Pancreatitis

The pancreas is a digestive and endocrine organ lying behind the stomach in the upper abdomen (see Your Digestive Tract). The pancreas secretes digestive juices containing enzymes into the small intestine (duodenum) to help break down food into smaller molecules that can be absorbed by the body. It also secretes the hormone insulin into the bloodstream to keep the concentration of glucose in our blood at the correct level (endocrine function).

Pancreatitis occurs when the pancreas becomes inflamed. Its own enzymes are released into the blood as well as within the organ itself, and into the surrounding tissues, further adding to tissue damage.

Frequency in the Community

Chronic pancreatitis is more frequent in men than women.

Cause of Pancreatitis

Pancreatitis may be either acute or chronic.

ACUTE PANCREATITIS: Common causes include excessive alcohol consumption and gallstones. Less common causes include medications, high blood fats, high blood calcium, inherited factors, congenital abnormalities of the pancreas, viral infections, severe injury to the upper abdomen (trauma), and idiopathic (no obvious cause).

CHRONIC PANCREATITIS: Chronic pancreatitis is often caused by alcohol abuse, but in some patients there is no obvious cause. Rarer causes include haemochromatosis and other unknown factors. Inflammation and scarring over a long period of time eventually destroys the glandular tissue in the pancreas. This results in an inability to properly digest fat due to a lack of pancreatic enzymes, and reduced production of insulin.

Symptoms

Most patients with acute pancreatitis suffer severe central upper abdominal pain, frequently radiating straight through to the back. Vomiting is common, and often early signs of shock (rapid pulse, low blood pressure) are seen. Shock occurs when large amounts of fluid pour into the abdominal cavity in response to the inflamed pancreas, combined with vomiting and poor oral fluid intake. Other conditions such as a perforated peptic ulcer may mimic acute pancreatitis, which requires careful differentiation from a surgically treatable "acute abdomen".

While the patient with chronic pancreatitis does not usually develop the severe life-threatening complications which may be seen in acute pancreatitis, chronic pain, weight loss, inability to digest food, and lack of insulin all combine to produce a disabling condition.

COMPLICATIONS: In a minority of patients, infection may occur from bacteria in the intestinal tract, an abscess may develop and bleeding may occur (from the stomach, duodenum or from blood vessels digested by pancreatic enzymes). A collection of fluid may occur (pseudocyst)in the abdomen.

Medical Treatment

Treatment is aimed at replacing the large amounts of body fluid by intravenous infusion. The pancreas and digestive system in general should be rested to minimise enzyme production. This is achieved by fasting the patient, using medications which reduce the secretions from the pancreas, and sometimes using a nasogastric tube (into the stomach) to remove upper gastrointestinal secretions. Large doses of injected narcotic pain relievers are usually necessary.