Pancreatitis (Inflamed Pancreas)

What is pancreatitis?

Pancreatitis is a medical condition where there is severe abdominal pain with nausea and vomiting due to inflammation of the pancreas. Depending upon the onset pancreatitis can be of two types, namely acute with sudden onset and chronic which progresses slowly. Pancreatitis occurs when the digestive enzymes of the pancreas become activated while still in the pancreas.

Gallstones is the most common cause of acute pancreatitis whereas most common cause of chronic pancreatitis is alcoholism. However, a very heavy bout of alcohol consumption, often seen during the festive season, can lead to acute pancreatitis. The chances of pancreatic carcinoma (cancer of the pancreas) is greater among people with chronic pancreatitis.

Signs and Symptoms

Usually symptoms depend upon the type of pancreatitis – acute or chronic.

Acute Pancreatitis

The symptoms of acute pancreatitis include :

• Upper abdominal pain: typically dull, boring in nature usually felt in the upper part of the abdomen but often the pain radiates towards back and flanks. The pain usually starts suddenly and its severity increases gradually over time and ultimately become constant. The pain commonly lasts for more than one day. With change in position the intensity of the pain varies according to the position of the patient as discomfort often improves in supine position.
• Diarrhea.
• Nausea and vomiting.
• Fever.

Untreated acute pancreatitis may lead to complications like :

• Breathing problems due to impaired lung function.
• Fluid collection in the abdomen leading to pseudocyst. Usually it takes about 4 weeks for a pseudocyst to form after an attack of acute pancreatitis.
• Pancreatic abscess due to pus collection within or adjacent to pancreas.
• Increased risk of developing a bacterial infection and bleeding inside the abdomen.
• Impaired kidney function.

Chronic Pancreatitis

The symptoms of chronic pancreatitis are :

• Intermittent attacks of severe upper abdominal pain usually lasting for several hours. The pain characteristically occurs after eating a meal and tends to radiate to the back.
• Chronic diarrhea.
• Weight loss

Long term chronic pancreatitis may lead to diabetes, malnutrition even pancreatic cancer.

Causes and Risk Factors

The pancreas is a gland located in the upper abdomen. The two principal functions of pancreas are the production of hormones like insulin and glucagon (exocrine function) and the endocrine function where there is the production of various enzymes that facilitate metabolism of carbohydrate, fat and protein.

The healthy pancreas produces about 15 varieties of different enzymes in the inactivated form within the pancreatic acinar cells. Zymogens are the storage granules that store the inactive enzymes and release them in the duodenum of the small intestine to initiate the metabolism of different nutrients obtained from food.

Due to injury to the pancreatic cells the enzymes may become active within the pancreas itself. This can lead to auto-digestion which irritates the the pancreas and is marked by inflammatory changes of pancreatic tissue. Common causes of pancreatitis includes :

• Chronic alcohol intake.
• Gallstone disease.
• Trauma to the abdomen.
• Abdominal surgery.
• Endoscopic procedures like ERCP.
• Intake of certain drugs like azathioprine, sulfonamide, tetracycline, valproic acid, estrogen and corticosteroids.
• Autoimmune disease when the body mistakenly produce antibodies against its own tissues.
• Lipid imbalances like raised blood triglyceride levels.
• High calcium and parathyroid hormone level in the blood.
• Cystic fibrosis/
• Abdominal infection.

Pancreatitis can affect any person of any age. However, certain people are at a greater risk of developing pancreatitis. This includes :

• Alcoholism.
• Gallstones.
• Smoking.
• Family history.

Treatment

Acute pancreatitis should not be left untreated as it can lead to severe complications. Chronic pancreatitis cannot be cured but should be managed appropriately. Treatment options include :

• Symptomatic relief can be achieved by fasting during acute attacks and changing to low fat meals after the pain subsides. Alcohol should be avoided.
• Pancreatic enzymes are available as supplements to facilitate metabolism.
• Intravenous fluid administration is often necessary in acute pancreatitis.
• Pain medication may be used to manage the pain which is often intense.

The underlying cause of pancreatitis should be identified and treated or managed as necessary. This can help ease pancreatitis. It may involve surgery at times, such as removal of the gallbladder if there are gallstones.