The pancreas is a large gland located behind the stomach that secretes digestive enzymes into the duodenum (the first part of the small intestine) through one or more ducts and also secretes the hormone insulin. The pancreas has a double function: partly endocrine by secreting insulin and glucagon for carbohydrate metabolism; partly exocrine by producing enzymes for the digestion of food.

Pancreatitis is the most common form of exocrine pancreatic disease. In pancreatitis, the “factory” manufacturing and storing digestive enzymes for transport into the intestines explodes and the enzymes escape into the surrounding tissues. The enzymes digest and destroy the surrounding tissues resulting in considerable swelling or inflammation and increased amounts of blood in the pancreatic vessels. Pancreatitis can be very serious and is often fatal if not treated and lifestyle changes made. Multiple attacks of pancreatitis will eventually irreparably damage your pancreas and chronic pancreatitis will develop.

Who does it affect?

Most acute patients and almost all chronic patients are middle-aged or elderly. Children can develop less common types of acute pancreatitis caused by hereditary and metabolic abnormalities.

What causes pancreatitis?

  • Alcoholism
  • Gallstones
  • Biliary tract disease
  • Any conditions obstructing the pancreatic duct
  • Nutritional deficiencies
  • Prolonged use of certain medications (diuretics, oral contraceptives)
  • Cigarette smoking
  • Fat metabolism disturbances

Factors other than alcohol consumption are usually corrected without must difficulty.

How does alcohol affect the pancreas and pancreatitis?

Alcohol is a powerful stimulant of gastric acid which is the acid secreted by the stomach to digest food. The increased level of gastric acid is thought to stimulate the pancreas to secrete excessive amounts of the enzymes that do damage during pancreatitis.

What are the symptoms of pancreatitis?

In some cases there may be no clear symptoms and the condition may go undetected until it is advanced and irreversible.

Symptoms of acute pancreatitis:

  • severe abdominal pain
  • abdominal distention and tenderness
  • vomiting
  • constipation
  • fever
  • jaundice
  • very severe cases can have hemorrhage and possible shock

Symptoms of chronic pancreatitis:

  • constant abdominal pain
  • weight loss – due to malabsorption of food
  • diabetes – if severe damage has occurred, insulin production may be affected

How is pancreatitis diagnosed?

Acute pancreatitis:

  • Serum Enzyme Test – measures the degree and duration of enzyme elevation in the blood which quickly rises above normal a few hours after the onset of acute pancreatitis
  • Urine Test – approximately 50% of cases have abnormally high sugar in the urine
  • Blood Glucose Test – approximately 50% of cases have abnormally high sugar in the blood
  • X-ray – rule out other conditions such as appendicitis, perforated ulcer, intestinal obstruction or other abdominal emergency

Chronic pancreatitis:

  • History of previous attacks of acute pancreatitis
  • Presence of elevated serum enzymes
  • Increase blood sugar levels
  • Diabetes – often present with impaired digestion and presence of fat in the stool (steatorrhea)

How is pancreatitis treated?

Mild to Moderate Acute Cases:

  • Treatment is focused primarily on reducing pancreatic secretion. Medications are used which work on the nerves and tissues which influence acid secretion by the stomach.
  • Analgesics and narcotics are usually prescribed for pain relief.
  • Recovery is usually in several days
  • Preventative measures:
    • Low-fat diet
    • Small frequent meals
    • Abstinence or greatly reduced consumption of alcohol
  • Surgical or medical treatment if indicated due to conditions caused by other factors such as gallstones or metabolic disturbances

In severe acute cases especially when shock or hemorrhage is present or there is no response to treatment, blood transfusion, replacement of fluids lost, and possible surgical intervention is necessary.

Chronic Cases:

  • Treatments are similar to those with acute pancreatitis.
  • Control of Diabetes, steatorrhea, and other complications
  • Surgical interventions to relieve pain and halt the progression of the disease – seldom successful and used only as a last resort
  • Outlook is good if abstain from alcohol; outlook is grim if alcohol consumption is continued

Effects of stress and tension on pancreatitis

Emotional stress can excite the vagus nerve (connects the brain with the stomach) and causes the stomach to be stimulated to produce excessive amounts of acid. As noted, this increase in acid stimulates an increase in pancreatic secretion production. This can exacerbate pancreatitis once it has been established. Because of this, you should work with your doctor to decrease your stress levels.

Can I develop cancer of the pancreas?

There is evidence people with pancreatitis are predisposed to a slightly higher risk of cancer of the pancreas.

Moving forward with pancreatitis

New tests and procedures are being developed that are designed to improve the diagnostic accuracy for pancreatitis and increase our understanding and control of pancreatic disease.

Prognosis for a complete recovery is excellent for those who abstain from alcohol. Abstinence from alcohol is a key component to recovery and prevention of reoccurrence of pancreatitis.