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Home , Acute pancreatitis, Cystic duct, Gallbladder, Hereditary pancreatitis, Pancreas, Pancreatitis

National Digestive Diseases Information Clearinghouse

What is pancreatitis? Pancreatitis is of the . The pancreas is a large behind the and close to the —the U.S. Department first part of the . The pan­ of Health and Human Services creas secretes digestive juices, or , Hepatic ducts

into the duodenum through a tube called Cystic NATIONAL the . Pancreatic enzymes INSTITUTES join with —a liquid produced in the liver OF HEALTH and stored in the —to digest Gallbladder

food. The pancreas also releases the hor­ Pancreas mones and into the blood­ Common stream. These help the body Duodenum regulate the it takes from food for Pancreatic duct energy. The gallbladder and the ducts that carry bile and Normally, digestive enzymes secreted by the other digestive enzymes from the liver, gallbladder, pancreas do not become active until they and pancreas to the small intestine are called the biliary system. reach the small intestine. But when the pancreas is inflamed, the enzymes inside it attack and damage the tissues that produce them. What is ? Acute pancreatitis is inflammation of the Pancreatitis can be acute or chronic. Either pancreas that occurs suddenly and usually form is serious and can lead to complica­ resolves in a few days with treatment. tions. In severe cases, , , Acute pancreatitis can be a life-threatening and permanent tissue damage may occur. illness with severe complications. Each Both forms of pancreatitis occur more often year, about 210,000 people in the United in men than women. States are admitted to the hospital with acute pancreatitis.1 The most common cause of acute pancreatitis is the presence of —small, pebble-like substances made of hardened bile—that cause inflam­ mation in the pancreas as they pass through

1Russo MW, Wei JT, Thiny MT, et al. Digestive and statistics, 2004. . 2004;126:1448–1453. the . Chronic, heavy Diagnosis use is also a common cause. Acute While asking about a person’s medical his­ pancreatitis can occur within hours or as tory and conducting a thorough physical long as 2 days after consuming alcohol. examination, the doctor will order a blood Other causes of acute pancreatitis include test to assist in the diagnosis. During acute , medications, , pancreatitis, the blood contains at least tumors, and genetic abnormalities of the three times the normal amount of amy­ pancreas. lase and , digestive enzymes formed Symptoms in the pancreas. Changes may also occur in other body chemicals such as glucose, Acute pancreatitis usually begins with grad­ calcium, magnesium, sodium, potassium, ual or sudden pain in the upper and . After the person’s condi­ that sometimes extends through the back. tion improves, the levels usually return to The pain may be mild at first and feel worse normal. after . But the pain is often severe and may become constant and last for sev­ Diagnosing acute pancreatitis is often dif­ eral days. A person with acute pancreatitis ficult because of the deep location of the usually looks and feels very ill and needs pancreas. The doctor will likely order one immediate medical attention. Other symp­ or more of the following tests: toms may include • Abdominal . Sound waves • a swollen and tender abdomen are sent toward the pancreas through a handheld device that a technician • and glides over the abdomen. The sound • waves bounce off the pancreas, gallbladder, liver, and other organs, • a rapid pulse and their echoes make electrical Severe acute pancreatitis may cause dehy­ impulses that create a picture—called dration and low . The heart, a sonogram—on a video monitor. If , or kidneys can fail. If bleeding occurs gallstones are causing inflammation, in the pancreas, and even death may the sound waves will also bounce off follow. them, showing their location.

2 Pancreatitis • Computerized tomography (CT) scan. Treatment The CT scan is a noninvasive x ray that Treatment for acute pancreatitis requires produces three-dimensional pictures of a few days’ stay in the hospital for intrave­ parts of the body. The person lies on nous (IV) fluids, , and medication a table that slides into a donut-shaped to relieve pain. The person cannot eat or machine. The test may show gallstones drink so the pancreas can rest. If vomiting and the extent of damage to the pan­ occurs, a tube may be placed through the creas. nose and into the stomach to remove fluid • (EUS). After and air. spraying a solution to numb the Unless complications arise, acute pancreati­ patient’s throat, the doctor inserts an tis usually resolves in a few days. In severe endoscope—a thin, flexible, lighted cases, the person may require nasogastric tube—down the throat, through the feeding—a special liquid given in a long, stomach, and into the small intestine. thin tube inserted through the nose and The doctor turns on an ultrasound throat and into the stomach—for several attachment to the scope that produces weeks while the pancreas heals. sound waves to create visual images of the pancreas and bile ducts. Before leaving the hospital, the person will be advised not to smoke, drink alcoholic • Magnetic resonance cholangiopan­ beverages, or eat fatty meals. In some creatography (MRCP). MRCP uses cases, the cause of the pancreatitis is clear, magnetic resonance imaging, a nonin­ but in others, more tests are needed after vasive test that produces cross-section the person is discharged and the pancreas is images of parts of the body. After healed. being lightly sedated, the patient lies in a cylinder-like tube for the test. The technician injects dye into the patient’s that helps show the pancreas, gallbladder, and pancreatic and bile ducts.

3 Pancreatitis Therapeutic Endoscopic Retrograde Cholangiopancreatography (ERCP) for Acute and

ERCP is a specialized technique used to bile ducts and makes a tiny cut to enlarge view the pancreas, gallbladder, and bile the duct opening. When a is ducts and treat complications of acute present, the duct is drained. and chronic pancreatitis—gallstones, removal. The endoscope is narrowing or blockage of the pancreatic used to remove pancreatic or bile duct duct or bile ducts, leaks in the bile ducts, stones with a tiny basket. Gallstone and —accumulations of fluid removal is sometimes performed along and tissue debris. with a sphincterotomy. Soon after a person is admitted to the placement. Using the endoscope, hospital with suspected narrowing of the the doctor places a tiny piece of plastic pancreatic duct or bile ducts, a physician or metal that looks like a straw in a nar­ with specialized training performs ERCP. rowed pancreatic or bile duct to keep it After lightly sedating the patient and open. giving medication to numb the throat, the Balloon dilatation. Some endoscopes doctor inserts an endoscope—a long, have a small balloon that the doctor uses flexible, lighted tube with a camera— to dilate, or stretch, a narrowed pancre­ through the mouth, throat, and stomach atic or bile duct. A temporary stent may into the small intestine. The endoscope is be placed for a few months to keep the connected to a computer and screen. The duct open. doctor guides the endoscope and injects a special dye into the pancreatic or bile People who undergo therapeutic ERCP ducts that helps the pancreas, gallbladder, are at slight risk for complications, includ­ and bile ducts appear on the screen while ing severe pancreatitis, infection, bowel x rays are taken. perforation, or bleeding. Complications of ERCP are more common in people The following procedures can be per­ with acute or recurrent pancreatitis. A formed using ERCP: patient who experiences fever, trouble Sphincterotomy. Using a small wire on swallowing, or increased throat, chest, the endoscope, the doctor finds the mus­ or after the procedure cle that surrounds the pancreatic duct or should notify a doctor immediately.

Complications using therapeutic endoscopic retrograde Gallstones that cause acute pancreatitis cholangiopancreatography (ERCP)—a require surgical removal of the stones specialized technique used to view the and the gallbladder. If the pancreatitis pancreas, gallbladder, and bile ducts and is mild, gallbladder removal—called treat complications of acute and chronic —may proceed while the pancreatitis. Cholecystectomy is delayed person is in the hospital. If the pancreatitis for a month or more to allow for full is severe, gallstones may be removed recovery. For more information, see the 4 Pancreatitis Gallstones fact sheet from the National The most common cause of chronic pan­ Institute of and Digestive and creatitis is many years of heavy alcohol use. Diseases (NIDDK). The chronic form of pancreatitis can be trig­ gered by one acute attack that damages the If an infection develops, ERCP or pancreatic duct. The damaged duct causes may be needed to drain the infected area, the pancreas to become inflamed. Scar also called an abscess. Exploratory surgery tissue develops and the pancreas is slowly may also be necessary to find the source destroyed. of any bleeding, to rule out conditions that resemble pancreatitis, or to remove severely Other causes of chronic pancreatitis are damaged pancreatic tissue. • hereditary disorders of the pancreas Pseudocysts—accumulations of fluid and tissue debris—that may develop in the pan­ • —the most common creas can be drained using ERCP or EUS. inherited disorder leading to chronic If pseudocysts are left untreated, enzymes pancreatitis and toxins can enter the bloodstream and • hypercalcemia—high levels of calcium affect the heart, lungs, kidneys, or other in the blood organs. • or hypertriglyceride­ Acute pancreatitis sometimes causes kidney mia—high levels of blood failure. People with need blood-cleansing treatments called dialysis or • some medicines a kidney transplant. • certain autoimmune conditions In rare cases, acute pancreatitis can cause • unknown causes breathing problems. Hypoxia, a condition that occurs when body cells and tissues do can present in a not get enough oxygen, can develop. Doc­ person younger than age 30, but it might not tors treat hypoxia by giving oxygen to the be diagnosed for several years. Episodes of patient. Some people still experience abdominal pain and lasting several failure—even with oxygen—and require a days come and go over time and can prog­ respirator for a while to help them breathe. ress to chronic pancreatitis. A diagnosis of hereditary pancreatitis is likely if the person has two or more family members with pan­ What is chronic creatitis in more than one generation. pancreatitis? Chronic pancreatitis is inflammation of the Symptoms pancreas that does not heal or improve—it Most people with chronic pancreatitis gets worse over time and leads to perma­ experience upper abdominal pain, although nent damage. Chronic pancreatitis, like some people have no pain at all. The pain acute pancreatitis, occurs when digestive may spread to the back, feel worse when enzymes attack the pancreas and nearby eating or , and become constant tissues, causing episodes of pain. Chronic and disabling. In some cases, abdominal pancreatitis often develops in people who are between the ages of 30 and 40.

5 Pancreatitis pain goes away as the condition worsens, Treatment most likely because the pancreas is no lon­ Treatment for chronic pancreatitis may ger making digestive enzymes. Other symp­ require hospitalization for pain manage­ toms include ment, IV hydration, and nutritional support. • nausea Nasogastric feedings may be necessary for several weeks if the person continues to lose • vomiting weight. • When a normal diet is resumed, the doctor • diarrhea may prescribe synthetic pancreatic enzymes if the pancreas does not secrete enough of • oily stools its own. The enzymes should be taken with People with chronic pancreatitis often lose every meal to help the person digest food weight, even when their appetite and eating and regain some weight. The next step is to habits are normal. The weight loss occurs plan a nutritious diet that is low in and because the body does not secrete enough includes small, frequent meals. A dietitian pancreatic enzymes to digest food, so nutri­ can assist in developing a meal plan. Drink­ ents are not absorbed normally. Poor diges­ ing plenty of fluids and limiting caffeinated tion leads to due to excretion beverages is also important. of fat in the stool. People with chronic pancreatitis are strongly advised not to smoke or consume Diagnosis alcoholic beverages, even if the pancreatitis Chronic pancreatitis is often confused with is mild or in the early stages. acute pancreatitis because the symptoms are similar. As with acute pancreatitis, the Complications doctor will conduct a thorough medical his­ People with chronic pancreatitis who con­ tory and . Blood tests tinue to consume large amounts of alcohol may help the doctor know if the pancreas may develop sudden bouts of severe abdom­ is still making enough digestive enzymes, inal pain. but sometimes these enzymes appear nor­ mal even though the person has chronic As with acute pancreatitis, ERCP is used to pancreatitis. identify and treat complications associated with chronic pancreatitis such as gallstones, In more advanced stages of pancreatitis, pseudocysts, and narrowing or obstruction when and diabetes can occur, of the ducts. Chronic pancreatitis also can the doctor may order blood, urine, and stool lead to calcification of the pancreas, which tests to help diagnose chronic pancreatitis means the pancreatic tissue hardens from and monitor its progression. deposits of insoluble calcium salts. Surgery After ordering x rays of the abdomen, the may be necessary to remove part of the doctor will conduct one or more of the pancreas. tests used to diagnose acute pancreatitis— In cases involving persistent pain, surgery abdominal ultrasound, CT scan, EUS, and or other procedures are sometimes recom­ MRCP. mended to block the in the abdomi­ nal area that cause pain.

6 Pancreatitis When pancreatic tissue is destroyed in chronic pancreatitis and the insulin- Points to Remember producing cells of the pancreas, called beta cells, have been damaged, diabetes • Pancreatitis is inflammation of may develop. People with a family history the pancreas, causing digestive of diabetes are more likely to develop the enzymes to become active inside disease. If diabetes occurs, insulin or other the pancreas and damage pancre­ medicines are needed to keep blood glucose atic tissue. at normal levels. A health care provider • Pancreatitis has two forms: acute works with the patient to develop a regimen and chronic. of medication, diet, and frequent blood glu­ cose monitoring. • Common causes of pancreatitis are gallstones and heavy alcohol use. For more information about diabetes, see the booklet Your Guide to Diabetes: Type 1 • Sometimes the cause of pancreati­ and Type 2 from the NIDDK. tis cannot be found. • Symptoms of acute pancreatitis How common is pancreatitis include abdominal pain, nausea, in children? vomiting, fever, and a rapid pulse. Chronic pancreatitis in children is rare. • Treatment for acute pancreatitis Trauma to the pancreas and hereditary pan­ includes intravenous (IV) fluids, creatitis are two known causes of childhood antibiotics, and pain medications. pancreatitis. Children with cystic fibrosis— Surgery is sometimes needed to a progressive and incurable lung disease— treat complications. may be at risk of developing pancreatitis. • Acute pancreatitis can become But more often the cause of pancreatitis in chronic if pancreatic tissue is per­ children is unknown. manently destroyed and scarring develops. Hope through Research • Symptoms of chronic pancreatitis The National Institute of Diabetes and include abdominal pain, nausea, Digestive and Kidney Diseases’ Division of vomiting, weight loss, diarrhea, and Digestive Diseases and Nutrition supports oily stools. basic and clinical research into gastrointesti­ nal diseases, including the causes of pancre­ • Treatment for chronic pancreatitis atitis and cell in the gastrointestinal may involve IV fluids; pain medica­ tract. In addition, researchers are studying tion; a low-fat, nutritious diet; and the genetics of hereditary pancreatitis and supplements. Surgery may risk factors such as cystic fibrosis. be necessary to remove part of the pancreas. Participants in clinical trials can play a more active role in their own health care, gain access to new research treatments before they are widely available, and help others by contributing to medical research. For information about current studies, visit www.ClinicalTrials.gov.

7 Pancreatitis For More Information National Digestive Diseases American Dietetic Association Information Clearinghouse 120 South Riverside Plaza, Suite 2000 2 Information Way Chicago, IL 60606–6995 Bethesda, MD 20892–3570 Phone: 1–800–877–1600 or 312–899–0040 Phone: 1–800–891–5389 Fax: 312–899–4899 TTY: 1–866–569–1162 Email: [email protected] Fax: 703–738–4929 Internet: www.eatright.org Email: [email protected] American Gastroenterological Association Internet: www.digestive.niddk.nih.gov 4930 Del Ray Avenue Bethesda, MD 20814 The National Digestive Diseases Informa- Phone: 301–654–2055 tion Clearinghouse (NDDIC) is a service Fax: 301–654–5920 of the National Institute of Diabetes and Email: [email protected] Digestive and Kidney Diseases (NIDDK). Internet: www.gastro.org The NIDDK is part of the National Insti- tutes of Health of the U.S. Department of American Pancreatic Association Health and Human Services. Established in P.O. Box 14906 1980, the Clearinghouse provides informa- Minneapolis, MN 55414 tion about digestive diseases to people with Phone: 612–626–9797 Fax: 612–625–7700 digestive disorders and to their families, Email: [email protected] health care professionals, and the public. Internet: www.american-pancreatic- The NDDIC answers inquiries, develops association.org and distributes publications, and works closely with professional and patient organi- zations and Government agencies to coordi- You may also find additional information about this nate resources about digestive diseases. topic by visiting MedlinePlus at www..gov. Publications produced by the Clearinghouse This publication may contain information about med- ications. When prepared, this publication included are carefully reviewed by both NIDDK sci- the most current information available. For updates entists and outside experts. This publication or for questions about any medications, contact was originally reviewed by David C. Whit- the U.S. Food and Drug Administration toll-free at 1–888–INFO–FDA (463–6332) or visit www.fda.gov. comb, M.D., University of Pittsburgh. Consult your doctor for more information.

This publication is not copyrighted. The Clearing- house encourages users of this fact sheet to duplicate and distribute as many copies as desired. This fact sheet is also available at www.digestive.niddk.nih.gov.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health

NIH Publication No. 08–1596 July 2008