Pancreatitis

Pancreatitis

Pancreatitis refers to inflammation of the pancreas itself, which can be an acute process or can sometimes lead to chronic damage and inflammation referred to as chronic pancreatitis.  The most common causes of abrupt onset (acute pancreatitis) are gallstones and excessive alcohol consumption.  Sometimes medications, abdominal trauma, infections and genetic abnormalities of the pancreas are also implicated.  Chronic pancreatitis refers to chronic inflammation and scarring of the pancreas that usually results from repetitive bouts of pancreatitis.  This can lead to impaired digestion of food as well as insufficient production of insulin that can lead to diabetes.  The most common causes of chronic pancreatitis are excessive consumption of alcohol and genetic abnormalities of the pancreas.  In some cases, the etiology of pancreatitis cannot be identified and this is referred to as idiopathic pancreatitis.

ACUTE PANCREATITIS:

As mentioned above, the most common causes of acute pancreatitis are alcohol intake and gallstone disease.  As in most medical problems, it is a combination of clinical symptoms, physical examination and certain abnormal laboratory tests that lead to the diagnosis.  The symptoms are typically gradual or sudden onset of severe upper abdominal pain that very often radiates to the back and can be associated with nausea, vomiting and even fever.  When these symptoms are present and the physical exam is suggestive of acute pancreatitis, usually some blood work will be obtained to measure two enzymes that are produced by the pancreas that are referred to as amylase and lipase.  Very often an abdominal CAT scan may also be part of the evaluation.

CHRONIC PANCREATITIS:

Chronic pancreatitis is characterized by more of a constant abdominal discomfort that can flare up at times in intensity.  These episodes typically last for at least a few days.  The diagnosis of chronic pancreatitis is again usually entertained with the right clinical history, symptoms and imaging studies.  Because the chronic inflammation can lead to scarring and malfunction of the pancreas, there can be maldigestion of fatty foods, which typically present as greasy or oily stools (steatorrhea), weight loss due to malabsorption and recurrent abdominal pain.

DIAGNOSIS:

Both acute and chronic pancreatitis are typically diagnosed by laboratory tests that would include liver function tests and very often an abdominal ultrasound to evaluate the gallbladder and see whether gallstones are part of the problem.  Other examinations might easily include an abdominal CT scan as mentioned above, MRIs of the pancreas and the bile ducts, endoscopic tests referred to endoscopic ultrasound and another endoscopic test referred to as ERCP.  These latter two tests are particularly useful when it is necessary to evaluate the common bile duct and pancreatic ducts.

TREATMENT OF PANCREATITIS:

The most important treatment for acute pancreatitis is typically resting the GI tract by restricting oral intake, keeping the patient well hydrated with intravenous fluids and using medications to relieve pain.  Typically, episodes will settle down within days, but some more severe episodes can affect multiple organ systems and have potentially life-threatening consequences.  When alcohol is considered the major causative factor, it is imperative that patients abstain and do the best they can to avoid any further alcohol consumption.  If gallstones are implicated, then typically the gallbladder, which contains stones, will ultimately need to be removed surgically.  If stones are found to exist in the common bile duct outside the gallbladder, then the endoscopic test known as an ERCP is the current test of choice to investigate the bile duct and potentially clear out any stones in the common bile duct.

Unfortunately, chronic pancreatitis can lead to chronic abdominal pain that is best managed with formal pain management specialists.  Sometimes the complications of an insufficiently functioning pancreas can lead to maldigestion, which is treated by using pancreatic enzyme supplements, and diabetes, which is controlled by diet, oral medications and perhaps even insulin.