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Pancreatitis is inflammation
of the pancreas, an organ in your belly that makes the
glucagon. These two hormones control how your body
uses the sugar found in the food you eat. Your pancreas also makes other
enzymes that help you break down food.
Usually the digestive enzymes stay in one part of the pancreas. But if
these enzymes leak into other parts of the pancreas, they can irritate it and
cause pain and swelling. This may happen suddenly or over many years. Over
time, it can damage and scar the pancreas.
Most cases are caused
gallstones or alcohol abuse. The disease can also be
caused by an injury, an infection, or certain medicines.
Long-term, or chronic, pancreatitis may occur after one attack. But it
can also happen over many years. In Western countries, alcohol abuse is the most common cause of chronic cases.
In some cases doctors don't know what caused
The main symptom of
pancreatitis is medium to severe pain in the upper belly. Pain may also spread
to your back.
Some people have other symptoms too, such as nausea,
vomiting, a fever, and sweating.
Your doctor will do
a physical exam and ask you questions about your symptoms and past health. You
may also have blood tests to see if your levels of certain enzymes are higher
than normal. This can mean that you have pancreatitis.
may also want you to have a
complete blood count (CBC), a liver test, or a stool
Other tests include an
CT scan, or an ultrasound of your belly (abdominal ultrasound) to look for gallstones.
A test called endoscopic retrograde cholangiopancreatogram, or ERCP, may
help your doctor see if you have chronic pancreatitis. During this test, the
doctor can also remove gallstones that are stuck in the
Most attacks of pancreatitis
need treatment in the hospital. Your doctor will give you pain medicine and
fluids through a vein (IV) until the pain and swelling go
Fluids and air can build up in your stomach when there are
problems with your pancreas. This buildup can cause severe vomiting. If buildup
occurs, your doctor may place a tube through your nose and into your stomach to
remove the extra fluids and air. This will help make the pancreas less active
Although most people get well after an attack of
pancreatitis, problems can occur. Problems may include cysts, infection, or
death of tissue in the pancreas.
You may need surgery to remove
your gallbladder or a part of the pancreas that has been damaged.
If your pancreas has been severely damaged, you may need to take insulin
to help your body control blood sugar. You also may need to take pancreatic
enzyme pills to help your body digest fat and protein.
If you have
chronic pancreatitis, you will need to follow a low-fat diet and stop drinking
alcohol. You may also take medicine to manage your pain. Making changes like
these may seem hard. But with planning, talking with your doctor, and getting
support from family and friends, these changes are possible.
Learning about pancreatitis:
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Normally, the structure of the
pancreas and the pancreatic duct prevent digestive
enzymes from damaging the pancreas. But certain conditions can develop that
cause damage and
Most attacks of pancreatitis
are caused by
gallstones that block the flow of pancreatic enzymes
or by excessive amounts of alcohol. Sudden (acute) pancreatitis may happen
after a drinking binge or after many episodes of heavy drinking.
Other causes of acute pancreatitis are:
Sometimes the cause is not known.
Excessive alcohol use is the most common cause of ongoing pancreatitis (chronic pancreatitis).1
Other causes of chronic pancreatitis include cystic fibrosis or a blockage in the pancreas. Chronic pancreatitis may run in families. And smoking cigarettes seems to increase the risk for this disease. In about 1 out of 4 cases, doctors aren't sure what causes it.2
Experts don't know how alcohol irritates the pancreas. Most believe that
alcohol either causes enzymes to back up into the pancreas or changes the
chemistry of the enzymes, causing them to inflame the pancreas.
The main symptom of sudden (acute)
pancreatitis is sudden moderate to severe
pain in the
upper area of the belly (abdomen). Sometimes the pain is mild. But the pain
may feel as though it bores through the abdomen to the back. Sitting up or
leaning forward sometimes reduces the pain. Other symptoms of an attack of
Long-term (chronic) pancreatitis also causes pain in
the upper abdomen.
Other conditions that have similar symptoms include
peptic ulcer disease, and
usually appears as a sudden (acute) attack of pain in the
upper area of the belly (abdomen). The disease may be mild or severe.
Most people with pancreatitis
have mild acute pancreatitis. The disease does not affect their other organs,
and these people recover without problems. In most cases, the disease goes away within
a week after treatment begins. Treatment takes place in the hospital with pain
medicines and intravenous (IV) fluids. After inflammation goes away, the
pancreas usually returns to normal.
In some cases, pancreatic tissue is permanently damaged or even
dies (necrosis). These complications increase the risk of infection and organ
In severe cases, pancreatitis can be fatal.
(chronic pancreatitis) may occur after one or more episodes of acute
pancreatitis. The most common cause of chronic pancreatitis is long-term alcohol abuse.
What happens during the course of chronic
pancreatitis varies. Ongoing pain and complications often occur.
Complications may include flare-ups of symptoms, fluid buildup, and blockage of
a blood vessel, the bile duct, or the small intestine.
If much of
your pancreatic tissue has died, you may become malnourished. This happens because the
pancreas no longer produces enzymes needed to digest fat and protein. So fat is released into your stool. This condition, called steatorrhea,
causes loose, pale, unusually foul-smelling stools that may float in the toilet
If the damaged pancreas stops making enough
insulin, you also may develop
Chronic pancreatitis increases
the risk of pancreatic cancer. About 4 out of 100 people with chronic
pancreatitis develop this cancer.1
Several things can increase
your risk of pancreatitis, including:
Call your doctor immediately if you have severe belly (abdominal)
pain with vomiting that does not go away after a few
hours, or mild to moderate pain that does not improve with home treatment after
a couple of days. These symptoms may be caused by
Pancreatitis can be a severe, potentially
life-threatening illness. It is not appropriate to take a wait-and-see
approach, which is called watchful waiting, if you have severe pain in the
upper area of the abdomen that does not go away in a few hours.
The following health professionals can
diagnose and treat pancreatitis:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
If your doctor thinks you have
pancreatitis, he or she will
ask questions about your medical history and do a physical exam along with
lab and imaging tests.
Two blood tests that measure
enzymes are used to diagnose an attack of
pancreatitis. These tests are:
Other blood tests may be done, such as:
Imaging tests that may be done include:
If your doctor is not sure whether your pancreatic tissue
is infected, he or she may use a needle to take some fluid from the inflamed
area. The fluid is then tested for organisms that can cause infection.
In severe, chronic pancreatitis, a
stool analysis may be done to look for fat in stools,
which is a sign that you may not be getting enough nutrition. This happens when
the pancreas no longer produces the enzymes you need to digest fat.
pancreatitis depends on whether you have a sudden
(acute) attack of pancreatitis or you have had the condition for a long time
For acute pancreatitis. You will receive treatment in the hospital to allow the
pancreas to heal. You will receive
intravenous (IV) fluids to replace lost fluids and
maintain your blood pressure. And you will get medicines to control pain until
inflammation goes away.
To help rest
your pancreas, you likely will not be given anything to eat for several
gallstones are causing
pancreatitis, you may have a procedure called
endoscopic retrograde cholangiopancreatogram (ERCP) to
remove the stones from the
common bile duct. After recovering from pancreatitis,
you may have surgery to remove the
gallbladder. This surgery often prevents future
attacks of pancreatitis. For more information, see the Surgery section of this
For chronic pancreatitis. People who
have chronic pancreatitis also may have episodes of acute pancreatitis, which
are treated the same as an initial episode of acute pancreatitis.
Excessive use of alcohol is the most common cause of chronic
pancreatitis. It is extremely important that you not
drink any alcohol. Drinking even small amounts can cause severe pain and
complications. Drinking large amounts of alcohol when you have chronic
pancreatitis can shorten your life. For more information on quitting alcohol,
see the topic
Alcohol Abuse and Dependence.
If you have
chronic pancreatitis, you may struggle with ongoing pain.
Treatment for pain includes avoiding alcohol, eating a
low-fat diet, using pain medicine, and in some cases taking enzyme pills to
help rest your pancreas.
You may need
surgery or another procedure to widen a narrow pancreatic duct or to remove tissue or stones that
are blocking the pancreatic duct. Surgery can also drain a pseudocyst or an
Your doctor will want to see you regularly to make sure that your pain medicine is helping you and that you do not have complications of chronic pancreatitis. Complications of chronic
pancreatitis may include recurring flare-ups of symptoms, fluid buildup, and
blockage of a blood vessel, the bile duct, or the small intestine. Chronic
pancreatitis also increases your risk of pancreatic cancer.
In advanced chronic pancreatitis, your body may
not absorb fat. This causes loose, oily, especially foul-smelling stools
(called steatorrhea). You may lose weight as a result, because your pancreas no
longer produces the enzymes you need to digest fat and protein. Pancreatic
enzyme pills can replace lost enzymes.
You may need
insulin if your pancreas has stopped producing enough
If infection develops, you may need antibiotics and you might have
surgery to remove the infected and dead tissue. But surgery is avoided when
possible, because the pancreas is damaged easily.
You may need
surgery if you develop complications from acute or chronic pancreatitis.
Surgery also may be done if there is no infection and your condition has not
You cannot completely prevent
pancreatitis caused by
gallstones. But you may be able to reduce your risk of
forming gallstones by staying at a healthy weight with a balanced diet and
regular exercise. For more information, see the topic
You can reduce your chance of
having pancreatitis by not drinking alcohol excessively. The amount of alcohol
needed to cause pancreatitis varies from one person to another. Generally,
moderate consumption is considered no more than 2
alcoholic beverages a day for men and 1 a day for
women and older people.
Smoking may increase your chance of having
pancreatitis. If you smoke, it's a good idea to quit.
If you have ongoing (chronic)
pancreatitis caused by excessive use of alcohol, you
will need to quit drinking to reduce severe pain and complications. Drinking
large amounts when you have chronic pancreatitis can shorten your life. For
more information on quitting alcohol, see the topic
Alcohol Abuse and Dependence.
the role of diet in pancreatitis is not clear, doctors recommend eating a
low-fat diet and staying at a healthy body
In addition to pain medicine,
people who have chronic illness may take pancreatic enzymes and
insulin because their damaged pancreas no longer
produces enough of these.
You may need one or more medicines to treat chronic
pancreatitis. Be safe with medicines. Read and follow all instructions on the label.
Side effects of pancreatic
enzymes that are given to treat chronic pancreatitis include abdominal
(belly) discomfort and soreness of the mouth and the anus. People who are allergic to
pork or who do not eat pork for other reasons should not take these enzymes,
because they are made of pork protein. In young children, high doses of
pancreatic enzymes could cause a
Surgery of the pancreas is
avoided, if possible, because the gland is easily damaged. But surgery may be
needed to remove infected or damaged tissue (pancreatic necrosis). The gallbladder may be removed
to prevent future attacks from
One of two surgeries can be done to remove the
gallbladder if gallstones are causing pancreatitis:
Surgeons may choose among several techniques to remove
damaged pancreatic tissue.
Endoscopic retrograde cholangiopancreatogram (ERCP) is
a procedure used to remove one or more gallstones from the common bile
duct. ERCP can also be used to widen or drain blocked ducts and insert stents.
The American Gastroenterological Association is a
society of doctors who specialize in the digestive system
(gastroenterologists). This Web site can help you find a gastroenterologist in
your area. They also have patient information on many gastrointestinal diseases
This clearinghouse is a service of the U.S. National
Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the
U.S. National Institutes of Health. The clearinghouse answers questions;
develops, reviews, and sends out publications; and coordinates information
resources about digestive diseases. Publications produced by the clearinghouse
are reviewed carefully for scientific accuracy, content, and readability.
Forsmark CE (2010). Chronic pancreatitis. In M Feldman et al., eds., Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 9th ed., vol. 1, pp. 985–1015. Philadelphia: Saunders.
Cote G, et al. (2011). Alcohol and smoking as risk factors in an epidemiology study of patients with chronic pancreatitis. Clinical Gastroenterology and Hepatology, 9(3): 266–273.
Other Works Consulted
American Gastroenterological Association (1998).
American Gastroenterological Association technical review: Treatment of pain in
chronic pancreatitis. Gastroenterology, 115(3):
American Gastroenterological Association Institute
(2007). Medical position statement on acute pancreatitis. Gastroenterology, 132(5): 2019–2021.
American Gastroenterological Association Institute
(2007). Technical review on acute pancreatitis. Gastroenterology, 132(5): 2022–2044.
Banks PA, et al. (2006). Practice guidelines in acute
pancreatitis. American Journal of Gastroenterology,
Greenberger AJ, et al. (2012). Acute and chronic pancreatitis. In DL Longo et al., eds., Harrison's Principles of Internal Medicine, 18th ed., vol. 2, pp. 2634–2648. New York: McGraw-Hill.
Kocher HM, Kadaba R (2011). Chronic pancreatitis, search date August 2011. BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.
Steer ML (2006). Acute pancreatitis. In MM Wolfe et
al., eds., Therapy of Digestive Disorders, 2nd ed., pp.
417–426. Philadelphia: Saunders Elsevier.
Tolstrup JS, et al. (2009). Smoking and risk of acute
and chronic pancreatitis among women and men: A population-based cohort study.
Archives of Internal Medicine, 169(6):
May 24, 2013
E. Gregory Thompson, MD - Internal Medicine & Peter J. Kahrilas, MD - Gastroenterology
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