Topic Overview
What is pancreatitis?
Pancreatitis is inflammation
of the pancreas, an organ in your belly that makes the
hormones
insulin and
glucagon. These two hormones control how your body
uses the sugar found in the food you eat. Your pancreas also makes other
hormones and
enzymes that help you break down food.
Usually the digestive enzymes stay in one part of the pancreas. But if
these enzymes leak into other parts of the pancreas, they can irritate it and
cause pain and swelling. This may happen suddenly or over many years. Over
time, it can damage and scar the pancreas.
What causes pancreatitis?
Most cases are caused
by
gallstones or alcohol misuse. The disease can also be
caused by an injury, an infection, or certain medicines.
Long-term, or chronic, pancreatitis may occur after one attack. But it
can also happen over many years. In Western countries, alcohol misuse is the most common cause of chronic cases.
In some cases doctors don't know what caused
the disease.
What are the symptoms?
The main symptom of
pancreatitis is medium to severe pain in the upper belly. Pain may also spread
to your back.
Some people have other symptoms too, such as nausea,
vomiting, a fever, and sweating.
How is pancreatitis diagnosed?
Your doctor will do
a physical exam and ask you questions about your symptoms and past health. You
may also have blood tests to see if your levels of certain enzymes are higher
than normal. This can mean that you have pancreatitis.
Your doctor
may also want you to have a
complete blood count (CBC), a liver test, or a stool
test.
Other tests include an
MRI, a
CT scan, or an ultrasound of your belly (abdominal ultrasound) to look for gallstones.
A test called endoscopic retrograde cholangiopancreatogram, or ERCP, may
help your doctor see if you have chronic pancreatitis. During this test, the
doctor can also remove gallstones that are stuck in the
bile duct.
How is it treated?
Most attacks of pancreatitis
need treatment in the hospital. Your doctor will give you pain medicine and
fluids through a vein (IV) until the pain and swelling go
away.
Fluids and air can build up in your stomach when there are
problems with your pancreas. This buildup can cause severe vomiting. If buildup
occurs, your doctor may place a tube through your nose and into your stomach to
remove the extra fluids and air. This will help make the pancreas less active
and swollen.
Although most people get well after an attack of
pancreatitis, problems can occur. Problems may include cysts, infection, or
death of tissue in the pancreas.
You may need surgery to remove
your gallbladder or a part of the pancreas that has been damaged.
If your pancreas has been severely damaged, you may need to take insulin
to help your body control blood sugar. You also may need to take pancreatic
enzyme pills to help your body digest fat and protein.
If you have
chronic pancreatitis, you will need to follow a low-fat diet and stop drinking
alcohol. You may also take medicine to manage your pain. Making changes like
these may seem hard. But with planning, talking with your doctor, and getting
support from family and friends, these changes are possible.
Frequently Asked Questions
Learning about pancreatitis: | |
Being diagnosed: | |
Getting treatment: | |
Cause
Normally, the structure of the
pancreas and the pancreatic duct prevent digestive
enzymes from damaging the pancreas. But certain conditions can develop that
cause damage and
pancreatitis.
Acute pancreatitis
Most attacks of pancreatitis
are caused by
gallstones that block the flow of pancreatic enzymes
or by excessive amounts of alcohol. Sudden (acute) pancreatitis may happen
after a drinking binge or after many episodes of heavy drinking.
Other causes of acute pancreatitis are:
Sometimes the cause is not known.
Chronic pancreatitis
Excessive alcohol use is the most common cause of ongoing pancreatitis (chronic pancreatitis).footnote 1
Other causes of chronic pancreatitis include cystic fibrosis or a blockage in the pancreas. Chronic pancreatitis may run in families. And smoking cigarettes seems to increase the risk for this disease. In about 1 out of 4 cases, doctors aren't sure what causes it.footnote 2
Experts don't know how alcohol irritates the pancreas. Most believe that
alcohol either causes enzymes to back up into the pancreas or changes the
chemistry of the enzymes, causing them to inflame the pancreas.
Symptoms
The main symptom of sudden (acute)
pancreatitis is sudden moderate to severe
pain in the
upper area of the belly (abdomen). Sometimes the pain is mild. But the pain
may feel as though it bores through the abdomen to the back. Sitting up or
leaning forward sometimes reduces the pain. Other symptoms of an attack of
pancreatitis are:
- Nausea and
vomiting.
- Fever.
- Fast heart
rate.
- Sweating.
- Yellowing of the skin or the whites of
the eyes (jaundice).
- Shock.
Long-term (chronic) pancreatitis also causes pain in
the upper abdomen.
Other conditions that have similar symptoms include
bowel obstruction,
appendicitis,
cholecystitis,
peptic ulcer disease, and
diverticulitis.
What Happens
Pancreatitis
usually appears as a sudden (acute) attack of pain in the
upper area of the belly (abdomen). The disease may be mild or severe.
Acute pancreatitis
Most people with pancreatitis
have mild acute pancreatitis. The disease does not affect their other organs,
and these people recover without problems. In most cases, the disease goes away within
a week after treatment begins. Treatment takes place in the hospital with pain
medicines and intravenous (IV) fluids. After inflammation goes away, the
pancreas usually returns to normal.
In some cases, pancreatic tissue is permanently damaged or even
dies (necrosis). These complications increase the risk of infection and organ
failure.
In severe cases, pancreatitis can be fatal.
Chronic pancreatitis
Long-term pancreatitis
(chronic pancreatitis) may occur after one or more episodes of acute
pancreatitis. The most common cause of chronic pancreatitis is long-term alcohol misuse.
What happens during the course of chronic
pancreatitis varies. Ongoing pain and complications often occur.
Complications may include flare-ups of symptoms, fluid buildup, and blockage of
a blood vessel, the bile duct, or the small intestine.
If much of
your pancreatic tissue has died, you may become malnourished. This happens because the
pancreas no longer produces enzymes needed to digest fat and protein. So fat is released into your stool. This condition, called steatorrhea,
causes loose, pale, unusually foul-smelling stools that may float in the toilet
bowl.
If the damaged pancreas stops making enough
insulin, you also may develop
diabetes.
Chronic pancreatitis increases
the risk of pancreatic cancer. About 4 out of 100 people with chronic
pancreatitis develop this cancer.footnote 1
What Increases Your Risk
Several things can increase
your risk of pancreatitis, including:
- Alcohol misuse. The amount needed to cause pancreatitis is not known. Alcohol
tolerance varies from one person to another. Moderate consumption is considered
no more than 2
alcoholic beverages a day for men and 1 a day for
women and older people.
- A family history of pancreatitis.
- A high level of fat (triglycerides) in the blood.
- Gallstones. A
small gallstone can move far enough into the bile duct to block the flow of
pancreatic enzymes into the small intestine.
- Having cystic fibrosis.
- Smoking cigarettes.
- Structural problems of the pancreas or the bile and
pancreatic ducts, especially a condition in which the pancreas is divided and
has two main ducts (pancreas divisum).
- Taking certain
medicines, including estrogen therapy and some
antibiotics.
When To Call a Doctor
Call your doctor immediately if you have severe belly (abdominal)
pain with vomiting that does not go away after a few
hours, or mild to moderate pain that does not improve with home treatment after
a couple of days. These symptoms may be caused by
pancreatitis.
Watchful waiting
Pancreatitis can be a severe, potentially
life-threatening illness. It is not appropriate to take a wait-and-see
approach, which is called watchful waiting, if you have severe pain in the
upper area of the abdomen that does not go away in a few hours.
Who to see
The following health professionals can
diagnose and treat pancreatitis:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
If your doctor thinks you have
pancreatitis, he or she will
ask questions about your medical history and do a physical exam along with
lab and imaging tests.
Two blood tests that measure
enzymes are used to diagnose an attack of
pancreatitis. These tests are:
- Serum amylase. An increase of amylase
in the blood usually indicates pancreatitis.
- Serum lipase.
Sudden (acute) pancreatitis almost always raises the level of lipase in the
blood.
Other blood tests may be done, such as:
Imaging tests that may be done include:
- CT scan with
contrast dye. A CT scan can help rule out other causes of abdominal pain,
determine whether tissue is dying (pancreatic necrosis), and find complications
such as fluid around the pancreas, blocked veins, and obstructed bowels.
- Abdominal ultrasound. This test can locate gallstones.
It also can show an enlarged common bile duct.
- Endoscopic retrograde cholangiopancreatogram (ERCP).
This procedure allows the doctor to see the structure of the common bile duct,
other bile ducts, and the pancreatic duct.
ERCP is the only diagnostic test that also can be used
to treat narrow areas (strictures) of the bile ducts and remove gallstones from
the common bile duct.
- Magnetic resonance cholangiopancreatogram (MRCP). This form
of MRI can detect gallstones in the common bile duct. This test is not
available everywhere.
- Endoscopic ultrasound. In this form of
ultrasound, a probe attached to a lighted scope is placed down the throat and
into the stomach. Sound waves show images of organs in the abdomen. Endoscopic
ultrasound may reveal gallstones in the common bile duct.
- MRI. Sometimes an MRI is used to look for signs of
pancreatitis. It provides information similar to that of a CT
scan.
If your doctor is not sure whether your pancreatic tissue
is infected, he or she may use a needle to take some fluid from the inflamed
area. The fluid is then tested for organisms that can cause infection.
In severe, chronic pancreatitis, a
stool analysis may be done to look for fat in stools,
which is a sign that you may not be getting enough nutrition. This happens when
the pancreas no longer produces the enzymes you need to digest fat.
Treatment Overview
Treatment of
pancreatitis depends on whether you have a sudden
(acute) attack of pancreatitis or you have had the condition for a long time
(chronic).
Initial treatment
For acute pancreatitis. You will receive treatment in the hospital to allow the
pancreas to heal. You will receive
intravenous (IV) fluids to replace lost fluids and
maintain your blood pressure. And you will get medicines to control pain until
the
inflammation goes away.
To help rest
your pancreas, you likely will not be given anything to eat for several
days.
If
gallstones are causing
pancreatitis, you may have a procedure called
endoscopic retrograde cholangiopancreatogram (ERCP) to
remove the stones from the
common bile duct. After recovering from pancreatitis,
you may have surgery to remove the
gallbladder. This surgery often prevents future
attacks of pancreatitis. For more information, see the Surgery section of this
topic.
For chronic pancreatitis. People who
have chronic pancreatitis also may have episodes of acute pancreatitis, which
are treated the same as an initial episode of acute pancreatitis.
Ongoing treatment
Excessive use of alcohol is the most common cause of chronic
pancreatitis. It is extremely important that you not
drink any alcohol. Drinking even small amounts can cause severe pain and
complications. Drinking large amounts of alcohol when you have chronic
pancreatitis can shorten your life. For more information on quitting alcohol,
see the topic
Alcohol Misuse and Dependence.
If you have
chronic pancreatitis, you may struggle with ongoing pain.
Treatment for pain includes avoiding alcohol, eating a
low-fat diet, using pain medicine, and in some cases taking enzyme pills to
help rest your pancreas.
You may need
surgery or another procedure to widen a narrow pancreatic duct or to remove tissue or stones that
are blocking the pancreatic duct. Surgery can also drain a pseudocyst or an
obstructed duct.
Your doctor will want to see you regularly to make sure that your pain medicine is helping you and that you do not have complications of chronic pancreatitis. Complications of chronic
pancreatitis may include recurring flare-ups of symptoms, fluid buildup, and
blockage of a blood vessel, the bile duct, or the small intestine. Chronic
pancreatitis also increases your risk of pancreatic cancer.
Treatment if the condition gets worse
In advanced chronic pancreatitis, your body may
not absorb fat. This causes loose, oily, especially foul-smelling stools
(called steatorrhea). You may lose weight as a result, because your pancreas no
longer produces the enzymes you need to digest fat and protein. Pancreatic
enzyme pills can replace lost enzymes.
You may need
insulin if your pancreas has stopped producing enough
of it.
If infection develops, you may need antibiotics and you might have
surgery to remove the infected and dead tissue. But surgery is avoided when
possible, because the pancreas is damaged easily.
You may need
surgery if you develop complications from acute or chronic pancreatitis.
Surgery also may be done if there is no infection and your condition has not
improved.
Prevention
You cannot completely prevent
pancreatitis caused by
gallstones. But you may be able to reduce your risk of
forming gallstones by staying at a healthy weight with a balanced diet and
regular exercise. For more information, see the topic
Gallstones.
You can reduce your chance of
having pancreatitis by not drinking alcohol excessively. The amount of alcohol
needed to cause pancreatitis varies from one person to another. Generally,
moderate consumption is considered no more than 2
alcoholic beverages a day for men and 1 a day for
women and older people.
Smoking may increase your chance of having
pancreatitis. If you smoke, it's a good idea to quit.
Home Treatment
If you have ongoing (chronic)
pancreatitis caused by excessive use of alcohol, you
will need to quit drinking to reduce severe pain and complications. Drinking
large amounts when you have chronic pancreatitis can shorten your life. For
more information on quitting alcohol, see the topic
Alcohol Misuse and Dependence.
Although
the role of diet in pancreatitis is not clear, doctors recommend eating a
low-fat diet and staying at a healthy body
weight.
Medications
Chronic pancreatitis
In addition to pain medicine,
people who have chronic illness may take pancreatic enzymes and
insulin because their damaged pancreas no longer
produces enough of these.
Medicine choices
You may need one or more medicines to treat chronic
pancreatitis. Be safe with medicines. Read and follow all instructions on the label.
- Pain medicine. Mild
pain is first treated with a medicine such as acetaminophen or ibuprofen. If
you have stronger pain, you may be given an opioid pain reliever.
- Pancreatic enzyme supplements. In
advanced chronic pancreatitis, the pancreas may stop producing the enzymes
needed to digest fats, proteins, and carbohydrates. Enzyme supplements at meals
can help the body digest fats, allowing you to retain nutrients and gain
weight.
- Insulin. Advanced chronic
pancreatitis can lead to
diabetes if the part of the pancreas that produces
insulin becomes damaged.
What to think about
Side effects of pancreatic
enzymes that are given to treat chronic pancreatitis include abdominal
(belly) discomfort and soreness of the mouth and the anus. People who are allergic to
pork or who do not eat pork for other reasons should not take these enzymes,
because they are made of pork protein. In young children, high doses of
pancreatic enzymes could cause a
bowel obstruction.
Surgery
Surgery of the pancreas is
avoided, if possible, because the gland is easily damaged. But surgery may be
needed to remove infected or damaged tissue (pancreatic necrosis). The gallbladder may be removed
to prevent future attacks from
gallstones.
Surgery choices
One of two surgeries can be done to remove the
gallbladder if gallstones are causing pancreatitis:
Surgeons may choose among several techniques to remove
damaged pancreatic tissue.
Other Places To Get Help
Organizations
American Gastroenterological
Association
www.gastro.org
National Institute of Diabetes and Digestive and Kidney Diseases (U.S.)
www.digestive.niddk.nih.gov
References
Citations
- Forsmark CE (2010). Chronic pancreatitis. In M Feldman et al., eds., Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 9th ed., vol. 1, pp. 985-1015. Philadelphia: Saunders.
- Cote G, et al. (2011). Alcohol and smoking as risk factors in an epidemiology study of patients with chronic pancreatitis. Clinical Gastroenterology and Hepatology, 9(3): 266-273.
Other Works Consulted
- American Gastroenterological Association Institute (2007). Medical position statement on acute pancreatitis. Gastroenterology, 132(5): 2019-2021.
- American Gastroenterological Association Institute (2007). Technical review on acute pancreatitis. Gastroenterology, 132(5): 2022-2044.
- Banks PA, et al. (2006). Practice guidelines in acute pancreatitis. American Journal of Gastroenterology, 101(10): 2379-2400.
- Conwell DL, et al. (2015). Acute and chronic pancreatitis. In DL Kasper et al., eds., Harrison's Principles of Internal Medicine, 19th ed., vol. 2, pp. 2090-2102. New York: McGraw-Hill Education.
- Kocher HM, Kadaba R (2015). Chronic pancreatitis: Dietary supplements. BMJ Clinical Evidence. http://clinicalevidence.bmj.com/x/systematic-review/0417/overview.html. Accessed April 14, 2016.
- Steer ML (2006). Acute pancreatitis. In MM Wolfe et al., eds., Therapy of Digestive Disorders, 2nd ed., pp. 417-426. Philadelphia: Saunders Elsevier.
- Tolstrup JS, et al. (2009). Smoking and risk of acute and chronic pancreatitis among women and men: A population-based cohort study. Archives of Internal Medicine, 169(6): 603-609.
Credits
ByHealthwise Staff
Primary Medical ReviewerE. Gregory Thompson, MD - Internal Medicine
Adam Husney, MD - Family Medicine
Kathleen Romito, MD - Family Medicine
Specialist Medical ReviewerPeter J. Kahrilas, MD - Gastroenterology