Pancreatitis: Diagnosis, Tests, Management and Treatment

Pancreatitis is an inflammation (swelling) of the pancreas. When the pancreas is inflamed, the powerful digestive enzymes it makes can damage its tissue. The inflamed pancreas can cause release of inflammatory cells and toxins that may harm your lungs, kidneys and heart.

Pancreatitis

There are two forms of pancreatitis:

Acute pancreatitis is a sudden and short bout of inflammation.
Chronic pancreatitis is ongoing inflammation.

Where is the pancreas located?

The pancreas is an organ in the upper abdomen (belly). It connects to the beginning of the small intestine (the duodenum). It contains the pancreatic duct (tube), which drains digestive enzymes (chemicals) into the small intestine (the duodenum).

What is the function of the pancreas?

Your pancreas has two primary functions. First, it makes digestive enzymes (chemicals) and releases them into the small intestine. These enzymes break down carbohydrates, proteins and fat from food.

Your pancreas also produces several hormones and releases them into the blood. Amongst these hormones is insulin which regulates the amount of sugar in your blood (glucose). Insulin also helps provide energy now and stores some for later.

Who gets pancreatitis?

You’re more likely to develop pancreatitis if you:

Are male.
Are African-American.
Have other people in your family who’ve had pancreatitis.
Have gallstones or have family members with gallstones.
Have obesity, high triglycerides (fat in the blood) or diabetes.
Are a smoker.
Are a heavy drinker (three or more drinks a day).

What causes pancreatitis?

Gallstones or heavy alcohol drinking are usually the cause of pancreatitis. Rarely, you can also get pancreatitis from:

Medications (many can irritate the pancreas).
High triglyceride levels (fat in the blood).
Infections.
Abdominal injury.
Metabolic disorders such as diabetes.
Genetic disorders such as cystic fibrosis.

What are the symptoms of pancreatitis?

Pancreatitis symptoms vary, depending on the type of condition:

Acute pancreatitis symptoms

If you have acute pancreatitis, you may experience:

Moderate to severe upper abdominal pain that may spread to your back.
Pain that comes on suddenly or builds up over a few days.
Pain that worsens when eating.
Swollen, tender abdomen.
Nausea and vomiting.
Fever.
Faster than usual heart rate.

Chronic pancreatitis symptoms

Chronic pancreatitis may cause some of the same symptoms as acute pancreatitis. You may also develop:

Constant, sometimes disabling pain that spreads to your back.
Unexplained weight loss.
Foamy diarrhea with visible oil droplets (steatorrhea).
Diabetes (high blood sugar), if insulin-producing pancreas cells are damaged.

How is pancreatitis diagnosed?

Your provider may suspect pancreatitis based on your symptoms or risk factors, such as heavy alcohol use or gallstone disease. To confirm diagnosis, you may go through additional tests.

Diagnosing acute pancreatitis

For acute pancreatitis, your provider may order a blood test that measures the levels of two digestive enzymes (amylase and lipase) produced by the pancreas. High levels of these enzymes indicate acute pancreatitis. An ultrasound or computed tomography (CT scan) provides images of your pancreas, gall bladder and bile duct that can show abnormalities.

Diagnosing chronic pancreatitis

Diagnosing chronic pancreatitis is more involved. You may also need:

Secretin pancreatic function test: This test checks for your pancreas’s response to a hormone (secretin) released by the small intestine. Secretin usually triggers the pancreas to release a digestive juice. A medical professional passes a tube from your throat, through your stomach, into the upper part of the small intestine to insert secretin and measure the response.
Oral glucose tolerance test: You may need this test if your provider suspects that pancreatitis has damaged your insulin-producing pancreas cells. It measures how your body handles sugar with a blood test before and after you drink a sugary liquid.
Stool test: Your provider may order a stool test using a sample of your stool to see if your body is having difficulty breaking down fat.
Endoscopic ultrasound (endosonography): An internal (endoscopic) ultrasound takes clearer pictures of your pancreas and connecting ducts (tubes). A healthcare professional inserts a thin tube with a tiny ultrasound attachment into your throat, through your stomach and into your small intestine. The endoscopic ultrasound takes detailed pictures of your internal organs including pancreas, part of liver, gall bladder and bile duct.
ERCP (endoscopic retrograde cholangiopancreatography): A tube with a tiny camera is passed from your throat to your stomach and into your small intestine up to the area called the ampulla, where the pancreas and bile duct opens. Dye is injected into the pancreas duct and /or bile duct. The test lets your provider see inside the pancreas and bile duct. Anything blocking the pancreas or bile duct, such as a gallstone or pancreas stone, may be removed.

How is pancreatitis treated?

If you have pancreatitis, your primary care provider will probably refer you to a specialist. A doctor who specializes in the digestive system (gastroenterologist) should oversee your care.

Doctors use one or more of these methods to treat acute pancreatitis:

Hospitalization with supportive care and monitoring.
Pain medication to provide comfort.
Endoscopic procedure or surgery to remove a gallstone, other blockage or damaged part of the pancreas.
Supplemental pancreatic enzymes and insulin, if your pancreas isn’t functioning well.

Procedures used to treat pancreatitis

Most pancreatitis complications like pancreatic pseudocyst (type of inflammatory cyst) or infected pancreas tissue are managed through endoscopic procedure (inserting a tube down your throat until it reaches your small intestine, which is next to your pancreas). Gallstones and pancreas stones are removed with an endoscopic procedure.

If surgery is recommended, surgeons can often perform a laparoscopic procedure. This surgical technique involves smaller cuts that take less time to heal.

During laparoscopic surgery, your surgeon inserts a laparoscope (an instrument with a tiny camera and light) into keyhole-sized cuts in your abdomen. The laparoscope sends images of your organs to a monitor to help guide the surgeon during the procedure.

Can pancreatitis be prevented?

The best way to prevent pancreatitis is to have a healthy lifestyle. Aim to:

Maintain a healthy weight.
Get regular exercise.
Stop smoking.
Avoid alcohol.

These healthy lifestyle choices will also help you avoid gallstones, which cause 40% of acute pancreatitis cases. Your provider may recommend removing your gallbladder if you have painful gallstones multiple times.

How long does pancreatitis last?

Typically, acute pancreatitis lasts only a few days. But if you have a more severe case, it may take several weeks to months to recover. Chronic pancreatitis requires lifelong management.

Will pancreatitis go away?

With treatment, most people with acute pancreatitis completely recover.

Chronic pancreatitis is a long-lasting condition. Once it’s severely damaged, your pancreas doesn’t function properly. You need ongoing support to digest food and manage blood sugar.

Can pancreatitis return?

With chronic pancreatitis, painful episodes can come and go or persist (last a long time).

You can also have another attack of acute pancreatitis, especially if you haven’t resolved the underlying problem. For example, if you have another gallstone that blocks the opening to the pancreas, you can get acute pancreatitis again.

Is pancreatitis fatal?

Most people with a mild case of acute pancreatitis fully recover. However, those with severe pancreatitis are more likely to have life-threatening complications such as:

Infection of the pancreas.
Bleeding in the pseudocyst or damaged pancreas.
Heart, lung or kidney failure from spreading infection or if the pancreas leaks toxins into the blood.