(Chronic Pancreatitis; Acute Pancreatitis)En Español (Spanish Version)
Pancreatitis is a disease in which the pancreas becomes inflamed. The pancreas is a long, flattened, pear-shaped organ located behind the stomach. It makes digestive enzymes and hormones including insulin. In pancreatitis, the digestive enzymes attack the tissue that produces them.
- Acute pancreatitis—occurs suddenly, with severe upper abdominal pain (This can be a serious, life-threatening illness if not treated.)
- Chronic pancreatitis—a progressive disorder that can destroy the pancreas
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- Alcohol abuse (most common cause)
- Gallstones and other obstructions of the bile ducts
- Surgery or trauma to the pancreas
- Certain medicines
- Unknown causes (approximately 15% of cases)
- Elevated blood triglyceride levels (hypertriglyceridemia)
- Infections (bacterial, viral, fungal, or parasitic)
- HIV infection
- Congenitally abnormal pancreas duct (pancrease divisum)
- Complication of ERCP (endoscopic retrograde cholangiopancreatography)
A risk factor is something that increases your chance of getting a disease or condition.
- Alcohol abuse
- Family history of pancreatitis
- Personal history of previous acute pancreatitis—Pancreatitis can be recurrent or chronic (long-lasting).
- Pancreatic cancer
- Hyperlipidemia (excessive levels of fat in the blood)
- Hypercalcemia (increased calcium in the blood)
- Viral infections, such as mumps
Severe pain in the center of the upper abdomen that:
- Sometimes spreads into the upper back
- Is often made worse by eating, walking, or lying down on your back
- Is less severe in chronic pancreatitis, with a gradual onset that may be tolerable for weeks
- Nausea and vomiting
- Jaundice (yellowing of the skin)
- Shock —a severe change in the body's vital processes (eg, rapid but weak pulse, rapid and shallow respiration, and low blood pressure) (in severe, acute cases)
- Unexplained weight loss
- Increased thirst
- Increased urination
The doctor will ask about your symptoms and medical history, and perform a physical exam. There will be specific questions about how much alcohol you drink and what medicines you take.
Other tests may include:
- Blood tests—to measure levels of certain digestive enzymes and check for biliary obstruction and complications of pancreatitis (eg, diabetes, kidney failure , infection)
- Abdominal ultrasound or abdominal CT scan —to look for gallstones and determine the extent of pancreatic inflammation
- Magnetic resonance cholangiopancreatography (MRCP)—a radiology test ( MRI ) that looks at the pancreas, pancreatic duct, and nearby bile ducts
- Endoscopic retrograde cholangiopancreatography (ERCP) —a lighted instrument passed through the mouth and into the pancreatic ducts to examine the damage from pancreatitis and diagnose ailments related to the pancreatic and biliary ducts
Treatment for acute pancreatitis depends on the severity of the attack. Hospitalization may be necessary. The main goal is to rest the pancreas. In mild cases, this means you may not have food for 3 to 4 days. In severe cases, you may not be able to have food for 3-6 weeks. You will likely need strong pain medicine during this time.
Treatment may also include:
- Intravenous (IV) fluids
- IV nutrients if you are unable to eat for an extended period of time
- Antibiotics if you have an infection
- Surgery to drain the fluid building up in the abdomen
The goals of treatment for chronic pancreatitis are to relieve pain and manage nutritional and meta2bolic problems. Specific steps include:
- Strict avoidance of alcohol
- Eating less fat
- Taking pills containing pancreatic enzymes to help with digestion
- Taking insulin to control blood sugar (if diabetes develops)
- Eating smaller meals more frequently
Surgery and/or ERCP may be needed to:
- Open a blocked pancreatic or biliary duct
- Remove part (or rarely all) of the pancreas
- Drain pancreatic cysts
If you are diagnosed with pancreatitis, follow your doctor's instructions .
The best way to avoid pancreatitis is to limit your intake of alcohol to two drinks or less per day for men and one drink or less per day for women. If you have hyperlipidemia, restrict your intake of fat and follow your doctor’s treatment plan to lower your lipids. Get vaccinated against mumps.
American Gastroenterological Association
National Institute of Diabetes and Digestive and Kidney Diseases
National Pancreas Foundation
Canadian Association of Gastroenterology
American Gastroenterological Association website. Available at: http://www.gastro.org/wmspage.cfm?parm1=2 . Accessed July 16, 2009.
Braganza JM, Lee SH, McCloy RF, McMahon MJ. Chronic pancreatitis. Lancet . 2011;377(9772):1184-1197.
Feldman, Scharschmidt BF, Sleisenger MH, Fordtran JS, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease . 7th ed. Philadelphia, PA: Saunders: 2002.
National Pancreas Foundation website. Available at: http://www.pancreasfoundation.org . Accessed July 16, 2009.
Pancreatitis. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/pancreatitis/ . Updated July 2008. Accessed July 16, 2009.
Tadataka Y, Alpers DH, Kaplowitz N, Laine L, Owyang C, Powell DW. Textbook of Gastroenterology . 4th ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2003.
Last reviewed September 2011 by Lawrence Frisch, MD, MPH
Last updated Updated: 9/20/2011
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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