Acute pancreatitis may begin as either a gradual or sudden pain in the upper abdomen that may radiate through the back. It is often worse after eating. The pain can become severe, even constant, lasting for several days.

Without treatment, severe pancreatitis can cause dehydration, low blood pressure and failure of other organs, including the kidneys. If bleeding occurs in the pancreas, shock and death may follow. This condition requires immediate medical attention.

Causes

The most common causes of acute pancreatitis are:

• Gallstones—small crystals of hardened bile—that inflame the pancreas as they pass through the common bile duct
• Chronic alcohol abuse, which can inflame the pancreas within a few hours or days after consuming alcohol
• Abdominal trauma, medications, infections, tumors and genetic abnormalities of the pancreas

Diagnosis

Diagnosing acute pancreatitis is often difficult because of the location of the pancreas, deep in the abdomen, behind the stomach. In addition to a physical exam and blood tests, your physician may order one or more of the following tests:

• Abdominal ultrasound

A hand-held ultrasound probe is passed over the abdomen. If gallstones are the cause, sound waves can reveal their location.

• Computerized tomography (CT) scan

A three-dimensional image that may show gallstones as well as any damage to the pancreas.

• Endoscopic ultrasound (EUS)

A thin, flexible, lighted tube is passed down the throat, through the stomach and into the small intestine. An ultrasound attached to the probe produces sound waves to create visual images of the pancreas and bile ducts.

• Magnetic resonance cholangiopancreatography (MRCP)

A magnetic resonance imaging device takes cross-section images of pancreas, gallbladder, pancreatic and bile ducts.

Treatment

Treatment for acute pancreatitis usually requires hospitalization for a few days to allow the pancreas to rest while the patient is given intravenous (IV) fluids, antibiotics and pain medication.

In severe cases, the pancreas may need several weeks to heal. During that time, a patient may need to be fed a special liquid delivered by a thin tube inserted through the nose, down the throat and into the stomach.

In some cases, the cause is clear. In others, more tests may be ordered after the patient is discharged and the pancreas has had time to heal. After a bout of acute pancreatitis, patients are advised to avoid fatty foods, alcoholic beverages and tobacco.

If gallstones are found to be the cause, surgical removal of the stones and the gallbladder may be recommended.

Acute pancreatitis sometimes causes kidney failure. People with kidney failure need blood-cleansing treatments called dialysis or a kidney transplant.

Chronic pancreatitis is an inflammation that worsens over time and results in permanent damage. Like acute pancreatitis, it occurs when digestive enzymes attack the pancreas and nearby tissues, causing episodes of pain.

The chronic form of pancreatitis may be triggered by one acute attack that causes damage to the pancreatic duct. The damaged duct causes inflammation of the pancreas. As scar tissue develops, the pancreas is slowly destroyed.

The most common cause of chronic pancreatitis is many years of heavy alcohol use. Other causes are:

• Hereditary disorders of the pancreas
• Cystic fibrosis—the most common inherited disorder leading to chronic pancreatitis
• Hypercalcemia—high levels of calcium in the blood
• Hyperlipidemia or hypertriglyceridemia—high levels of blood fats
• Some medications
• Some autoimmune conditions, including autoimmune pancreatitis

Hereditary pancreatitis can occur in people under age 30, but it may go undiagnosed for years. Episodes of abdominal pain and diarrhea lasting several days come and go over time and can progress to chronic pancreatitis. A diagnosis of hereditary pancreatitis is likely if the person has two or more family members of different generations who have had pancreatitis.

Autoimmune pancreatitis is caused by the body's immune system attacking the pancreas. and it can be mistaken for pancreatic cancer.

Symptoms

Most people with chronic pancreatitis experience upper abdominal pain, although some people have no pain at all. The pain may spread to the back, feel worse when eating or drinking, and become constant and disabling. In some cases, abdominal pain goes away as the condition worsens, most likely because the pancreas is no longer making digestive enzymes.

People with chronic pancreatitis often lose weight despite a normal appetite and eating habits. The weight loss occurs because the body cannot produce enough enzymes to digest the food.

Diagnosis

With similar symptoms, chronic pancreatitis is easily confused with acute pancreatitis. After a physical examine, the physician may order blood tests, which can reveal whether the pancreas is still producing sufficient digestive enzymes. However, enzymes sometimes may appear normal even with chronic pancreatitis.

In more advanced stages, when malabsorption and diabetes can occur, the doctor may order blood, urine and stool tests to help diagnose chronic pancreatitis and monitor its progression.

Other tests—X-rays, abdominal ultrasound, CT, EUS and MRCP—may be ordered.

Treatment

Treatment for chronic pancreatitis may require hospitalization for pain management, intravenous hydration, and nutritional support. Nasogastric feedings may be necessary for several weeks if the person continues to lose weight.

When a normal diet is resumed, the doctor may prescribe a regimen of synthetic pancreatic enzymes if the pancreas does not secrete enough of its own. The patient also needs to have a diet low in fat and consumed in small, frequent meals.

Even if chronic pancreatitis is in its early stages, patients should avoid alcoholic beverages and stop smoking.

Surgical intervention may be recommended for some patients. Procedures may include:

• Distal pancreatectomy (removal of the tail of the pancreas)
• Whipple procedure (removal of the head of the pancreas)
• Peustow procedure (drainage procedure)
• Beger or Frey procedure (resection and drainage procedure)

Some patients may be candidates for total pancreatectomy (removal of the entire pancreas), isolation of islet cells (the cells that make insulin) and implantation of the islet cells within the liver.

Complications

People with chronic pancreatitis who continue to consume large amounts of alcohol may develop sudden bouts of severe abdominal pain.

Chronic pancreatitis also can lead to calcification of the pancreas, which means the pancreatic tissue hardens from deposits of insoluble calcium salts. Surgery may be necessary to remove part of the pancreas.

In cases involving persistent pain, surgery or other procedures are sometimes recommended to block the nerves in the abdominal area that cause pain.

Chronic pancreatitis also may cause diabetes, triggering the need for insulin or other medication to maintain blood glucose levels.

Our UCI Health hepatobiliary specialists are part of a multidisciplinary team that comprises internists, medical oncologists and surgeons, as well as highly trained nurses and other clinical professionals.

Our core team includes: