What is Pancreatitis?

Everything You
Need to Know

Based on a major global study in 2017, around 76 in 100,000 people worldwide develop some form of pancreatitis. So, while not extremely widespread, this condition still impacts a meaningful number of folks.
If you or someone you care about has been diagnosed with pancreatitis, you understand how confusing this condition can be. Understanding how the pancreatitis comes about and its symptoms can help you manage it.

Well, pancreatitis happens when those commonly helpful digestive enzymes go rogue, activating too soon while still inside your pancreas and attacking it. This will cause inflammation and damage to the pancreas as it tries to
defend itself.

The condition can take two forms. The first one is acute pancreatitis, which is the sudden short-term variety that comes on quickly but usually resolves within days or weeks with treatment. The other one is chronic pancreatitis, which is the persistent, long-term version, with an inflammation that slowly damages the pancreas over many years.

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What is the Pancreas?

The pancreas is a 6-inch long flattened gland that sits tucked behind the stomach in the upper abdomen. It has two main functional components:

Usually, the enzymes made by the exocrine pancreas are
inactive when they are produced and stored in the pancreas. They only become activated once they reach the small intestine. But in pancreatitis, these enzymes prematurely start while still inside the pancreas, digesting and damaging the organ’s tissues and causing inflammation.

What is Pancreatitis?

Pancreatitis Forms

Acute Pancreatitis

Chronic pancreatitis is persistent, long-standing pancreas inflammation leading to permanent damage over time. It’s progressive, meaning it gets worse over many years.

Causes

Repeated bouts of acute pancreatitis ultimately cause permanent damage and chronic inflammation. Alcohol abuse is the most common culprit. Hereditary factors like CFTR gene mutations also play a role.

Symptoms

Upper abdominal pain is the hallmark symptom. It’s characterized by feeling worse after consuming fatty or large meals. Unexplained weight loss, oily stools, and nausea are also common.

Most doctors use:

  • Blood tests
  • Stool tests
  • CT scans
  • Endoscopic procedures like ERCP

These tools help doctors assess your pancreas’ structure and function. Other times, the doctor may suggest a pancreas biopsy.

Treatment

The treatment of this condition focuses primarily on pain control, replacing lost pancreatic enzymes/insulin, and treating complications when they arise. You might require surgery in some instances to remove obstructing stones/tumors or drain pseudocysts.
Outlook

There is no cure for chronic pancreatitis. Managing this condition is lifelong, and there are potential complications like:

Chronic Pancreatitis

Acute pancreatitis is a sudden inflammation of the pancreas that develops quickly and lasts for a short period. It’s usually mild, fully recovering within 5-10 days after treatment. However, in some cases, it can be a severe life-threatening illness with serious complications.

Causes

Gallstones are a frequent culprit, blocking the pancreatic duct and allowing premature enzyme activation. Heavy alcohol use is another common cause, injuring pancreatic tissues through toxic byproducts. High blood triglycerides, certain medications like diuretics, viral infections, trauma, inherited gene mutations, and anatomical abnormalities can also precipitate attacks. In many cases, no cause is found (idiopathic).

Symptoms

The hallmark symptom is severe, persistent pain in the upper abdomen that can radiate to the back. This is often described as a dull, penetrating pain, worse when lying down and improved when leaning forward. Other symptoms include:

  • Nausea and vomiting
  • Fever
  • Rapid heart rate
  • Abdominal tenderness on exam.
Diagnosis

Doctors will check pancreas enzyme levels in the blood, like amylase and lipase. Levels 3 times the standard limit indicate pancreatitis. Imaging like a CT scan or transabdominal ultrasound will show pancreatic inflammation and complications.

Treatment

Mild cases may only require IV fluids, pain management, and a few days of bowel rest. Severe cases will be hospitalized for close monitoring. Antibiotics may be administered if need be to treat complications. If a gallstone is the cause, surgery to remove it or the gallbladder is often required. Other times, the patients may need time in the ICU.

Outlook

While most mild cases resolve within 5-10 days, severe acute pancreatitis requires hospitalization. It can lead to serious, even fatal, complications like:

  • Infected pancreatic tissue
  • Organ failure
  • Lung injury.

Complications of Pancreatitis

While mild cases of pancreatitis usually resolve without issue, severe acute pancreatitis and long-standing chronic pancreatitis can both lead to serious complications:

Acute Pancreatitis Complications
  1. Necrotizing pancreatitis – This leads to dead pancreatic tissue that is prone to infection. This infected necrosis spreads bacteria to the bloodstream and can be fatal. Surgery is often needed to remove the dead tissue.
  2. Pseudocysts – These are encapsulated fluid collections caused by pancreatic duct disruption. Pseudocysts may rupture and cause bleeding or abscesses. Drainage or surgical removal is sometimes necessary.
  3. Systemic inflammatory response syndrome (SIRS) – Occurs when the pancreatitis triggers a body-wide inflammatory response involving the immune system. This can lead to: Shock Respiratory distress Kidney failure Death in most cases.
  4. Respiratory failure -Chemical changes leading to fluid accumulation and low oxygen levels in the lungs may cause this. Mechanical ventilation may be required.
Chronic Pancreatitis Complications
  1. Exocrine pancreatic insufficiency – This condition leaves the body unable to properly digest
    food due to inadequate enzyme secretion, causing chronic diarrhea and weight loss. Enzyme replacement is needed.
  2. Endocrine insufficiency – Results in diabetes as insulin production drops. This requires life long insulin therapy and blood sugar monitoring. It may also require other diabetic medications such as Victoza or Mounjaro.
  3. Chronic pain – The pain can be constant and extremely difficult to manage, even with narcotic medication, nerve blocks, and counseling.
  4. Pancreatic cancer – The risk is 5-10 times higher compared to the general population due to persistent inflammation. Screening via endoscopic ultrasound is recommended.
  5. Pseudocysts – Can develop and may require drainage or surgical excision if symptomatic.
Risk Factors and Prevention

Several risk factors make pancreatitis more likely:

  • Alcohol abuse – Heavy drinking over 4-5 drinks daily significantly increases risk.
  • Gallstones – Account for up to 40% of acute pancreatitis cases in the Western world.
  • High triglycerides – Blood fat above 1000 mg/dL can precipitate an attack.
  • Medications – Certain meds like steroids or diuretics may cause problems.
  • Obesity – BMI over 30 is linked to higher incidence.
  • Smoking – Increases the risk of chronic pancreatitis threefold.
  • Family history – Hereditary factors play a role for some people.

You can help prevent pancreatitis by:

  • Limiting your alcohol intake is one of the most effective ways to prevent both acute and chronic pancreatitis. Alcohol is a direct toxin to pancreatic tissues and a known causative agent, so reducing your intake to below three drinks per day for men and two drinks per day for women will significantly help. Sometimes, complete abstinence is required based on your family’s history or previous pancreatitis episodes.
  • Obesity is linked to a higher incidence of acute pancreatitis. This is likely due to associated factors like high triglycerides, cholesterol, and blood glucose. Losing some of your weight if your BMI is over 30 and exercising regularly can lower risk.
  • Carefully reviewing your medications can identify any drugs that could be triggering pancreatitis. Some drugs thought to start pancreatitis include steroids, diuretics, certain anti-HIV, and seizure meds, among others. It is, therefore, wise to provide your doctor with a complete medication list to determine if changes need to be made or if they require the removal of any high-risk prescriptions.
  • Understanding your family history can help assess hereditary risk factors. It would be best if you talked to relatives about any history of acute or chronic pancreatitis, especially at a young age. Specific genetic mutations like PRSS1, CFTR, and SPINK1 are linked to pancreatitis and may warrant genetic testing based on family patterns.
  • Conducting routine lipid panel screening may help prevent this condition. These tests help detect elevated cholesterol and triglyceride levels, especially if other risk factors are present. Hypertriglyceridemia above 1000 mg/dL is a known trigger for acute pancreatitis. Keeping triglycerides optimally below 150 mg/dL will help avoid this risk.
  • Gallstones are responsible for 70% of acute pancreatitis cases when they temporarily obstruct pancreatic duct drainage. If you have a history of symptomatic gallstones, urgent surgical treatment may be needed to remove the gallbladder and prevent recurrent acute pancreatitis that could lead to chronic damage.

Living with Pancreatitis

Conclusion

Pancreatitis is very common and potentially serious when the digestive enzymes prematurely inflame and damage the pancreas. Acute cases manifest very fast, while chronic pancreatitis is
progressive, causing severe damage over many years.

Diagnosis for this condition is made via blood tests and imaging. Its treatment focuses on pain relief, rest, fluids, and hospitalization only for severe cases.

Pancreatitis can be fatal in some cases but is treatable if identified early. Limiting alcohol intake and maintaining a healthy lifestyle with medical guidance can help prevent attacks. If you develop persistent abdominal pain, ensure to see a doctor fast to determine if you may have pancreatitis.

FAQs

What lifestyle changes should I make?
After a diagnosis and treatment, the best way to manage the disease is to make lifestyle changes. Try abstaining from alcohol, avoiding smoking, eating a low-fat diet, and ensuring you hydrate your body throughout. Also, remember to take your pancreatic enzymes as prescribed and always follow your doctor’s advice.

What can I do to prevent the condition from getting worse?
The key is to prevent further damage to your pancreas. You can do this by stopping alcohol use and smoking. Eating smaller, healthy meals, limiting fats, and staying active throughout the treatment can also aid in your recovery.

Will I need surgery? Are there other options?
Sometimes, yes. You may need surgery like gallbladder removal. This, however, depends on the cause and severity. Your doctor may suggest undergoing other procedures like endoscopy or draining fluid collections. Luckily, most people can comfortably manage chronic pancreatitis with diet, enzymes, pain relief, and monitoring instead.

What types of medications treat pancreatitis? What are the side effects?
Treating pancreatitis mainly focuses on the doctor providing pain relief, IV fluids, and antibiotics if needed. The side effects depend on the medication but may include constipation, nausea, drowsiness, and other issues. Please always work with your doctor to find the best pain management options.

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