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Pancreatitis

Pancreatitis

Gallstones that get lodged in the opening of the pancreas are the most common cause of pancreatitis. Alcohol is the next leading culprit. Usually, it takes several years of heavy drinking — such as a 12-pack of beer of every day — to inflame the pancreas.

What is pancreatitis?

The pancreas is a small, hard-working organ that sits behind the lower part of your stomach. A center that manufactures digestive juices and enzymes (which break down food in the stomach so the body can absorb it) and hormones such as insulin, it usually goes about its business without causing any trouble. But if something damages the organ, it can become inflamed, often causing agonizing pain. This rare condition is called pancreatitis.

For 80 percent of patients, the inflammation dies down within a few days, the pancreas heals completely, and pain is only a memory. The other 20 percent aren’t nearly so lucky. In severe cases, the inflammation can spread to other organs such as the lungs and the kidneys, and patients can go into shock. Without quick, aggressive treatment, severe pancreatitis can be fatal.

Rarely, does pancreatitis become a chronic problem such that the pancreas never completely heals, and pain keeps coming back. Most people with chronic pancreatitis are heavy drinkers.

What causes pancreatitis?

Gallstones that get lodged in the opening of the pancreas are the most common cause of pancreatitis. Alcohol is the next leading culprit. Usually, it takes several years of heavy drinking — such as a 12-pack of beer of every day — to inflame the pancreas. However, as little as four beers a day may be enough. Together, gallstones and alcohol account for 80 percent of all cases of pancreatitis.

In rare instances, pancreatitis can be triggered by certain medicines, including diuretics, heart drugs known as ACE inhibitors, estrogens, and corticosteroids. Other possible causes include injuries to the pancreas, viral or bacterial infections, parasites, hypertriglyceridemia (excess amount of fats in the blood), peptic ulcers, Crohn’s disease, cystic fibrosis, and hypothermia, and the mumps. For about 15 percent of cases, there’s no known cause.

What are the symptoms of pancreatitis?

The most obvious sign of pancreatitis is excruciating pain. The pain starts in the upper abdomen and often spreads to the sides and the back. If your pancreatitis is caused by gallstones, the pain will probably strike soon after a large meal. If the inflammation is caused by alcohol, you’ll probably feel the pain six to 12 hours after a drinking binge. Other common symptoms include nausea, vomiting, fever, jaundice, and a racing heartbeat.

How is pancreatitis diagnosed?

If you have symptoms of pancreatitis, your doctor will measure the level of certain enzymes in your blood. High readings are a strong sign that your pancreas is in trouble. To confirm the diagnosis, your doctor may need to take a closer look with an ultrasound or a computed tomography (CT) scan.

How is pancreatitis treated?

As soon as your doctor suspects pancreatitis, he or she will immediately send you to a hospital. If you have a mild-to-moderate case and don’t show any signs of complications, your medical team will work to make you comfortable while the pancreas heals itself. Most patients need a drug for pain relief. You’ll receive fluids through an IV tube. If you have nausea and vomiting, you’ll have to go without food until your stomach settles down. You should feel much better within two to three days.

If your pancreatitis is severe, you will need to be monitored closely in an intensive care unit. Your doctor will give you large amounts of fluid through an IV to prevent shock. If inflammation in your lungs makes it hard to breathe, you’ll be hooked up to a ventilator. Likewise, you’ll need dialysis if your kidneys shut down.

If gallstones caused your pancreatitis, your doctor may want to remove them before you leave the hospital. This can be done with a special surgical device inserted through a small incision in your abdomen.

If you have chronic pancreatitis or trouble absorbing fats in your food, your doctor will likely give you dietary guidelines to follow that include limiting your fat intake. You may also need to take pancreatic enzyme supplements with your food to help you better absorb nutrients. And if your pancreatitis stems from drinking alcohol, stop drinking altogether.

References

Munoz A and DA Katerndahl. Diagnosis and management of acute pancreatitis. American Family Physician, Vol. 62(1):164-174.

Beckingham IJ and PC Bornman. Acute pancreatitis. British Medical Journal, Vol. 322:595-598.

Bornman PC and IJ Beckingham. Chronic pancreatitis. British Medical Journal, Vol. 322:660-663.

National Digestive Diseases Information Clearinghouse. Pancreatitis. July 2008.

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