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Pancreatitis is an inflammation of the pancreas. The pancreas is
a large gland behind the stomach and close to the duodenum. The
duodenum is the upper part of the small intestine. The pancreas
secretes digestive enzymes into the small intestine through a tube
called the pancreatic duct. These enzymes help digest fats,
proteins, and carbohydrates in food. The pancreas also releases the
hormones insulin and glucagon into the bloodstream. These hormones
help the body use the glucose it takes from food for energy.
Normally, digestive enzymes do not become active until they reach
the small intestine, where they begin digesting food. But if these
enzymes become active inside the pancreas, they start "digesting"
the pancreas itself.
Acute pancreatitis occurs suddenly and lasts for a short period
of time and usually resolves. Chronic pancreatitis does not resolve
itself and results in a slow destruction of the pancreas. Either
form can cause serious complications. In severe cases, bleeding,
tissue damage, and infection may occur. Pseudocysts, accumulations
of fluid and tissue debris, may also develop. And enzymes and toxins
may enter the bloodstream, injuring the heart, lungs, and kidneys,
or other organs.
Some people have more than one attack and recover completely
after each, but acute pancreatitis can be a severe, life-threatening
illness with many complications. About 80,000 cases occur in the
United States each year; some 20 percent of them are severe. Acute
pancreatitis occurs more often in men than women.
Acute pancreatitis is usually caused by gallstones or by drinking
too much alcohol, but these aren't the only causes. If alcohol use
and gallstones are ruled out, other possible causes of pancreatitis
should be carefully examined so that appropriate treatment--if
Acute pancreatitis usually begins with pain in the upper abdomen
that may last for a few days. The pain may be severe and may become
constant--just in the abdomen--or it may reach to the back and other
areas. It may be sudden and intense or begin as a mild pain that
gets worse when food is eaten. Someone with acute pancreatitis often
looks and feels very sick. Other symptoms may include
- swollen and tender abdomen
- rapid pulse
Severe cases may cause dehydration and low blood pressure. The
heart, lungs, or kidneys may fail. If bleeding occurs in the
pancreas, shock and sometimes even death follow.
Besides asking about a person's medical history and doing a
physical exam, a doctor will order a blood test to diagnose acute
pancreatitis. During acute attacks, the blood contains at least
three times more amylase and lipase than usual. Amylase and lipase
are digestive enzymes formed in the pancreas. Changes may also occur
in blood levels of glucose, calcium, magnesium, sodium, potassium,
and bicarbonate. After the pancreas improves, these levels usually
return to normal.
A doctor may also order an abdominal ultrasound to look for
gallstones and a CAT (computerized axial tomography) scan to look
for inflammation or destruction of the pancreas. CAT scans are also
useful in locating pseudocysts.
Treatment depends on the severity of the attack. If no kidney or
lung complications occur, acute pancreatitis usually improves on its
own. Treatment, in general, is designed to support vital bodily
functions and prevent complications. A hospital stay will be
necessary so that fluids can be replaced intravenously.
If pancreatic pseudocysts occur and are considered large enough
to interfere with the pancreas's healing, your doctor may drain or
surgically remove them.
Unless the pancreatic duct or bile duct is blocked by gallstones,
an acute attack usually lasts only a few days. In severe cases, a
person may require intravenous feeding for 3 to 6 weeks while the
pancreas slowly heals. This process is called total parenteral
nutrition. However, for mild cases of the disease, total parenteral
nutrition offers no benefit.
Before leaving the hospital, a person will be advised not to
drink alcohol and not to eat large meals. After all signs of acute
pancreatitis are gone, the doctor will try to decide what caused it
in order to prevent future attacks. In some people, the cause of the
attack is clear, but in others, more tests are needed.
Acute pancreatitis can cause breathing problems. Many people
develop hypoxia, which means that cells and tissues are not
receiving enough oxygen. Doctors treat hypoxia by giving oxygen
through a face mask. Despite receiving oxygen, some people still
experience lung failure and require a ventilator.
Sometimes a person cannot stop vomiting and needs to have a tube
placed in the stomach to remove fluid and air. In mild cases, a
person may not eat for 3 or 4 days and instead may receive fluids
and pain relievers through an intravenous line.
If an infection develops, the doctor may prescribe antibiotics.
Surgery may be needed for extensive infections. Surgery may also be
necessary to find the source of bleeding, to rule out problems that
resemble pancreatitis, or to remove severely damaged pancreatic
Acute pancreatitis can sometimes cause kidney failure. If your
kidneys fail, you will need dialysis to help your kidneys remove
wastes from your blood.
Gallstones can cause pancreatitis and they usually require
surgical removal. Ultrasound or a CAT scan can detect
gallstones and can sometimes give an idea of the severity of
the pancreatitis. When gallstone surgery can be scheduled
depends on how severe the pancreatitis is. If the pancreatitis
is mild, gallstone surgery may proceed within about a week.
More severe cases may mean gallstone surgery is delayed for a
month or more.
After the gallstones are removed and inflammation goes
away, the pancreas usually returns to normal.
For more information about gallstones, please see the
Gallstones fact sheet from the National Institute of
Diabetes and Digestive and Kidney Diseases
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If injury to the pancreas continues, chronic pancreatitis may
develop. Chronic pancreatitis occurs when digestive enzymes attack
and destroy the pancreas and nearby tissues, causing scarring and
pain. The usual cause of chronic pancreatitis is many years of
alcohol abuse, but the chronic form may also be triggered by only
one acute attack, especially if the pancreatic ducts are damaged.
The damaged ducts cause the pancreas to become inflamed, tissue to
be destroyed, and scar tissue to develop.
While common, alcoholism is not the only cause of chronic
pancreatitis. The main causes of chronic pancreatitis are
- blocked or narrowed pancreatic duct because of trauma or
pseudocysts have formed
- unknown cause (idiopathic)
Damage from alcohol abuse may not appear for many years, and then
a person may have a sudden attack of pancreatitis. In up to 70
percent of adult patients, chronic pancreatitis appears to be caused
by alcoholism. This form is more common in men than in women and
often develops between the ages of 30 and 40.
Hereditary pancreatitis usually begins in childhood but may not
be diagnosed for several years. A person with hereditary
pancreatitis usually has the typical symptoms that come and go over
time. Episodes last from 2 days to 2 weeks. A determining factor in
the diagnosis of hereditary pancreatitis is two or more family
members with pancreatitis in more than one generation. Treatment for
individual attacks is usually the same as it is for acute
pancreatitis. Any pain or nutrition problems are treated just as
they are for acute pancreatitis. Surgery can often ease pain and
help manage complications.
Other causes of chronic pancreatitis are
- congenital conditions such as pancreas divisum
- cystic fibrosis
- high levels of calcium in the blood (hypercalcemia)
- high levels of blood fats (hyperlipidemia or
- some drugs
- certain autoimmune conditions
Most people with chronic pancreatitis have abdominal pain,
although some people have no pain at all. The pain may get worse
when eating or drinking, spread to the back, or become constant and
disabling. In certain cases, abdominal pain goes away as the
condition advances, probably because the pancreas is no longer
making digestive enzymes. Other symptoms include nausea, vomiting,
weight loss, and fatty stools.
People with chronic disease often lose weight, even when their
appetite and eating habits are normal. The weight loss occurs
because the body does not secrete enough pancreatic enzymes to break
down food, so nutrients are not absorbed normally. Poor digestion
leads to excretion of fat, protein, and sugar into the stool. If the
insulin-producing cells of the pancreas (islet cells) have been
damaged, diabetes may also develop at this stage.
Diagnosis may be difficult, but new techniques can help.
Pancreatic function tests help a doctor decide whether the pancreas
is still making enough digestive enzymes. Using ultrasonic imaging,
endoscopic retrograde cholangiopancreatography (ERCP), and CAT
scans, a doctor can see problems indicating chronic pancreatitis.
Such problems include calcification of the pancreas, in which tissue
hardens from deposits of insoluble calcium salts. In more advanced
stages of the disease, when diabetes and malabsorption occur, a
doctor can use a number of blood, urine, and stool tests to help
diagnose chronic pancreatitis and to monitor its progression.
For more information about ERCP, please see the ERCP fact
sheet from the NIDDK.
Relieving pain is the first step in treating chronic
pancreatitis. The next step is to plan a diet that is high in
carbohydrates and low in fat.
A doctor may prescribe pancreatic enzymes to take with meals if
the pancreas does not secrete enough of its own. The enzymes should
be taken with every meal to help the body digest food and regain
some weight. Sometimes insulin or other drugs are needed to control
In some cases, surgery is needed to relieve pain. The surgery may
involve draining an enlarged pancreatic duct or removing part of the
For fewer and milder attacks, people with pancreatitis must stop
drinking alcohol, stick to their prescribed diet, and take the
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Chronic pancreatitis is rare in children. Trauma to the pancreas
and hereditary pancreatitis are two known causes of childhood
pancreatitis. Children with cystic fibrosis, a progressive,
disabling, and incurable lung disease, may also have pancreatitis.
But more often the cause is not known.
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- Pancreatitis begins when the digestive enzymes become active
inside the pancreas and start "digesting" it.
- Pancreatitis has two forms: acute and chronic
- Common causes of pancreatitis are gallstones or alcohol
- Sometimes no cause for pancreatitis can be found.
- Symptoms of acute pancreatitis include pain in the abdomen,
nausea, vomiting, fever, and a rapid pulse.
- Treatment for acute pancreatitis can include intravenous
fluids, oxygen, antibiotics, or surgery.
- Acute pancreatitis becomes chronic when pancreatic tissue is
destroyed and scarring develops.
- Treatment for chronic pancreatitis includes easing the pain;
eating a high-carbohydrate, low-fat diet; and taking enzyme
supplements. Surgery is sometimes needed as well.
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NIDDK's Division of Digestive Diseases and Nutrition supports
basic and clinical research into gastrointestinal diseases,
including the causes of pancreatitis and mechanisms of cell injury
in the gastrointestinal tract. In addition, researchers are studying
the genetics of hereditary pancreatitis, as well as risk factors
such as cystic fibrosis.
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