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Pancreatitis

Pancreatitis is inflammation in the pancreas. The pancreas is a long, flat gland that sits tucked behind the stomach in the upper abdomen. The pancreas produces enzymes that assist digestion and hormones that help regulate the way your body processes sugar (glucose).

Pancreatitis can occur as acute pancreatitis — meaning it appears suddenly and lasts for days. Or pancreatitis can occur as chronic pancreatitis, which describes pancreatitis that occurs over many years.

Mild cases of pancreatitis may go away without treatment, but severe cases can cause life-threatening complications.

Signs and symptoms of pancreatitis may vary, depending on which type you experience.

Acute pancreatitis signs and symptoms include:

  • Upper abdominal pain
  • Abdominal pain that radiates to your back
  • Abdominal pain that feels worse after eating
  • Nausea
  • Vomiting
  • Tenderness when touching the abdomen

Chronic pancreatitis signs and symptoms include:

  • Upper abdominal pain
  • Losing weight without trying
  • Oily, smelly stools (steatorrhea)

When to see a doctor

Make an appointment with your doctor if you have persistent abdominal pain. Seek immediate medical help if your abdominal pain is so severe that you can’t sit still or find a position that makes you more comfortable.

What happens in pancreatitis

Pancreatitis occurs when digestive enzymes produced in your pancreas become activated while inside the pancreas, causing damage to the organ.

During normal digestion, the inactivated pancreatic enzymes move through ducts in your pancreas and travel to the small intestine, where the enzymes become activated and help with digestion. In pancreatitis, the enzymes become activated while still in the pancreas. This causes the enzymes to irritate the cells of your pancreas, causing inflammation and the signs and symptoms associated with pancreatitis.

With repeated bouts of acute pancreatitis, damage to the pancreas can occur and lead to chronic pancreatitis. Scar tissue may form in the pancreas, causing loss of function. A poorly functioning pancreas can cause digestion problems and diabetes.

Pancreatitis has many causes

A number of causes have been identified for acute pancreatitis and chronic pancreatitis, including:

  • Alcoholism
  • Gallstones
  • Abdominal surgery
  • Certain medications
  • Cigarette smoking
  • Cystic fibrosis
  • Endoscopic retrograde cholangiopancreatography (ERCP), when used to treat gallstones
  • Family history of pancreatitis
  • High calcium levels in the blood (hypercalcemia), which may be caused by an overactive parathyroid gland (hyperparathyroidism)
  • High triglyceride levels in the blood (hypertriglyceridemia)
  • Infection
  • Injury to the abdomen
  • Pancreatic cancer
Pancreatitis can cause serious complications, including:

  • Pseudocyst. Acute pancreatitis can cause fluid and debris to collect in cyst-like pockets in your pancreas. A large pseudocyst that ruptures can cause complications such as internal bleeding and infection.
  • Infection. Acute pancreatitis can make your pancreas vulnerable to bacteria and infection. Pancreatic infections are serious and require intensive treatment, such as surgery to remove the infected tissue.
  • Breathing problems. Acute pancreatitis can cause chemical changes in your body that affect your lung function, causing the level of oxygen in your blood to fall to dangerously low levels.
  • Diabetes. Damage to insulin-producing cells in your pancreas from chronic pancreatitis can lead to diabetes, a disease that affects the way your body uses blood sugar.
  • Kidney failure. Acute pancreatitis may cause kidney failure, which can be treated with dialysis if the kidney failure is severe and persistent.
  • Malnutrition. Both acute and chronic pancreatitis can cause your pancreas to produce fewer of the enzymes that are needed to break down and process nutrients from the food you eat. This can lead to malnutrition, diarrhea and weight loss, even though you may be eating the same foods or the same amount of food.
  • Pancreatic cancer. Long-standing inflammation in your pancreas caused by chronic pancreatitis is a risk factor for developing pancreatic cancer.
Tests and procedures used to diagnose pancreatitis include:

  • Blood tests to look for elevated levels of pancreatic enzymes
  • Stool tests in chronic pancreatitis to measure levels of fat that could suggest your digestive system isn’t absorbing nutrients adequately
  • Computerized tomography (CT) scan to look for gallstones and assess the extent of pancreas inflammation
  • Abdominal ultrasound to look for gallstones and pancreas inflammation
  • Endoscopic ultrasound to look for inflammation and blockages in the pancreatic duct or bile duct
  • Magnetic resonance imaging (MRI) to look for abnormalities in the gallbladder, pancreas and ducts

Your doctor may recommend other tests, depending on your particular situation.

Treatment for pancreatitis usually requires hospitalization. Once your condition is stabilized in the hospital and inflammation in the pancreas is controlled, doctors can treat the underlying cause of your pancreatitis.

Hospitalization to stabilize pancreatitis

If you’re experiencing pancreatitis, your doctor may admit you to the hospital for care.

Initial treatments to help control the inflammation in your pancreas and make you more comfortable may include:

  • Fasting. You’ll stop eating for a couple of days in the hospital in order to give your pancreas a chance to recover.Once the inflammation in your pancreas is controlled, you may begin drinking clear liquids and eating bland foods. With time, you can go back to your normal diet.If your pancreatitis persists and you still experience pain when eating, your doctor may recommend a feeding tube to help you get nutrition.
  • Pain medications. Pancreatitis can cause severe pain. Your health care team will give you medications to help control the pain.
  • Intravenous (IV) fluids. As your body devotes energy and fluids to repairing your pancreas, you may become dehydrated. For this reason, you’ll receive extra fluids through a vein in your arm during your hospital stay.

How long you stay in the hospital will depend on your situation. Some people recover quickly and others develop complications that require a longer hospitalization.

Treating the underlying cause of pancreatitis

Once your pancreatitis is brought under control, your health care team can treat the underlying cause of your pancreatitis.

Treatment will depend on the cause of your pancreatitis, but examples of treatment may include:

  • Procedures to remove bile duct obstructions. Pancreatitis caused by a narrowed or blocked bile duct may require procedures to open or widen the bile duct.A procedure called endoscopic retrograde cholangiopancreatography (ERCP) uses a long tube with a camera on the end to examine your pancreas and bile ducts. The tube is passed down your throat, and the camera sends pictures of your digestive system to a monitor.ERCP can aid in diagnosing problems in the bile duct and in making repairs.
  • Gallbladder surgery. If gallstones caused your pancreatitis, your doctor may recommend surgery to remove your gallbladder (cholecystectomy).
  • Pancreas surgery. Surgery may be necessary to drain fluid from your pancreas or to remove diseased tissue.
  • Treatment for alcohol dependence. Drinking several drinks a day over many years can cause pancreatitis. If this is the cause of your pancreatitis, your doctor may recommend you enter a treatment program for alcohol addiction. Continuing to drink may worsen your pancreatitis and lead to serious complications.

Additional treatments for chronic pancreatitis

Chronic pancreatitis may require additional treatments, depending on your situation. Other treatments for chronic pancreatitis may include:

  • Pain management. Chronic pancreatitis can cause persistent abdominal pain. Your doctor may recommend medications to control your pain and may refer you to a pain specialist.Severe pain may be relieved with surgery to block nerves that send pain signals from the pancreas to the brain.
  • Enzymes to improve digestion. Pancreatic enzyme supplements can help your body break down and process the nutrients in the foods you eat. Pancreatic enzymes are taken in tablet form with each meal.
  • Changes to your diet. Your doctor may refer you to a dietitian who can help you plan low-fat meals that are high in nutrients.
Once you leave the hospital, you can take steps to continue your recovery from pancreatitis, such as:

  • Stop drinking alcohol. If you’re unable to stop drinking alcohol on your own, ask your doctor for help. Your doctor can refer you to local programs to help you stop drinking.
  • Stop smoking. If you smoke, quit. If you don’t smoke, don’t start. If you can’t quit on your own, ask your doctor for help. Medications and counseling can help you stop smoking.
  • Choose a low-fat diet. Choose a diet that limits fat and emphasizes fresh fruits and vegetables, whole grains, and lean protein.
  • Drink more fluids. Pancreatitis can cause dehydration, so drink more fluids throughout the day. It may help to keep a water bottle or glass of water with you.
Alternative therapies can’t treat pancreatitis, but some alternative therapies may help you cope with the pain associated with pancreatitis.

People with chronic pancreatitis may experience constant pain that isn’t easily controlled with medications. Using complementary and alternative medicine therapies along with medications prescribed by your doctor may help you feel more in control of your pain.

Examples of alternative therapies that may help you cope with pain include:

  • Meditation
  • Relaxation exercises
  • Yoga

Pancreatic cysts

Pancreatic cysts are sac-like pockets of fluid on or within your pancreas. The pancreas is a large organ located behind the stomach. It produces hormones and enzymes that help digest food.

Most pancreatic cysts aren’t cancerous, and many don’t cause symptoms. In fact, many pancreatic cysts technically aren’t cysts at all. Called pseudocysts, these noncancerous (benign) pockets of fluids are lined with scar or inflammatory tissue, not the type of cells found in true cysts.

But some pancreatic cysts can be cancerous. Your doctor may want to take a sample of the pancreatic cyst fluid to determine if cancer cells are present.

Sometimes, your doctor may not be able to tell whether a cyst may become cancerous. Your doctor may recommend monitoring the cyst over time for changes in size or shape that may suggest the need to remove it surgically. Some cysts have a low potential for becoming cancerous, and your doctor may recommend watching them carefully.

You may not experience any symptoms from pancreatic cysts, including pseudocysts. Pancreatic cysts are often found when imaging tests of the stomach area (abdomen) are done for another reason.

When signs or symptoms of pancreatic cysts do occur, they typically include:

  • Persistent abdominal pain, which may radiate to your back
  • A mass you can feel in your upper abdomen
  • Nausea and vomiting

When to see a doctor

Cysts can become infected, though this is rare. See a doctor if you are feverish and have persistent abdominal pain.

A ruptured pseudocyst is a medical emergency. Fluid released by the pseudocyst can damage nearby blood vessels and cause massive bleeding. A ruptured pseudocyst can also cause infection of the abdominal cavity (peritonitis). Seek emergency medical treatment if you have signs or symptoms of internal bleeding and shock, including:

  • Fainting
  • Severe abdominal pain
  • Decreased consciousness
  • Weak and rapid heartbeat
  • Vomiting of blood
The cause of pancreatic cysts is often unknown. Cancerous cysts can be caused by genetic mutations. Some cysts are associated with rare illnesses including von Hippel-Lindau disease, a genetic disorder that can affect the pancreas and other organs.

Pseudocysts often follow a bout of pancreatitis, a painful condition in which digestive enzymes become prematurely active and irritate the pancreas. Pseudocysts can also result from injury to the abdomen, such as from a car accident.

Heavy alcohol use and gallstones are risk factors for pancreatitis, and pancreatitis is a risk factor for pseudocysts — the most common type of pancreatic cyst. Abdominal injury is also a risk factor for pseudocysts.
Pancreatic cysts are diagnosed more often than in the past because improved imaging technology finds them more readily. Many pancreatic cysts are found during abdominal scans for other problems.

The biggest challenge during diagnosis is determining whether the pancreatic cyst is cancerous. These procedures are often used to help with diagnosis and to help plan treatment:

  • Medical history. Previous experience of abdominal injury or pancreatitis may indicate a pseudocyst.
  • CT scan. This imaging test can provide detailed information about the structure of a pancreatic cyst.
  • MRI scan. This imaging test can highlight subtle details of a pancreatic cyst, including whether it has any solid components.
  • Endoscopic ultrasound. This test can provide a detailed image of the cyst, and fluid can be collected from the cyst for analysis in a laboratory for possible signs of cancer.

The characteristics and location of the pancreatic cyst, along with your age and sex, can help doctors pinpoint the type of cyst you have:

  • Serous cystadenoma can become large enough to displace nearby organs, causing abdominal pain and a feeling of fullness. Serous cystadenomas occur most frequently in middle-aged women and only rarely become cancerous.
  • Mucinous cystadenoma is usually located in the body or tail of the pancreas and occurs most often in middle-aged women. Mucinous cystadenoma is precancerous, which means it may become cancer if left untreated. Larger cysts may already be cancerous when found.
  • Intraductal papillary mucinous neoplasm (IPMN) is a growth in the main pancreatic duct or one of its side branches. IPMN may be precancerous or cancerous. Depending on its location and other factors, IPMN may require surgical removal.
  • Papillary cystic tumor is usually located in the body or tail of the pancreas, and occurs most often in young women. Also known as papillary cystic neoplasm, or solid and pseudopapillary neoplasm, it is usually cancerous.
  • Cystic islet cell tumor is mostly solid but can have cyst-like components. Cystic islet cell tumor can be confused with other pancreatic cysts and may be precancerous or cancerous.
Treatment depends on the type of cyst you have and whether it is causing symptoms.

Watchful waiting

A benign pseudocyst, even a large one, can be left alone as long as it isn’t bothering you. Serous cystadenoma rarely becomes cancerous, so it also can be left alone unless it causes symptoms or grows.

But all pancreatic cysts should be monitored. Cysts smaller than 10 millimeters (0.39 inches) can be imaged with CT scan after one year, and then less frequently if they remain stable. Cysts larger than 10 millimeters usually require regular endoscopic ultrasound to look for worrisome features.

Drainage

A pseudocyst that is causing bothersome symptoms or growing larger may be drained. A small flexible tube (endoscope) is passed through your mouth to your stomach and small intestine. The endoscope is equipped with a needle to drain the cyst.

Surgery

Surgery may be needed to remove an enlarged pseudocyst or a serous cystadenoma that’s causing pain or other symptoms. Other types of pancreatic cysts generally require surgical removal because of the risk of cancer.

A pseudocyst may recur if you have ongoing pancreatitis.