Pancreatitis

Pancreatitis is inflammation of the pancreas. It happens when the digestive enzymes that the organ makes begin to digest the pancreas. Acute pancreatitis is one of the most frequent gastrointestinal causes of hospital admissions.

It can be acute, meaning it develops suddenly and lasts for days or weeks, or chronic, in which the inflammation persists over a period of time. Both forms are serious and can cause serious complications. Treatment options for pancreatitis depend on the underlying cause and severity of illness.

• Acute pancreatitis is a medical emergency. It is short term, happening suddenly and requiring prompt treatment. The goal of treatment is to reduce inflammation and prevent further damage to the pancreas. The most common causes are gallstones obstructing the pancreatic ducts, hypertriglyceridemia (too many fats in your blood), metabolic syndrome, and excessive alcohol use. It affects people in their 50’s and 60’s. Treatment is supportive care. Short term hospitalization with IV antibiotics for several days, plus IV fluids and pain medications. Most patients with acute pancreatitis have a mild form and recover. However, 20%-30% of patients have develop a severe form and require intensive care.
• Chronic pancreatitis typically results from long-term or repeated episodes of acute pancreatitis. It is caused by heavy alcohol consumption, obesity, and smoking. Chronic pancreatitis does not improve. It worsens over time leading to permanent damage. The goal of treatment is to reduce inflammation, pain, and other symptoms. Treatment is usually hospitalization with IV antibiotics for several days, plus IV fluids, nutrition support and pain medications.
• In both types of pancreatitis, in addition to reducing pain and inflammation, medications and surgery, lifestyle changes are important to reduce risk factors.

• Symptoms of acute pancreatitis are severe abdominal pain in the upper right abdomen that may radiate to the back, nausea, and vomiting.
• Symptoms of chronic pancreatitis include nausea, vomiting, weight loss, and oily stool.

There are a lot of risk factors but 70-75% of acute pancreatitis cases are due to alcohol abuses or gallstones.

• Being male
• African Americans
• People with a family history of pancreatitis
• People with a history of gallstones
• People who drink alcohol excessively
• People who take certain medications such as steroids and some antibiotics
• People with diabetes
• People with high triglycerides and high levels of calcium in the blood
• People with genetic disorders of the pancreas
• People with certain autoimmune disorders
• People with cystic fibrosis
• Some kinds of infections can cause inflammation of the pancreas

Pancreatitis is usually diagnosed through a combination of medical history, physical exam, blood tests and abdominal imaging. Gastroenterology Associates of Brooklyn clinician will ask about your symptoms and other health issues to determine if pancreatitis may be the cause.

An abdominal ultrasound is recommended for all patients to assess pancreatic inflammation.  A chest x-ray may also be recommended to evaluate the lungs. A CT scan may be recommended to establish or rule out the diagnosis, and when a patient has failed to improve or worsens despite appropriate treatment. Blood tests are used to detect abnormal levels of pancreatic enzymes which leak into your bloodstream when it is inflamed.

They may also decide to order a test called a magnetic resonance cholangiopancreatography (MRCP) or perform an endoscopic retrograde cholangiopancreatography (ERCP) procedure if they suspect recurrent pancreatitis that may be caused by a blockage in the pancreatic or bile ducts. During the procedure gallstones that are blocking the bile or pancreatic ducts are removed, or a stent is placed in the ducts to hold them open to alleviate the obstruction.

If pancreatitis is severe, your doctor may perform gallbladder surgery or pancreatic surgery to remove damaged and diseased tissues. A biopsy may be performed to rule out cancer. This procedure involves collecting a small sample of tissue from the pancreas and sending it to a laboratory for examination under a microscope.

Acute and chronic pancreatitis can lead:

• Infection, abscesses, and pseudocysts
• Diabetes
• Nutritional deficiencies due to malabsorption
• Pancreatic damage and cancer
• Blockage of the bile duct or pancreatic duct
• Increased risk of gallstones and bile duct obstruction
• Heart, lung, or kidney failure
• Death
• Repeated episode of acute pancreatitis can lead to chronic pancreatitis and can also cause dehydration, bleeding, and infection.
• Chronic pain