Pancreatitis

Overview

Pancreatitis is a condition in which the pancreas becomes inflamed.

The pancreas is a large gland that lies behind the stomach and next to the small intestine. It is responsible for two critical functions:

  • After eating, it releases enzymes into the small intestine that are essential in the digestion of food.
  • It releases the hormones insulin and glucagon into the blood to help control how the body uses food for energy.

Pancreatitis can be acute, appearing suddenly and lasting for a short period of time, or chronic, where the inflammation is persistent, ongoing, and does not resolve on its own, resulting in the scarring of the pancreas over time.

Acute pancreatitis is fairly common and accounts for the most frequent gastrointestinal complaint that leads to hospital admissions in the US each year, affecting between 13 to 45 of every 100,000 people annually.  Chronic pancreatitis is much rarer, affecting 5 to 12 people of every 100,000 people each year.

Acute pancreatitis can range from mild pain to a grave, life-threatening illness causing shock and multi-organ damage. Acute pancreatitis is usually resolved with hospital treatment such as fluids, bowel rest, and pain medications; however, approximately 15% of patients develop severe disease that results in injury or necrosis (death of the cells) of the pancreas tissue.

Chronic pancreatitis (CP) can result in permanent damage to the pancreas. The pancreas becomes unable to produce enough enzymes to digest food or enough hormones to regulate blood sugar. This is due to ongoing inflammation causing scarring of the pancreas tissue. Chronic pancreatitis often leads to fibrosis (scarring) of the organ. The disease is widely characterized by the severe, chronic pain that affects more than 90% of people who suffer from the disease. Over time, chronic pancreatitis can lead to other problems such as diabetes, malnutrition, and bile duct obstruction. 

Compared with the general population, chronic pancreatitis patients have a significantly increased risk of developing pancreatic cancer: the risk can be 15 to 40 times higher, depending on the cause of their CP. The the risk of mortality increases by close to 4 times higher than the general population. Up to 50% of CP patients are either disabled or unemployed because of the effects of their disease.  

Our approach

The Northwell Health’s Pancreas Disease Center has extensive experience in the treatment of pancreatitis. Our skilled and experienced staff of surgeons, gastroenterologists, endocrinologists, pain specialists, dietitians, social workers and nurse practitioners are dedicated to setting you on a path of health and wellness through innovative treatments and customized care.

We understand that diseases of the pancreas can be difficult to diagnose and treat. The wide range of symptoms and risk factors require careful testing and examination. We’ll guide you through the process, step-by-step -- and once we make a thorough diagnosis, we’ll work with you to create a care plan with the best treatment options for you. Learn more about the Pancreas Disease Center.

Causes

Acute pancreatitis can be caused by:

  • Chronic heavy alcohol intake
  • Gallstones
  • Hypertriglyceridemia (a condition in which triglyceride levels are elevated)
  • Idiopathic reasons, meaning that it could occur for unknown reasons
  • Other, including medications, trauma or surgery

Chronic pancreatitis can be caused by:

  • Alcohol abuse
  • Hereditary disorders
  • Pancreatic duct strictures
  • Autoimmune conditions
  • Cystic fibrosis
  • Trauma to the pancreas
  • Idiopathic reasons, meaning that it could occur for unknown reasons

Symptoms

Acute pancreatitis

Pain is the most common symptom of pancreatitis.

Symptoms often include:

  • Gradual or sudden upper abdominal pain that may radiate to the back or chest
  • Abdominal pain that gets worse after eating
  • Nausea
  • Vomiting
  • Rapid pulse rate
  • Fever
  • Swelling and tenderness in the upper abdomen

Chronic pancreatitis

  • Pain is experienced by more than 90% of chronic pancreatitis patients.  Like acute pancreatitis, the is generally in the upper abdomen and radiates to the back, The pain is usually more intense after eating, especially after consuming large meals or fatty foods,  Pain that becomes more frequent and severe as the disease progresses.  Some patients suffer constant abdominal pain.
  • Nausea and vomiting are other common chronic pancreatitis symptoms, often experienced during episodes of pain.
  • Steatorrhea (loose, oily and foul smelling stools) is yet another symptom experienced by those who suffer from chronic pancreatitis, and is due to the inability of the pancreas to absorb fat.
  • Other chronic pancreatitis symptoms include bloating, abdominal cramps and flatulence (passing gas).
  • Diabetes Mellitus

Diagnosis

Acute Pancreatitis is diagnosed by:

  • Laboratory tests (including lipase and amylase levels)
  • Transabdominal computed tomography scan (CT or CAT scan): A CT scan combines a sequence of X-ray images from different angles of the body and uses computer processing to create more detailed information than X-rays do.
  • Magnetic Resonance Imaging (MRI): A test that uses a magnetic field and radio waves to generate detailed images of the organs in your body. The test produces images of body parts by injecting dye into a patient's veins that helps show the pancreas, gallbladder, and pancreatic and bile ducts.

Chronic Pancreatitis

Due to the complexities of chronic pancreatitis, our evaluation is comprehensive and aims to rule out other conditions.

Treatment

Acute Pancreatitis

In most cases, the pain is severe enough that a person will go to the emergency department. Acute pancreatitis normally requires a hospital stay.

The treatment goal is to rest the pancreas so that it recovers from the inflammation. This is accomplished through:

  • Fluids. The primary treatment for acute pancreatitis is hydration. For this reason, you'll receive extra fluids through IV during your hospital stay.
  • Fasting. You'll stop eating for a few days to give your pancreas a chance to recover. Once the inflammation has gone down, you can begin drinking clear liquids and eating some bland foods. After 2-3 days of bowel rest, nutrition becomes an important component in helping the body heal from an acute inflammation.
  • Pain control. Pancreatitis causes severe pain; you will receive pain medication intravenously (IV), which is the most effective method for treating acute pancreatitis pain). You may also receive medication to ease nausea. As the inflammation improves, these medications can be give by mouth instead of IV.

Chronic Pancreatitis

Chronic pancreatitis patients can experience acute flares of inflammation and pain requiring hospitalization and treatment which is similar to acute pancreatitis hospital treatment. This includes:

  • Fluids
  • Pancreas Rest Nutrition
  • Pain Control

Treatment may include the following procedures and courses of action:

  • Endoscopic retrograde cholangiopancreatography (ERCP)
  • Avoiding alcohol (if the pancreatitis is caused by alcohol usage)
  • Avoiding smoking
  • Pain management
  • Frequent blood tests (to monitor electrolytes and kidney function)
  • Pancreatic enzymes to take with meals to help digestion and absorption of food, and may also help the patient’s symptoms of fatty diarrhea and abdominal bloating

Our treatment planning starts by working with your current doctors to set you on a path to wellness based on your needs. We believe in comprehensive patient care. Learn more about how we take care of a patient from beginning to end; mentally, physically, emotionally, and everything in between.

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The Pancreas Disease Center team is available to discuss your treatment options.

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