What a pancreas does.
Your pancreas produces insulin, glucagon and other hormones which enable your
body's ability to use sugar. It also secretes enzymes and sodium bicarbonate
into your small intestine where they join bile from the liver and gallbladder.
These digestive substances break fats, proteins and carbohydrates into digestible
It is quite possible for a person eating a diet of sufficient quantity or
high quality food to actually starve to death if their pancreas does not produce
enough of these digestive substances.
An inflammation of the pancreas is called Pancreatitis.
While the pancreas is inflamed, it can be attacked by its own digestive juices. Mild
forms of pancreatitis (oedematous pancreatitis) may resolve quite quickly, within a few days, without residual damage to the pancreas or other organs.
The symptoms of Pancreatitis.
- Upper Abdominal Pain. The pain from pancreatitis can be
mild or severe, and can begin gradually or suddenly. The pain is usually felt
in the centre of the upper abdomen, and in many cases can be felt radiating
through the body to the back. The pain often is worsened by eating,
or by drinking alcohol. This pain may last for any period from minutes
to days. If untreated, this pain may eventually become continuous. Sometimes
the pain of pancreatitis may be relieved by sitting erect or leaning forward.
- Nausea and Vomiting.
- Fever. Abnormally high body temperature.
- Jaundice. Yellowish discoloration of the whites of the eyes, skin,
and mucous membranes caused by deposition of bile salts in these tissues.
- Symptoms of Shock
lips and fingernails, chest pain, cool,
clammy skin, decreased or no urine output,
nausea and vomiting, numbness,
sweating, moist skin, rapid pulse, shallow
breathing, excessive thirst, unconsciousness,
- Weight Loss. Particularly rapid and/or unexplained weight loss.
- Symptoms of Diabetes Mellitus. Excessive secretion of urine
(polyuria), thirst (polydipsia), weight loss and a feeling of lassitude.
- Abdominal bloating and tenderness.
If you have had continuous severe abdominal pain for 20 minutes or more, you should
see your doctor as soon as possible, and raise the possibility of your being
affected by pancreatitis with him
Typical acute pancreatitis is usually easy for a doctor to recognise. The clinical features are characteristic, and a simple blood test is confirmatory. One of the enzymes produced by the pancreas is called
In acute pancreatitis this enzyme spills into the blood stream, so that its level is markedly elevated. Raised levels of other enzymes
lipase can also be detected.
Both acute and chronic pancreatitis may be diagnosed by physical exam, medical history, blood tests that measure pancreatic function, or measurement of the fat content of bowel movements to check for poor absorption. Sometimes x-rays, ultrasound tests, CT scans, or tests that use
fiber optic cameras are used.
Normal levels of amylase and lipase do not rule out pancreatitis, especially when the pancreas has been damaged beforehand.
As with all types of inflammation, the number of white cells in the blood stream may be increased.
Acute pancreatitis is usually a sudden and severe illness when the pancreas rapidly becomes inflamed. Pancreas enzymes and various
toxins may enter the blood stream in an acute attack, and injure other organs such as the heart, lungs and kidneys. However, the pancreas can return to virtual normality if the cause of the attack is found and treated.
The most common cause of acute pancreatitis is gallstones. Gallstones,
produced in the gall bladder, often as a result of rapid weight loss, can travel
through the bile duct and become stuck at the papilla of Vater, which is the
outlet into the duodenum. As the bile duct shares the papilla of Vater with the
pancreas this blockage can affect the outflow of digestive juices from the
pancreas, causing the enzymes to back up and irritate or damage the
Alcohol abuse is another common cause of acute pancreatitis. The alcohol acts as a poison on
the pancreas, damaging it directly. People and their pancreases vary in their sensitivity to alcohol.
Some people drink heavily for years with no ill affects on their pancreases
being noted, while others suffer from a very light dose of alcohol.
Once pancreatitis has occurred, alcohol should be avoided completely. Alcohol can aggravate pancreatitis even if it has originally been caused by something else.
Acute pancreatitis can also occur due to poor drainage of the pancreatic duct resulting from partial
obstruction by small tumours, and scarring and spasm of the muscular sphincter (sphincter of
Some people are born with unusual drainage systems such as pancreas divisum which can
interfere with drainage.
Less common causes of pancreatitis are:
In 15% of cases of acute pancreatitis, the causal factor remains
About 20 percent of cases are severe. The patient may become dehydrated and have low blood pressure. Sometimes the patient's heart, lungs, or kidneys fail. In the most severe cases, bleeding can occur in the pancreas, leading to shock and sometimes death.
Treatment for Acute Pancreatitis
Treatment for acute pancreatitis focuses on relieving pain and taking care of nutrition and metabolism. Sometimes a person will need to be
hospitalised to receive medication and intravenous fluids to help rest and heal the pancreas. Antibiotics may be given if the pancreas has become infected.
If the episode is severe, surgery may be necessary for drainage or for removal of part of the pancreas.
If pancreatitis is caused by gallstones, the gallbladder may need to be removed.
Some treatment is aimed at replacing large amounts of body fluid by vein. The pancreas and digestive system in general should be shut down to minimize enzyme production through the use of a stomach tube and/or regular antacids to neutralize acid production. Large doses of injected narcotic pain relievers may be necessary.
If the attack has been caused by impacted gallstones, the gallbladder should almost always be removed
Gallstones are usually easy to discover (by standard tests
such as ultrasound scanning of the gallbladder). However, pancreatitis can be
caused by tiny stones (sludge or crystals) which cannot be seen on standard
x-ray tests and scans. They can be found by special techniques such as placing a
tube into the duodenum (duodenal drainage) and stimulation of gallbladder
contraction, or during an ERCP examination.
Following an attack of acute pancreatitis, patients are sometimes given dietary guidelines to reduce the amount of fat in their diet
and/or special enzyme medication to take with meals.
Most patients recover from acute attacks of pancreatitis with no residual complaints; tests of the pancreatic function (enzymes and insulin secretion) and structure (ultrasound and CT scans) may return completely to normal.
However, it is very important to look carefully for causative factors to prevent further attacks. Alcohol consumption should be avoided completely.
Chronic pancreatitis is different from acute pancreatitis. The inflammation and damage develop more slowly, and can become increasingly bad over time. The pancreas becomes scarred and loses its ability to make enough digestive enzymes and insulin. Thickening of the pancreatic juices may result in clogging of the ducts and from pancreatic stones (pancreatic calcification). These and damage to the ducts themselves (strictures) can result in aggravation of the pancreatitis due to obstruction.
Sometimes the condition is already chronic when it is first diagnosed. The most common cause
of chronic pancreatitis is excessive alcohol consumption.
Chronic pancreatitis is confirmed by x-ray tests and other scans. Ultrasound and CT scans can show enlargement and irregularity of the pancreas, and areas of scarring. They also demonstrate when the duct system is dilated, or contains stones. When these stones are calcified, they may show up on a simple x-ray of the abdomen. A newer scanning test is called MRCP shows the tissues of the pancreas and the duct systems in more detail.
Most patients with chronic pancreatitis have pain in the upper abdomen, which may also be felt in the back. This can be very severe and continuous, but is more often intermittent, and occurs in attacks, which are usually not sufficiently severe to require immediate treatment in hospital. A few patients with chronic pancreatitis never have pain.
Over a period of time, chronic pancreatitis can lead to diabetes, calcium deficiencies
or infections of the pancreas. It is possible for a person to have attacks of chronic pancreatitis over the course of many years.
It may also stop the pancreas producing the enzymes that the body needs for digestion, resulting in a variety of digestive problems.
Chronic pancreatitis occurs more often in men than in women. In rare cases
chronic pancreatitis can lead to pancreatic cancer.
Treatment of Chronic Pancreatitis
As with acute episodes, the treatment of chronic pancreatitis depends on the symptoms. Most treatment focuses on managing pain and providing appropriate nutrition, which sometimes includes enzyme supplements to help digest food. If the chronic condition has caused diabetes, insulin may be needed to control the levels of blood sugar in the body. Patients are often put on a low fat diet and may prefer eating frequent, small portions of food.
Most patients with chronic pancreatitis are treated by abstaining from alcohol,
and with medicines for pain relief, nutritional support, and replacement (by mouth) of missing digestive enzymes. Patients are normally advised to maintain a diet low in fat (less than 40 gm per day) when steatorrhea is present. Pancreatic enzyme supplements need to be taken in high dosage and with meals (often with medicines to reduce gastric acid). These help to digest fat, and may also sometimes reduce the amount of pain.
Severe Hemorrhagic Pancreatitis.
Unfortunately, some people develop severe hemorrhagic pancreatitis. This means that much of the pancreatic tissue is destroyed, with severe inflammation and leakage of enzymes, fluids and poisons. The pancreas becomes very swollen, and slushy; this is called a
phlegmon. This may develop into a collection of fluid and damaged pancreatic tissue called a
pseudocyst. If a pseudocyst becomes infected, it is called apancreatic abscess. Severe attacks of
hemorrhagic pancreatitis result in lowered blood pressure and poor circulation to the skin and other organs.
The kidneys may fail. Other poisons in the blood resulting from hemorrhagic pancreatitis can damage the heart and lungs. Inflammation in acute pancreatitis involves the whole pancreas, so
temporary or permanent diabetes can result due to damage to the islets of