Understanding and Managing Pancreatitis: A Comprehensive Guide for Patients

Pancreatitis, an inflammation of the pancreas, can manifest as an acute condition, appearing suddenly and potentially ranging from mild to severe, or as a chronic condition, which is long-term and does not heal or improve. The pancreas, a long, flat gland located behind the stomach and near the duodenum (the upper part of the small intestine), plays two major roles: secreting digestive enzymes into the small intestine through the pancreatic duct to help digest fats, proteins, and carbohydrates, and releasing the hormones insulin and glucagon into the bloodstream to regulate blood sugar.

Symptoms of Pancreatitis

Symptoms of pancreatitis may vary. 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 constant - just in the abdomen - or it may reach to the back and other areas. It may be sudden and intense, or begin as a mild pain that gets worse when food is eaten. Someone with acute pancreatitis often looks and feels very sick. Severe cases may cause dehydration and low blood pressure. The heart, lungs, or kidneys may fail. Most people with chronic pancreatitis have abdominal pain, although some people have no pain at all. The pain may get worse when eating or drinking, spread to the back, or become constant and disabling. In certain cases, abdominal pain goes away as the condition advances, probably because the pancreas is no longer making digestive enzymes.

When to Seek Medical Attention

It is crucial to make an appointment with a healthcare professional if you experience sudden belly pain or belly pain that doesn't improve. If you are experiencing severe abdominal pain, call your doctor or go to the nearest emergency room.

Causes and Risk Factors

The pancreas makes and stores "turned off" versions of digestive enzymes. If the enzymes are turned on too soon, they can start acting like digestive juices inside the pancreas. This action can irritate, damage, or destroy cells. Sometimes, a cause of pancreatitis is never found.

Common Causes

Gallstones: These hard stones form in the gallbladder. The gallbladder shares a tube with the pancreas into the small intestine. If gallstones block this tube, fluid can’t leave the pancreas, backing up and causing inflammation.
Excessive alcohol use: Damage from alcohol abuse may not appear for many years, and then a person may have a sudden attack of pancreatitis. In up to 70 percent of adult patients, chronic pancreatitis appears to be caused by alcoholism. Alcohol alters pancreatic physiology by increasing the viscosity of pancreatic secretions and promoting protein plug formation that obstructs small ducts.
Hypertriglyceridemia: Elevated triglyceride levels, usually exceeding 1000 mg/dL, are a recognized cause of acute pancreatitis.

Risk Factors

Being male
Race
Cigarette smoking: People who smoke cigarettes are three times more likely to develop pancreatitis than people who don't smoke.
Obesity
Diabetes
Family history of pancreatitis: A number of genes have been linked to chronic pancreatitis.
Personal or family history of gallstones
Kidney failure

Complications of Pancreatitis

Either acute or chronic pancreatitis can cause serious complications.

Read also: Understanding Asthma

Acute pancreatitis: May result in the kidneys not filtering waste from the blood, leading to kidney failure. It can also cause breathing problems, with many people developing hypoxia, where cells and tissues don't receive enough oxygen. Acute pancreatitis can make the pancreas vulnerable to infections, sometimes requiring surgery for extensive infections.
Pseudocyst: Acute and chronic pancreatitis can cause fluid and debris to collect in a "pocket" in the pancreas, called a pseudocyst.
Malnutrition: With chronic pancreatitis, the pancreas may not produce enough enzymes for the digestive system.
Osteoporosis: Chronic pancreatitis that causes malnutrition can weaken the bones.
Diabetes: Pancreatic damage can impair insulin production, leading to diabetes.
Pancreatic cancer: Chronic pancreatitis increases the risk for pancreatic cancer, necessitating regular screening.

Diagnosis of Pancreatitis

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 and lipase than usual. Amylase and lipase are digestive enzymes formed in the pancreas. Changes may also occur in blood levels of glucose, calcium, magnesium, sodium, potassium, and bicarbonate. A doctor may also order an abdominal ultrasound to look for gallstones and a CT (computerized tomography) scan to look for inflammation or destruction of the pancreas.

Diagnostic Tests

Blood tests: To measure levels of pancreatic enzymes (amylase and lipase).
Abdominal ultrasound: To look for gallstones.
CT scan: To look for inflammation or destruction of the pancreas.
Pancreatic function tests: To determine whether the pancreas is still making enough digestive enzymes.
Ultrasonic imaging, Endoscopic Retrograde Cholangiopancreatography (ERCP), and CT scans: To identify problems indicating chronic pancreatitis, such as calcification of the pancreas.
MRI (Magnetic resonance imaging): A radiologic test for imaging the pancreas and other intra-abdominal organs.
Ultrasonography (Ultrasound): A radiologic test for imaging the pancreas and other intra-abdominal organs.
ECRP (Endoscopic Retrograde Cholangiopancreatography): A procedure utilizing a long, narrow, flexible tube called an endoscope that is introduced via the mouth into the small intestine to examine the pancreatic duct and bile ducts.

Treatment and Management

Treatment depends on the severity of the attack. If no kidney or lung complications occur, acute pancreatitis usually improves on its own. Treatment, in general, is designed to support vital bodily functions and prevent complications. Sometimes a person cannot stop vomiting and needs to have a tube placed in the stomach to remove fluid and air. Unless the pancreatic duct or bile duct is blocked by gallstones, an acute attack usually lasts only a few days. In severe cases, a person may require intravenous feeding for 3 to 6 weeks while the pancreas slowly heals. This process is called total parenteral nutrition.

The most important goal in the treatment of chronic pancreatitis is to provide pain relief and prevent progression of disease. If pain is difficult to control, you may be referred to a chronic pain specialist. At times, relief of pain may require endoscopic, radiologic, or surgical treatment. If your pancreas is found to be unable to provide sufficient enzymes for adequate digestion, you may benefit from enzyme supplements. Also, if your blood sugar level is very high and not controlled by diet or oral medications, insulin may be required.

Acute Pancreatitis Treatment

Supportive care: Fluid resuscitation, pain control, and nutritional support.
Oxygen therapy: To treat hypoxia.
Antibiotics: If an infection develops.
Surgery: May be needed for extensive infections or gallstone removal.

Chronic Pancreatitis Treatment

Pain management: Relieving pain is the first step in treating chronic pancreatitis.
Pancreatic enzyme supplements: A doctor may prescribe pancreatic enzymes to take with meals if the pancreas does not secrete enough of its own. The enzymes should be taken with every meal to help the body digest food and regain some weight.
Insulin: May be required if blood sugar levels are very high and not controlled by diet or oral medications.
Endoscopic, radiologic, or surgical treatment: In some cases, surgery is needed to relieve pain.
Lifestyle modifications: Abstaining from alcohol and smoking, and adopting a healthy diet.
Surgical removal of the pancreas: In a few select patients, there is also the option of surgically removing the pancreas to reduce pain and transplanting the islets from the pancreas into the liver to potentially prevent diabetes.

Lifestyle Modifications

Making certain lifestyle modifications can help those with chronic pancreatitis manage the condition long-term and prevent acute flare-ups.

Avoid alcohol and cigarettes: After all signs of acute pancreatitis are gone, the doctor will try to decide what caused it in order to prevent future attacks. Alcohol abuse is one of the most common causes of pancreatitis, and abstaining prevents further damage to the pancreas. Doctors at NYU Langone recommend that people with pancreatitis stop smoking since it may worsen symptoms or delay recovery. In people with pancreatitis, smoking also increases the risk of developing pancreatic cancer.
Eat a balanced diet: Eat vegetables, fruit, whole grains and lean proteins. Stay hydrated. Eat a low-fat diet. Ask your provider for menus and other diet information. Eat foods that are high in protein and carbohydrates, but low in fat. Eat smaller meals, and eat more often. Your provider will help make sure you are getting enough calories to not lose weight.
Prevent or manage gallstones: Take steps to prevent gallstones by maintaining a healthy weight and eating a balanced diet.

Post-Hospital Care

You were in the hospital because you have pancreatitis. This is a swelling (inflammation) of the pancreas. This article tells you what you need to know to take care of yourself after you go home from the hospital.

Read also: Navigating Patient Care

Important Instructions

Find someone to drive you to appointments. Acute pancreatitis is a serious condition, and you should never drive if you have symptoms.
Stop drinking if your illness was caused by alcohol. Ask your health care provider about alcohol abuse programs and support groups, such as Alcoholics Anonymous. Ask your provider about prescription medicines that can help you stop drinking. Tell your provider about the alcohol withdrawal symptoms you have when you stop drinking. This is very important. You may need close medical supervision and special medicines when you stop drinking.
Take your medicines exactly as directed. Don’t skip doses.
Tell your provider about any medicines you are taking. Some medicines can cause this condition. Before starting any new medicine, ask your provider if it will harm your pancreas. This includes any new over-the-counter medicines, vitamins, or herbal supplements.
Tell your provider if you lose weight without dieting.
Be aware of symptoms that may mean your pancreatitis has come back. These symptoms include belly pain, nausea and vomiting, and fever.
Keep all follow-up appointments with your provider. Problems can often show up later.
If your pancreatitis was caused by gallstones, gallbladder removal will likely be advised.

When to Contact a Medical Professional

Contact your health care provider as advised if you experience:

Have a fever of 100.4° F ( 38°C) or higher, or as advised by your provider.
Have severe pain from your upper belly to your back.
Feel dizzy or lightheaded.
Have yellowing of your skin or eyes (jaundice).
Have bruises on your belly or back.
Have belly swelling and tenderness.
Have shallow, fast breathing.

tags: #pancreatitis #patient #education