulation of fluid and debris within the pancreas, leading to the formation of a large pseudocyst. If this pseudocyst ruptures, it may result in infection and internal bleeding.
Chronic pancreatitis can result in the following complications:-
  • Damage to islet cells that produce insulin in the pancreas. This may result in increased blood sugar levels, leading to diabetes.
  • Chronic pancreatitis is considered as a risk factor for pancreatic cancer.
Both acute and chronic pancreatitis can lead to malnutrition and weight loss due to inadequate digestion of food and malabsorption of nutrients.

Additional treatment is required for the treatment of chronic pancreatitis. It includes pain management with pain relievers, pancreatic enzyme supplements to improve digestion and certain changes in the diet, such as low-fat meals that are easy to digest and do not put added pressure on the already aggravated pancreas. There are some alternative treatments for pancreatitis. Certain therapies such as meditation, yoga and relaxation techniques can help the patient cope with abdominal pain. Mineral and vitamin supplements such as vitamin C, vitamin A, and selenium can help in reducing the pain.

Disclaimer: This HealthHearty article is for informative purposes only, and should not be used as a replacement for expert medical advice.