Pancreatitis - Acute and Chronic: Symptoms, Causes and Treatment (2024)

The pancreas is a narrow, flat glandular organ measuring 12 to 20 cm long; located inside the abdominal cavity, behind the stomach and below the liver. It has 4 (four) sections - head, neck, body, and tail. Its head section connects to the first part of the small intestine (duodenum), the neck is located near the superior mesenteric vessels, the body lies behind the posterior wall of the stomach, and the tail extends to the spleen.

The common bile duct also goes through the head section of the pancreas, carrying bile from the liver and gallbladder into the small intestine. The bile duct and pancreatic duct usually connect together before entering the duodenum and share a common opening into the small intestine.

The Pancreas secret pancreatic juice (a transparent fluid consists of electrolytes, water, and enzymes) that is rich in proteins and consists of bicarbonate fluid, digesting enzyme such as amylase, trypsin, nucleases, elastase, chymotrypsinogen, carboxypeptidase and lipase, these enzymes are essential for the digestion of fat, protein, fat, and carbohydrate in the food.

The pancreas performs two most important functions i.e. exocrine and endocrine function for human body -

• Exocrine function: It releases digestive enzymes to break down and digest fats, foods, carbohydrates, and proteins in our small intestine. The enzymes normally are produced and carried in an inactive form to the small intestine, where the enzymes are activated as needed. It also makes and releases bicarbonate that neutralizes stomach acids and allows for the activation of pancreatic enzymes.

• Endocrine function: it produces five hormones, beta cells secrete insulin, alpha cells secrete glucagon, delta cells secrete somatostatin, epsilon cells secrete ghrelin and PP (gamma) cells secrete pancreatic polypeptide; and releases them into the blood. These hormones regulate sugar (glucose) transport into the body's cells, where it is used for energy and to help maintain normal blood sugar levels.

Pancreatitis is a sudden inflammation of the pancreas, and it can start suddenly and stay for many days or years, it’s difficult to find in early stages. Pancreatitis is curable if diagnosed at the acute stage, chronic pancreatitis is not curable. In chronic pancreatitis patients, symptoms and associated pain may be prevented or managed.

Pancreatitis occurs when its digestive juices, or enzymes become activated inside pancreas and start damaging pancreas; which causing injury and irritation to pancreas and leading to inflammation. It may be a mild, short term condition and self-limiting or can cause severe life-threatening complications that can remain for many years.

Pancreatitis can cause severe complications that require immediate attention:

• Malnutrition, due to lack of digestive enzymes
• Diabetes, due to insulin mismanagement
• Pancreas infection
• Kidney problem / failure
• Pancreatic cancer
• Fatigue and dehydration due to diarrhea
• Necrotizing pancreatitis (tissues death inside the pancreas due to limited blood supply)
• Pancreatic pseudocyst (fluid collection in pancreas)
• Lungs problem such as difficult in breathing

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Signs and symptoms of pancreatitis depends on its type, there are some general symptoms that may indicate acute / chronic pancreatitis, include:-

• Severe abdominal pain after having food
• Pain in upper abdominal pain that goes back
• Rapid heart beat
• Upset stomach
• Fever
• Unwanted weight loss
• Nausea and Vomiting
• Stinking and oily stool
• Tender and swollen belly
• Diarrhea
• Bleeding
• Dehydration

There are a different type of conditions related to the pancreas including-

1. Acute pancreatitis is a short term condition and occurs suddenly; causing inflammation of the pancreas. Acute pancreatitis may be mild and can develop further complications if not treated and monitored properly, such as necrotizing pancreatitis, pancreas infection, pancreatic pseudocyst, or organ failure.
   Severe abdominal pain, tender and swollen belly, diarrhea, nausea, bloating, vomiting and fever are the common symptoms of acute pancreatitis.
2. Chronic pancreatitis is a long-term condition, causing inflammation of the pancreas. It is a progressive disorder associated with the damaging of the tissues of the pancreas that can't be reversed. It is more common in male aged between 32 and 45 years. Not only that, but it is long-term progressive disease; causing permanent damage to the pancreas. Initially symptoms of the chronic and acute pancreatitis are similar such as severe abdominal pain, tender and swollen belly, diarrhea, nausea, bloating, vomiting and fever. In chronic pancreatitis patient can develop unwanted weight loss, malnutrition, and malabsorption.
3. Hereditary pancreatitis is a rare genetic condition to occur due to recurrent pancreatic attacks, which can lead to chronic pancreatitis. Symptoms include severe abdominal pain, tender and swollen belly, diarrhea, nausea, bloating, vomiting and fever. It also increases lifetime risk of pancreatic cancer. Hereditary pancreatitis can't be cured completely, can be managed by medical management, pancreatic enzyme supplements to cope-up with indigestion, insulin for diabetes, medications to control pain and lifestyle changes to reduce the risk of pancreatic cancer.
4. Pancreatic cancer occur when uncontrolled cell growth begins in the tissues of the pancreas. Cancerous and noncancerous tumors growths can occur in the pancreas. Pancreatic cancer can be cured if detected early but in most of the cases due to no symptoms is early stages it’s difficult to find it. Pancreatic cancer can also slow down the production of digestive enzymes by the pancreas, resulting in difficulty to break down food and absorbing nutrients. This malabsorption causes bloating, watery, greasy, foul-smelling stool, further can lead to weight loss and vitamin deficiencies.

Pancreatitis, an inflammation of the pancreas occurs when digestive enzymes become activated while still in the pancreas, irritating the cells of your pancreas. These conditions can cause acute or chronic pancreatitis:

• Moderate or heavy alcohol consumption and smoking (25% cases of pancreatitis)
• Gallbladder stone (40% cases of acute pancreatitis)
• Hormonal abnormalities
• Abdominal injury
• Hereditary conditions
• Obesity
• Recurrent acute pancreatitis can cause chronic pancreatitis
• Cystic fibrosis (inherited life-threatening disorder that damages the digestive system and lungs)
• Certain Medications
• Increased level of triglycerides (fat in a blood that gives energy)
• Abdominal surgery

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Pain due to pancreatitis may be intermittent or chronic or frequently very severe sometimes people can experience intense stabbing upper abdominal pain than extend to the back. In mild cases affected from acute conditions, pain may present for few minutes and can last for several hours whereas in severe cases affected from chronic conditions, pain may become constant for years together.

Patients with pancreatitis likely to experience upper abdominal pain after food or when lying down. Treatment at early stage can help in reliving symptoms and fast recovery from it.

Pancreatitis has physical findings that affect body systems and can be diagnosed through blood test, imaging test and intervention procedure advised by doctor.

Depending on symptoms, the Gastroenterologist will ask about medical history, any family history of pancreatitis, eating and drinking habits, taking any prescription or over-the-counter medications, including vitamins and supplements.

To diagnose pancreatitis, a gastroenterologist may recommend:

• Blood and Stool tests: Amylase or lipase blood test and Stool routine test for digestive enzymes of the pancreas. It will be elevated 3 times in pancreatitis from its normal range. If blood test is showing normal ranges then we need to go to further evaluation.
  
• Imaging tests: To understand pancreatitis and figure out what’s the cause. Doctor may recommend X-rays with a barium meal and Ultrasound imaging: specifically evaluate the gallbladder for stones
  
• Endoscopic ultrasound (EUS): Endoscopic examination to evaluate pancreatic masses and tumors, pancreatic cysts, small stone in bile duct and gall bladder not identified during ultrasound. This procedure is performed to collect small tissues of pancreas using FNA needle through the wall of the stomach or intestine directly into the pancreas.
  
• CT Scan, Magnetic resonance imaging (MRI), Magnetic resonance cholangiopancreatography (MRCP), or PET scans: Non-invasive tests for detailed imaging of the pancreas and the surrounding. CT scans expose the patient to some amount of radiation. Furthermore, some patients are unable to receive IV contrast for their CT scans (due to allergies or kidney problems), and thus the quality of the pictures will be sub-optimal. A special kind of MRI called an MRCP can give high-quality pictures of the pancreas, the pancreas duct, and the bile ducts. However, some patients who are claustrophobic may decide against having an MRI performed.
  
• Biopsy or Tissue analysis: a tissue sample (biopsy) from pancreas may help diagnose pancreatitis and further look for signs of pancreatitis.
  
• Endoscopic retrograde cholangiopancreatography (ERCP): to view the bile duct and pancreatic duct. It helps to remove gallstones from the bile duct gallstones that are causing a blockage.

Pancreatitis treatment depends upon its type, cause, and stags. It’s very important to find the cause and extent of pancreas damage in guiding treatment.

Pancreatitis treatment usually require short-term or long-term hospitalization to initiate the aggressive treatment. In general the following treatment will be initiated for the treatment of pancreatitis -

• Pain medicine and antibiotics to lower down the infection.
• Intravenous (IV) fluids, it helps to prevent dehydration so that the rest of the organs of the body get adequate blood flow to support the healing process.
• Low-fat diet or fasting, to stop eating so your pancreas can recover. In this case, nutrition will be given through a feeding tube.
• Gallbladder surgery (cholecystectomy) if gallstones caused your pancreatitis.
• Endoscopic Retrograde Cholangiopancreatography (ERCP): to take out gallstones if they’re blocking your bile or pancreatic ducts. There different procedures that can be performed using ERCP like:
• Gallstone removal
• Sphincterotomy for pseudocyst drainage
• Balloon dilatation: to dilate, or stretch, a narrowed pancreatic or bile duct to keep the duct open
• Stent placement: placing a tiny piece of plastic or metal that looks like a straw into a narrowed pancreatic or bile duct to keep it open.
• Pancreas surgery such as
• Distal pancreatectomy
• Pancreaticoduodenectomy (Whipple procedure)
• Total pancreatectomy to clean out fluid or dead or diseased tissue a liver transplant.

Alcohol consumption and smoking cigarettes can increase the risk of pancreatitis. It is strongly recommended quitting smoking cigarettes and drinking alcohol to prevent pancreatitis.

A healthy diet rich in high fiber, maintaining healthy weight, limiting intake of sugars and regular exercise can protect you against any non-communicable disease such as pancreatitis.

These following risk factors can increase risk of pancreatitis –

• Obesity
• Heavy alcohol consumption
• Cigarettes smoking
• Hereditary conditions or genetics

Men are at high risk compared to women. Combination of any of the above risk factors can increase the chances of getting acute or chronic pancreatitis, for example obese people consuming excess alcohol or a person is smoking cigarettes and consuming alcohol may increase the risk of acute or chronic pancreatitis.

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