Pancreatitis is an extremely painful inflammation of the pancreas that affects about 80,000 people in the United States each year.
There are two main types of pancreatitis: acute and chronic. About 90% of all cases of pancreatitis are acute, while 10% are chronic.
Acute pancreatitis comes on suddenly and results in severe abdominal pain. Pancreatic enzymes (amylase and lipase) that are normally secreted into the intestine by the pancreas become elevated and begin to destroy the organ itself. A diagnosis is made by measuring the elevated enzymes in the blood.
Symptoms of acute pancreatitis include a swollen, tender abdomen with pain radiating to the back, which may be aggravated by eating foods high in fat. It is usually accompanied by nausea, fever, vomiting and increased heart rate.
- Prolonged alcohol use
- Gallstones getting stuck in the bile duct near the pancreas duct
- Drug reactions
In more than 1/3 of cases, pancreatitis occurs in the absence of these or other known factors. It can also be hereditary and can afflict family members with no precipitating event.
Treatments for acute pancreatitis include both supportive and surgical methods, and depend on the cause. Patients are hospitalized and given fluids to hydrate their body. They also may be given intravenous nutrition to rest their bowel. Antibiotics are given and patients may also be on dialysis or a respirator.
Surgical methods include endoscopic interventions, removal of the gallbladder, or drainage of the pseudocyst (pancreatic cyst).
Most patients (more than 80%) recover from the acute event and will not relapse if the original cause can be corrected (e.g. gallbladder removed if there are stones, refrain from alcohol, etc.).
If you think you may have acute pancreatitis, you should see your doctor immediately or go to an emergency room.
Acute pancreatitis can be accompanied by a number of secondary complications. Initially, complications can include lung, kidney and heart insufficiency. Local complications, such as abscesses or cysts, can be painful even after the acute episode is resolved and may require surgery.
Even in the absence of any of these complications, a percentage of patients will go on to develop chronic pancreatitis due to scarring in the pancreas as a result of the acute event. Chronic pancreatitis can also develop if certain causes, such as alcohol ingestion, are continued. Ongoing secretion of the digestive enzymes further damages the pancreas, causing persistent abdominal pain and, eventually, insulin dysfunction leading to diabetes.
Chronic pancreatitis can occur after a known episode of acute pancreatitis, or it may develop without an identifiable episode. If you’ve been diagnosed with chronic pancreatitis, you’ve probably experienced frequent hospitalizations or emergency room visits.
- Constant, sometimes disabling, pain in the upper abdomen that radiates to the back
- Weight loss and diarrhea, caused by poor absorption (malabsorption) of food because the pancreas is not secreting enough enzymes to break down food normally
In persistent cases, the pancreas may no longer produce enough insulin, causing diabetes.
Other conditions that have similar symptoms include bowel obstruction, appendicitis, cholecystitis, peptic ulcer disease and irritable syndrome.
- Chronic alcoholism
- Chronic obstruction of the pancreatic duct (typically caused by pseudocysts, inflammation, tumors or cystic fibrosis)
- Traumatic injury to the pancreatic duct
- Developmental variations in how the pancreas forms
- Damage to the pancreas from a previous acute attack
Intermittent attacks of acute pancreatitis may be called relapsing pancreatitis. Relapsing pancreatitis often leads to chronic pancreatitis in which the pancreas has become so scarred that amylase and lipase levels no longer elevate in the blood.
A variety of non-surgical treatments for chronic pancreatitis are available and depend on the cause of the disease, the success of previous treatment options, and the severity of the pain. These include:
- Correcting nutritional deficiencies
- Eliminating alcohol
- Analgesics or narcotics for pain
- Enzyme therapy, to help with intestinal absorption
- Endoscopic intervention to unblock scar tissue
- Treating diabetes, if needed
If a person is not responding to treatment or is experiencing the long-term pain of chronic pancreatitis and its complications, surgical treatments may be recommended:
- Drainage procedures (such as the Puestow)
- Partial resections (such as a Whipple procedure, where the head of the pancreas is removed, or a distal pancreatectomy, where the tail of the pancreas is removed)
- Removal of the pancreas (pancreatectomy)
- Pancreatectomy and auto-islet transplant, in which the patient’s own insulin-producing cells are transplanted back into the body
Removal of the pancreas is most likely to relieve pain; however, it induces diabetes. Without an accompanying auto-islet transplant, a patient who has a pancreatectomy will need to take insulin shots or be on an insulin pump for the rest of his or her life.
In an attempt to prevent diabetes in patients who undergo a pancreatectomy, Dr. David Sutherland at the University of Minnesota began performing pancreatectomies and auto islet transplants in 1977.
Today, the Schulze Diabetes Institute is a pioneer and world leader in the surgical treatment of pancreatitis through pancreatectomy and auto-islet cell transplantation.