Pancreatitis

What is pancreatitis?

Pancreatitis is a condition where your pancreas becomes inflamed. 

Your pancreas is an organ that's part of your digestive system. It’s found behind your stomach, close to the first part of your small intestine. It produces enzymes that help you break down food as well as hormones like insulin that help regulate blood sugar levels.

Your pancreas also produces and stores digestive enzymes. Your pancreas sends these enzymes through the pancreatic duct to your small intestine, where they are activated so they can break down proteins, carbohydrates and lipids (fatty compounds). If these enzymes become activated inside of your pancreas, they can irritate and damage your cells and cause inflammation, pain and changes in how your pancreas works. 

With inflammation of the pancreas, you may have digestive problems and long-term health issues.

There are two main types of pancreatitis:

• Acute pancreatitis is usually temporary. It happens suddenly, after something harms your pancreas. Most people recover in a few days with treatment. But severe cases can cause serious, life-threatening complications.
• Chronic pancreatitis is long-lasting and gets worse over time. The inflammation can cause scarring and damage to the pancreas that can't be reversed.

For both types of pancreatitis, you need medical care to help manage your symptoms and prevent complications.

Symptoms of pancreatitis 

Pancreatitis symptoms can be different depending on which type you have.

Acute pancreatitis may start with sudden, severe abdominal (belly) pain that may spread to your back or shoulder blade. The pain may be sharp and may get worse after you eat. The pain from acute pancreatitis can cause shock and organ failure, which may be life threatening.

You may also have:

• Upset stomach
• Nausea
• Vomiting
• Fever
• Fast pulse
• Swollen or tender abdomen

Chronic pancreatitis has symptoms that are not as severe but last longer. You may have:

• Abdominal pain after eating (in some cases it does not go away)
• Loss of appetite
• Nausea
• Vomiting
• Unexplained weight loss (since you can’t absorb food and nutrients)
• Lightheadedness
• Digestive issues such as diarrhea or oily stools over time, since your pancreas can't make digestive enzymes well

Symptoms of either type of pancreatitis may feel worse when you lie flat and better when you curl up into a ball.

If you have any signs or symptoms of pancreatitis, be sure to see your health care provider. Getting diagnosed early can help you avoid long term complications. Be sure to get care right away for pain that’s so bad you can’t get comfortable.

Causes and risk factors 

Several different risk factors can cause pancreatitis. Acute and chronic pancreatitis have different causes. Sometimes, it’s not clear what’s causing pancreatitis.

Acute pancreatitis may be caused by:

• Gallstones, which can block the pancreatic ducts and trap enzymes in the pancreas
• Heavy alcohol use, which may cause inflammation or activate digestive enzymes in your pancreas
• Certain medications, including estrogens, steroids and some diuretics
• Injury from trauma or surgery
• Infections, including mumps, salmonella and hepatitis A or B
• Autoimmune diseases
• Metabolic disorders
• Tumors

Chronic pancreatitis is most often caused by long-term heavy alcohol use and/or tobacco. These factors may also play a role:

• Repeated cases of acute pancreatitis
• Certain genetic disorders

Risk factors for both types of pancreatitis include:

• Family history
• Being male 
• African American ancestry
• Smoking
• Obesity, especially if your extra weight is around your belly
• Cystic fibrosis
• Diabetes
• High cholesterol levels
• High triglyceride levels (a type of fat in the blood)
• High blood calcium levels

Diagnosing pancreatitis 

To diagnose pancreatitis, your health care provider will ask about your medical history and symptoms and perform a physical examination. They may also recommend blood tests and imaging scans.

• In acute pancreatitis, your provider will check your blood for increased levels of pancreatic enzymes which could be signs of inflammation. X-rays, ultrasound, CT scans and MRIs can evaluate swelling, fluid buildup and damage to your pancreas.
• For chronic pancreatitis, your provider may test your blood sugar to see if your pancreas is producing insulin well and test your stool for enzymes and fat. They may also recommend magnetic resonance cholangiopancreatography (MRCP). MRCP is a non-invasive imaging technique that gives detailed images of your pancreas, bile ducts and other parts of your digestive system. With it, your provider can see blockages and damage to the pancreatic ducts that could be signs of chronic inflammation.  The only functional test that is most sensitive is an EGD with secretin stimulation.  This test can evaluate how well the pancreas is functioning.

Treatment for pancreatitis 

Treating pancreatitis depends on whether you have acute or chronic pancreatitis.

• Acute pancreatitis: There’s no medication to treat acute pancreatitis. The primary treatment is supportive care, which may include hospitalization, tube feeding so your pancreas can heal and IV fluids so you don’t get dehydrated. You’ll also likely need pain relief and your provider may also need to manage infections or other complications. Once you’re feeling better, your provider will focus on identifying and treating the underlying cause, such as gallstones, high triglycerides, medications or alcohol use.
• Chronic pancreatitis: For chronic pancreatitis treatment you may be referred to a gastroenterologist (digestive system specialist). Treatment can help manage pain, improve your enzyme functioning and address complications. Pain relief may involve medication, lifestyle changes and, in some cases, surgery. In severe cases, you may need pancreatic enzyme replacement therapy (PERT) to help manage digestive issues, as well as vitamin supplements.

If you have complications such as a blocked bile duct, damaged pancreatic ducts or if your pancreas is severely damaged, you may also need surgery to remove bile ducts or part or all of your pancreas.

Complications of acute and chronic pancreatitis 

Both acute and chronic pancreatitis can lead to serious complications if they aren’t treated.

Acute pancreatitis may cause:

• Infection 
• Kidney or other organ failure
• Breathing problems and low oxygen levels
• Pancreatic pseudocysts (fluid-filled sacs), which can cause bleeding and become infected
• Long-term damage to the pancreas, which can make it harder for your pancreas to produce digestive enzymes 
• Malnutrition
• Diarrhea
• Chronic pancreatitis
• Pancreatic cancer

Chronic pancreatitis may cause:

• Exocrine pancreatic insufficiency (EPI), since your pancreas isn’t producing enough of the enzymes that your digestive system needs
• Malnutrition, because when your pancreas can’t make enough digestive enzymes, you may have diarrhea and weight loss 
• Bile duct obstruction, which can lead to jaundice (yellowing of the skin and eyes)
• High or low blood sugar or diabetes, if the cells that produce insulin are damaged

Managing and preventing pancreatitis

To manage pancreatitis, you will need both treatment and lifestyle changes.

• Acute pancreatitis: Avoiding triggers, such as alcohol or high fat foods, is important. You may need to follow a low-fat diet to prevent flare ups.
• Chronic pancreatitis: Long-term management includes pain relief, avoiding alcohol and following a healthy diet. You may need to take pancreatic enzyme supplements to help you digest food and prevent malnutrition. You will need to see your health care provider regularly to watch for signs of complications such as pancreatic cancer or bile duct issues.

To prevent pancreatitis, consider these lifestyle changes:

• Limit or avoid alcohol
• Eat a balanced diet. A high-calorie, high-fat diet may increase your risk of pancreatitis.
• Quit smoking
• Manage conditions like high cholesterol or high triglycerides
• Work with your provider to monitor your health if you are at higher risk for pancreatitis

Getting care

At Banner Health, we offer expert care for both acute and chronic pancreatitis. Our team of specialists diagnose and treat pancreatitis with the latest advancements in medical technology, such as MRCP for accurately imaging the pancreas and bile ducts, draining fluid collections endoscopically and diagnosing chronic pancreatitis with the EGD/secretin stimulation test.

Whether you’re dealing with acute pancreatitis or managing chronic pancreatitis, our goal is to help you achieve the best outcomes and improve your quality of life. From pain relief to managing complications to surgery if needed, we are here to support you every step of the way.