Pancreatitis National Digestive Diseases Information Clearinghouse What is pancreatitis? Liver Pancreatitis is inflammation of the pancreas. The pancreas is a large gland behind the stomach and close to the duodenum—the U.S. Department first part of the small intestine. The pan­ of Health and Human Services creas secretes digestive juices, or enzymes, Hepatic ducts into the duodenum through a tube called Cystic duct NATIONAL the pancreatic duct. Pancreatic enzymes INSTITUTES join with bile—a liquid produced in the liver OF HEALTH and stored in the gallbladder—to digest Gallbladder food. The pancreas also releases the hor­ Pancreas mones insulin and glucagon into the blood­ Common bile duct stream. These hormones help the body Duodenum regulate the glucose 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? 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, bleeding, infection, 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 gallstones—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 liver disease statistics, 2004. Gastroenterology. 2004;126:1448–1453. the common bile duct. Chronic, heavy Diagnosis alcohol 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 abdominal trauma, medications, infections, pancreatitis, the blood contains at least tumors, and genetic abnormalities of the three times the normal amount of amy­ pancreas. lase and lipase, 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 abdomen and bicarbonate. 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 eating. 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 ultrasound. Sound waves • a swollen and tender abdomen are sent toward the pancreas through a handheld device that a technician • nausea and vomiting glides over the abdomen. The sound • fever 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 blood pressure. The heart, a sonogram—on a video monitor. If lungs, or kidneys can fail. If bleeding occurs gallstones are causing inflammation, in the pancreas, shock 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, antibiotics, 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 • Endoscopic ultrasound (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 veins that helps show the pancreas, gallbladder, and pancreatic and bile ducts. 3 Pancreatitis Therapeutic Endoscopic Retrograde Cholangiopancreatography (ERCP) for Acute and Chronic Pancreatitis 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 pseudocyst is ducts and treat complications of acute present, the duct is drained. and chronic pancreatitis—gallstones, Gallstone 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 pseudocysts—accumulations of fluid removal is sometimes performed along and tissue debris. with a sphincterotomy. Soon after a person is admitted to the Stent 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 abdominal pain 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 cholecystectomy—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 Diabetes and Digestive and creatitis is many years of heavy alcohol use. Kidney Diseases (NIDDK). The chronic form of pancreatitis can be trig­ gered by one acute attack that damages the If an infection develops, ERCP or surgery 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 • cystic fibrosis—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.