Where is pancreas pain?

Contents

What’s to know about chronic pancreatitis?

Share on PinterestThe pancreas produces important enzymes and hormones that help break down foods.

The following treatments are commonly recommended for chronic pancreatitis.

Lifestyle changes

People with chronic pancreatitis will need to undergo some lifestyle changes. These will include:

  • Stopping alcohol consumption: Giving up drinking will help prevent further damage to the pancreas. It will also contribute significantly towards relieving the pain. Some people may need professional help to quit alcohol.
  • Stopping tobacco use: Smoking is not a cause of pancreatitis, but it can accelerate the progression of the disease.

Pain management

Treatment should not only focus on helping ease the pain symptoms, but also depression which is a common consequence of long-term pain.

Doctors will usually use a step-by-step approach, in which mild painkillers are prescribed, gradually becoming stronger until pain becomes manageable.

Insulin

The pancreas may stop producing insulin if the damage is extensive. The individual is likely to have developed diabetes type 1.

Regular insulin treatment will become part of the treatment for the rest of the person’s life. Diabetes type 1 caused by chronic pancreatitis involves injections, not tablets, because most likely the digestive system will not be able to break them down.

Surgery

Severe chronic pain sometimes does not respond to painkilling medications. The ducts in the pancreas may have become blocked, causing an accumulation of digestive juices which puts pressure on them, causing intense pain. Another cause of chronic and intense pain could be inflammation of the head of the pancreas.

Several forms of surgery may be recommended to treat more severe cases.

Endoscopic surgery

A narrow, hollow, flexible tube called an endoscope is inserted into the digestive system, guided by ultrasound. A device with a tiny, deflated balloon at the end is threaded through the endoscope. When it reaches the duct, the balloon is inflated, thus widening the duct. A stent is placed to stop the duct from narrowing back.

Pancreas resection

The head of the pancreas is surgically removed. This not only relieves the pain caused by inflammation irritating the nerve endings, but it also reduces pressure on the ducts. Three main techniques are used for pancreas resection:

  • The Beger procedure: This involves resection of the inflamed pancreatic head with careful sparing of the duodenum, the rest of the pancreas is reconnected to the intestines.
  • The Frey procedure: This is used when the doctor believes pain is being caused by both inflammation of the head of the pancreas as well as the blocked ducts. The Frey procedure adds a longitudinal duct decompression to the pancreatic head resection – the head of the pancreas is surgically removed, and the ducts are decompressed by connecting them directly to the intestines.
  • Pylorus-sparing pancreaticoduodenectomy (PPPD): The gallbladder, ducts, and the head of the pancreas are all surgically removed. This is only done in very severe cases of intense chronic pain where the head of the pancreas is inflamed, and the ducts are also blocked. This is the most effective procedure for reducing pain and conserving pancreas function. However, it has the highest risk of infection and internal bleeding.

Total pancreatectomy

This involves the surgical removal of the whole pancreas. It is very effective in dealing with the pain. However, a person who has had a total pancreatectomy will be dependent on treatment for some of the vital functions of the pancreas, such as the release of insulin.

Autologous pancreatic islet cell transplantation (APICT)

During the total pancreatectomy procedure, a suspension of isolated islet cells is created from the surgically removed pancreas and injected into the portal vein of the liver. The islets cells will function as a free graft in the liver and will produce insulin.

Chronic pancreatitis

What are the main complications of chronic pancreatitis?

The main complication of chronic pancreatitis is diabetes. This is usually a form called Type 3c diabetes, which occurs because of damage to the Islets of Langerhans. The Islets produce many different hormones which contribute to the control of sugar levels, so Type 3c diabetes may be difficult to control. The usual treatment is insulin injections, but NICE has indicated a need for research in this area (see Research section).

Swelling and scarring of the pancreas occasionally leads to obstruction of the pancreas itself, the bile duct or the duodenum (the part of the small bowel which drains the stomach). Obstruction of the pancreatic or bile duct is usually treated by putting stents, (small internal drainage tubes) through the obstruction using an endoscope (ERCP), but surgical operations are also used. NICE has advised that more research is needed in this area. Duodenal obstruction is rare and usually needs an operation to bypass the blockage.

Some people with chronic pancreatitis also have episodes of acute pancreatitis.

If you have chronic pancreatitis, you have an increased risk of developing pancreatic cancer. This risk is particularly high if you have hereditary pancreatitis. Your pancreas team will monitor your condition and advise you if they judge that you should be investigated for cancer. People with hereditary pancreatitis may be asked to take part in a trial looking at ways of detecting cancer early.

Chronic pancreatitis can complicate other illnesses with genetic components, such as some hyperlipidaemias (high blood fats), high blood calcium, kidney disease and Inflammatory Bowel Disease.

Symptoms of Pancreatitis: Pain and Other Complications

The pain of pancreatitis occurs in a specific way and is a key symptom of the condition.

Pain in the upper abdominal area, usually under the ribs, is the most common symptom of both acute and chronic pancreatitis. Thinkstock

Pancreatitis is associated with pain and a handful of other symptoms, some of which can be severe. There are two types of pancreatitis: acute and chronic.

Gallstones and alcohol are the two main causes of acute pancreatitis. With chronic pancreatitis, it’s been estimated that up to 55 percent of cases in the United States are due to heavy drinking or alcoholism. (1)

Where Is the Pain of Pancreatitis Felt?

The most common symptom of both acute and chronic pancreatitis is pain in the upper abdominal area, usually under the ribs. This pain:

  • May be mild at first and get worse after eating or drinking
  • May become constant, severe, and last for several days
  • Tends to worsen while lying down on the back and lessen while leaning forward in a sitting position
  • Often radiates throughout the back
  • Is not aggravated by movement
  • Is not dull or located in the lower abdominal area

The abdominal pain may also differ depending on the cause of the pancreatitis.

The pain of gallstone pancreatitis, for instance, is usually sudden, stabbing, and may radiate to the back.

The pain of alcoholic pancreatitis, on the other hand, may develop more slowly and be less localized.

Other Symptoms of Acute Pancreatitis

In addition to abdominal pain, nausea and vomiting are hallmark symptoms of acute pancreatitis. The stress on various systems can also cause those with the condition to appear as ill as they are. They may look pale, sweaty, and in distress.

Other symptoms include:

  • Fever
  • Jaundice (yellowing of the skin and eyes)
  • Rapid pulse
  • Swollen or tender abdomen
  • Bloating
  • Hiccups
  • Indigestion
  • Clay-colored stools

Because pancreatitis causes a drop in your digestive enzyme supply, you can’t sufficiently break down food. When you can’t sufficiently break down food, it isn’t absorbed as it needs to be, and this is what creates a change in the nature of stools. This difficulty absorbing food and its nutrients can lead to weight loss as well.

RELATED: Here’s What May Be Causing Your Digestive Gas Pain

Symptoms of Chronic Pancreatitis

Symptoms of chronic pancreatitis often manifest themselves only when complications arise or the condition worsens.

The pain of chronic pancreatitis takes two forms. In the first kind, the pain may come and go, flaring up for several hours or several weeks, with no discomfort in between flare-ups. In the second, the pain is steady and debilitating.

In some cases, those with this form of pancreatic may feel pain in parts of the body other than the abdomen. There may sometimes be no pain at all.

Some of the defining symptoms of chronic pancreatitis include:

  • Diarrhea
  • Nausea
  • Vomiting
  • Weight loss
  • Oily stools

What Is Severe Pancreatitis?

Acute pancreatitis is classified as mild, moderate, or severe.

Whereas mild or moderate pancreatitis lasts for days, severe pancreatitis can last for a number of weeks.

Severe pancreatitis, which occurs in 15 to 20 percent of acute pancreatitis cases, can lead to multiple complications. (2)

The first stage of severe pancreatitis is marked by organ failure that doesn’t subside on its own within 48 hours.

Scientists are still not sure exactly how this organ failure occurs, but they think that pancreatitis, being an inflammatory condition, sets off a chain reaction of inflammation that damages and compromises the systems related to or near the pancreas.

The lungs are affected first. Inflammation causes surrounding blood vessels to leak into the air sacs, and the fluid in the lungs makes it hard to breathe.

Respiratory problems caused by organ failure are the most frequent complications of acute pancreatitis. (3)

If organ failure is treated within a few days, the risk of dying is low. It’s been estimated that if the organ failure persists for a week or more, there is a 1 in 3 chance of dying. (4)

In severe pancreatitis, the tissues in the pancreas die — this is called pancreatic necrosis — and often become infected. This complication occurs after organ failure has been detected. To prevent the further spread of infection, the dead tissue is frequently removed.

It is possible to have severe pancreatitis with necrosis but without organ failure.

Other complications of severe pancreatitis include:

  • Hemorrhaging (bleeding)
  • Obstruction of the common bile duct
  • Peritonitis, an inflammation of the tissue that lines the inner wall of the abdomen (the peritoneum)
  • Rupturing of the pancreatic duct
  • Acute respiratory distress syndrome (ARDS)
  • Acute lung injury

RELATED: Exocrine Pancreatic Insufficiency: A Complication of Pancreatitis You Should Know About

What Are Other Complications Associated With Pancreatitis?

These are some of the other complications that may develop as a result of acute, severe, or chronic pancreatitis:

  • Low blood pressure
  • Dehydration
  • Breathing problems due to hormone changes that affect lung function
  • Malnutrition due to the inefficient breakdown and absorption of food
  • Pancreatic pseudocysts, or fluid and debris-filled sacs, which may cause bleeding and infection if they rupture
  • Extra-pancreatic (outside of the pancreas) infections, including pneumonia, bloodstream infections, and urinary tract infections
  • Diabetes

Since your body is using its fluids to help fight the injuries to your pancreas, you may become dehydrated. Vomiting and the inability to eat may also contribute to dehydration, and it may also lead to low blood pressure.

How Is Pancreatitis Diagnosed?

As with most diseases, diagnosis of pancreatitis often begins with a medical history review and a physical examination.

Your doctor will also order a blood test and, possibly, one or more imaging tests, such as:

  • Magnetic resonance imaging (MRI) scan, particularly magnetic resonance cholangiopancreatography, which visualizes the biliary and pancreatic ducts
  • Computerized tomography (CT) scan
  • Abdominal ultrasound
  • Endoscopic ultrasound, which involves a long, thin tube that’s inserted into the small intestine through the throat
  • Endoscopic retrograde cholangiopancreatography (ERCP), a procedure that uses an endoscope to help X-ray the bile and pancreatic ducts
  • Magnetic resonance cholangiopancreatography (MRCP)

To be diagnosed with pancreatitis, you need to have at least two of the following symptoms:

  • Abdominal pain associated with pancreatitis
  • Blood test results showing you have levels of the pancreatic enzymes amylase or lipase that are at least three times the normal amount
  • Abdominal images showing changes that are characteristic of pancreatitis

Additional reporting by Carlene Bauer.

Common Disorders of the Pancreas

There are a variety of disorders of the pancreas including acute pancreatitis, chronic pancreatitis, hereditary pancreatitis, and pancreatic cancer.

The evaluation of pancreatic diseases can be difficult due to the inaccessibility of the pancreas. There are multiple methods to evaluate the pancreas. Initial tests of the pancreas include a physical examination, which is difficult since the pancreas is deep in the abdomen near the spine. Blood tests are often helpful in determining whether the pancreas is involved in a specific symptom but may be misleading. The best radiographic tests to evaluate the structure of the pancreas include CAT (computed tomography) scan, endoscopic ultrasound, and MRI (magnetic resonance imaging). Tests to evaluate the pancreatic ducts include ERCP (endoscopic retrograde cholangiopancreatography) and MRCP(magnetic resonance cholangiopancreatography). There are also instances in which surgical exploration is the only way to confirm the diagnosis of pancreatic disease.

Acute Pancreatitis

Acute pancreatitis is a sudden attack causing inflammation of the pancreas and is usually associated with severe upper abdominal pain. The pain may be severe and last several days. Other symptoms of acute pancreatitis include nausea, vomiting, diarrhea, bloating, and fever. In the United States, the most common cause of acute pancreatitis is gallstones. Other causes include chronic alcohol consumption, hereditary conditions, trauma, medications, infections, electrolyte abnormalities, high lipid levels, hormonal abnormalities, or other unknown causes. The treatment is usually supportive with medications showing no benefit. Most patients with acute pancreatitis recover completely.

For more information on acute pancreatitis, please visit here.

Chronic Pancreatitis

Chronic pancreatitis is the progressive disorder associated with the destruction of the pancreas. The disease is more common in men and usually develops in persons between 30 and 40 years of age. Initially, chronic pancreatitis may be confused with acute pancreatitis because the symptoms are similar. The most common symptoms are upper abdominal pain and diarrhea. As the disease becomes more chronic, patients can develop malnutrition and weight loss. If the pancreas becomes destroyed in the latter stages of the disease, patients may develop diabetes mellitus.

The most common cause of chronic pancreatitis in the United States is chronic alcohol consumption. Additional causes include cystic fibrosis and other hereditary disorders ofthe pancreas. For a significant percentage of patients there is no known cause. More research is needed to determine other causes of the disease.

The treatment for chronic pancreatitis depends on the symptoms. Most therapies center on pain management and nutritional support. Oral pancreatic enzyme supplements are used to aid in the digestion of food. Patients who develop diabetes require insulin to control blood sugar. The avoidance of alcohol is central to therapy.

For more information on chronic pancreatitis, please visit here.

Hereditary Pancreatitis

In some cases, pancreatitis is related to inherited abnormalities of the pancreas or intestine. Acute recurrent attacks of pancreatitis early in life (under age 30) can often progress to chronic pancreatitis. The most common inherited disorder that leads to chronic pancreatitis is cystic fibrosis. Recent research demonstrates genetic testing can be a valuable tool in identifying patients predisposed to hereditary pancreatitis.

As in chronic pancreatitis, hereditary pancreatitis is a progressive disease with a high risk of permanent problems. Patients with these disorders may have chronic pain, diarrhea, malnutrition, or diabetes. Treatment focuses on pain control and pancreatic enzyme replacement.

To read more about hereditary pancreatitis, please click here.

Pancreatic Cancer

Pancreatic cancer is the fourth most common cause of cancer death in men and the fifth in women. It accounts for more than 37,000 new cases per year in the United States. Cancer of the pancreas is resistant to many standard treatments including chemotherapy and radiation therapy. This cancer grows insidiously and initially does not cause symptoms. The classic presentation of pancreatic cancer is referred to as painless jaundice, a yellowish skin discoloration with no other symptoms. The diagnosis is usually made using different radiographic imaging techniques.

If detected in the early stages, pancreatic cancer can be cured by surgical resection. Unfortunately, early detection is more the exception than the rule. At later stages, treatment can improve the quality of life by controlling symptoms and complications.

For more information on pancreatic cancer, please visit here.

Pancreas Conditions

  • Diabetes, type 1: The body’s immune system attacks and destroys the pancreas’ insulin-producing cells. Lifelong insulin injections are required to control blood sugar.
  • Diabetes, type 2: The pancreas loses the ability to appropriately produce and release insulin. The body also becomes resistant to insulin, and blood sugar rises.
  • Cystic fibrosis: A genetic disorder that affects multiple body systems, usually including the lungs and the pancreas. Digestive problems and diabetes often result.
  • Pancreatic cancer: The pancreas has many different types of cells, each of which can give rise to a different type of tumor. The most common type arises from the cells that line the pancreatic duct. Because there are usually few or no early symptoms, pancreatic cancer is often advanced by the time it’s discovered.
  • Pancreatitis: The pancreas becomes inflamed and damaged by its own digestive chemicals. Swelling and death of tissue of the pancreas can result. Although alcohol or gallstones can contribute, sometimes a cause for pancreatitis is never found.
  • Pancreatic pseudocyst: After a bout of pancreatitis, a fluid-filled cavity called a pseudocyst can form. Pseudocysts may resolve spontaneously, or they may need surgical drainage.
  • Islet cell tumor: The hormone-producing cells of the pancreas multiply abnormally, creating a benign or cancerous tumor. These tumors produce excess amounts of hormones and then release them into the blood. Gastrinomas, glucagonomas, and insulinomas are examples of islet cell tumors.
  • Enlarged pancreas: An enlarged pancreas may mean nothing. You may simply have a pancreas that is larger than normal. Or, it can be because of an anatomic abnormality. But other causes of an enlarged pancreas may exist and require treatment.

The pancreas is an abdominal organ that is located behind the stomach and is surrounded by other organs, including the spleen, liver and small intestine. The pancreas is about 6 inches (15.24 centimeters) long, oblong and flat.

The pancreas plays an important role in digestion and in regulating blood sugar. Three diseases associated with the pancreas are pancreatitis, pancreatic cancer and diabetes.

Function of the pancreas

The pancreas serves two primary functions, according to Jordan Knowlton, an advanced registered nurse practitioner at the University of Florida Health Shands Hospital. It makes “enzymes to digest proteins, fats, and carbs in the intestines” and produces the hormones insulin and glucagon, he said.

Dr. Richard Bowen of Colorado State University’s Department of Biomedical Sciences wrote in Hypertexts for Pathophysiology: Endocrine System, “A well-known effect of insulin is to decrease the concentration of glucose in blood.” This lowers blood sugar levels and allows the body’s cells to use glucose for energy.

Insulin also allows glucose to enter muscle and other tissue, works with the liver to store glucose and synthesize fatty acids, and “stimulates the uptake of amino acids,” according to Bowen. Insulin is released after eating protein and especially after eating carbohydrates, which increase glucose levels in the blood. If the pancreas does not produce sufficient insulin, type 1 diabetes will develop.

Unlike insulin, glucagon raises blood sugar levels. According to the Johns Hopkins University Sol Goldman Pancreatic Cancer Research Center, the combination of insulin and glucagon maintains the proper level of sugar in the blood.

The pancreas’ second, exocrine function is to produce and release digestive fluids. After food enters the stomach, digestive enzymes called pancreatic juice travel through several small ducts to the main pancreatic duct and then to the bile duct, according to the Medical University of South Carolina’s Digestive Disease Center. The bile duct takes the juice to the gallbladder, where it mixes with bile to aid in digestion.

Location of the pancreas

“The pancreas is located in the upper abdomen behind the stomach,” Knowlton said. The right end of the pancreas is wide and called the head. From the head, the organ tapers to the left. The middle sections are called the neck and body, while the narrow end on the left side of the body is called the tail.

The Hume-Lee Transplant Center at Virginia Commonwealth University described the pancreas as “j-shaped.” The portion of the pancreas called the uncinate process bends backward from the head and underneath the body, according to the Pancreatic Cancer Action Network.

Pancreas pain

Intense pancreatic pain is usually associated with acute pancreatitis. It can be hard to identify pancreas pain and evaluate pancreas diseases because the organ sits deep in the abdomen, according to The National Pancreas Association. Other signs that the pain may be pancreatic include jaundice, itchy skin and unexplained weight loss. If you are experiencing pancreas pain, consult your doctor.

Pancreatitis

The National Institutes of Health defines pancreatitis as inflammation of the pancreas, happening when “digestive enzymes start digesting the pancreas itself.” It can be acute or chronic, but both forms should be taken seriously and may lead to additional health problems.

Chronic pancreatitis

There are up to 23 cases of chronic pancreatitis per 100,000 people per year worldwide. In just the United States, it results in more than 122,000 outpatient visits and more than 56,000 hospitalizations per year, according to the Cleveland Clinic.

“Chronic pancreatitis is a persistent inflammation (greater than three weeks) of the pancreas that causes permanent damage,” Knowlton said. The condition is often caused by “heavy, ongoing” alcohol consumption, but she added that there are other causes, including “those that cause acute pancreatitis attacks.” Other causes may be cystic fibrosis, high levels of calcium or fat in the blood and autoimmune disorders.

Symptoms include upper abdominal pain, nausea, vomiting, weight loss, and oily stools. According to Peter Lee and Tyler Stevens, in an article for the Cleveland Clinic, “clinically apparent” oily stools (steatorrhea) do not appear until “90 percent of pancreatic function has been lost.”

“Chronic pancreatitis requires dietary modifications, including a low-fat diet and cessation of alcohol and smoking,” Knowlton said. Chronic pancreatitis does not heal and tends to worsen with time, and “treatment options are mostly for pain relief.” She added that treatments “may include a pancreas stent or, for severe cases, surgery (either a lateral pancreaticojejunostomy, or a Whipple procedure).” Pancreatiocojejunostomies are designed to decrease pancreatic leakage while the Whipple procedure removes the head of the pancreas where, according to the Mayo Clinic, most tumors occur.

There may be a link between chronic pancreatitis and pancreatic cancer. According to the University of California Los Angeles Center for Pancreatic Diseases, “Recent studies reveal a 2-5 times increase in the incidence of pancreatic cancer in patients with chronic pancreatitis from a variety of causes.”

Acute pancreatitis

“Acute pancreatitis is inflammation of the pancreas (lasting less than three weeks), that is most often caused by gallstones,” said Knowlton. It usually comes on suddenly and disappears within a few days of treatment. In addition to gallstones, Knowlton said that causes “may include medications, high triglycerides, high calcium in the blood and high alcohol consumption.”

Pancreas pain is the chief symptom of acute pancreatitis, according to Medscape. The pain is usually severe and sudden. It increases in severity until it becomes a constant ache. This pancreas pain is felt in the upper abdomen. The Mayo Clinic noted that the pain can radiate through to the back, and Knowlton pointed out that it might be worse after eating. Other symptoms of acute pancreatitis include nausea, vomiting, fever and diarrhea.

According to Knowlton, “This patient often looks acutely ill, and requires hospitalization (typically for three to five days), intravenous (IV) hydration, nothing by mouth (for bowel rest), pain medication, treatment of underlying conditions, and possibly a radiologic procedure called an endoscopic retrograde cholangiopancreatography (ERCP), which can more specifically target the problem.” If the acute pancreatitis was caused by gallstones, doctors may recommend removing the gallbladder.

Pancreatic cancer

It is hard to diagnose pancreatic cancer early. The Mayo Clinic noted that symptoms typically don’t occur until the cancer has advanced. Knowlton said, “Unfortunately, symptoms can be vague, but can include abdominal pain, jaundice, severe itching, weight-loss, nausea, vomiting, and digestive problems.”

Making matters even more complicated is the pancreas’ deep-in-the-abdomen location. The NIH pointed out that as a result, tumors cannot usually be felt by touch. Because of the difficulty of early diagnosis and the rapidity with which pancreatic cancer spreads, the prognosis is often poor.

Risk factors for pancreatic cancer include smoking, long-term diabetes and chronic pancreatitis, according to the National Cancer Institute.

According to the American Cancer Society, pancreatic cancer usually begins in the cells that produce pancreatic (digestive) juices or in the cells that line the ducts. In rare occasions, pancreatic cancer will begin in the cells that produce hormones.

According to the University of Texas MD Anderson Cancer Center, to diagnose pancreatic cancer, doctors typically conduct physical exams, blood tests, imaging tests, endoscopic ultrasounds and tests and biopsies. Treatment options include surgery, radiation, chemotherapy and therapies targeted to attack cancer cells without harming normal cells.

Artificial pancreas

When a person’s pancreas isn’t functioning properly or has to be removed, doctors may replace or supplement it with an artificial pancreas. These devices that automatically monitor blood glucose and provide the appropriate insulin doses are often called closed-loop systems, automated insulin delivery systems, or autonomous systems for glycemic control, according to the Food and Drug Administration.

In a 2014 study published in the journal The Lancet Diabetes & Endocrinology, researchers found that an artificial pancreas offer people with type 1 diabetes a reliable way to keep glucose levels in check, when compared to other treatments. “Our study confirms that both artificial pancreas systems improve glucose control and reduce the risk of hypoglycemia compared to conventional pump therapy,” study author Ahmad Haidar, of Institut de Recherches Cliniques de Montreal, said in a statement.

Additional reporting by Alina Bradford, Live Science contributor.

Additional resources

  • National Pancreas Foundation: About the Pancreas
  • The Pancreas Center at Columbia University: The Pancreas and Its Functions
  • Cleveland Clinic: Chronic Pancreatitis

Related pages about the human body

  • Human Body: Anatomy, Facts & Functions

Parts of the human body

Systems of the human body

  • Circulatory System: Facts, Function & Diseases
  • Digestive System: Facts, Function & Diseases
  • Endocrine System: Facts, Functions and Diseases
  • Immune System: Diseases, Disorders & Function
  • Lymphatic System: Facts, Functions & Diseases
  • Muscular System: Facts, Functions & Diseases
  • Nervous System: Facts, Function & Diseases
  • Reproductive System: Facts, Functions and Diseases
  • Respiratory System: Facts, Function & Diseases
  • Skeletal System: Facts, Function & Diseases
  • Skin: Facts, Diseases & Conditions
  • Urinary System: Facts, Functions & Diseases

Pancreatitis

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 available – can begin.
Symptoms

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
  • nausea
  • vomiting
  • fever
  • 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.
Diagnosis

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 CT (computerized tomography) scan to look for inflammation or destruction of the pancreas. CT scans are also useful in locating pseudocysts.

Treatment

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.

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 IV (intravenous) line.

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.

Complications

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 tissue.

Acute pancreatitis can sometimes cause your kidneys to fail. If this happens, dialysis will be necessary to help your kidneys remove wastes from your blood.

Gallstones and Pancreatitis

Gallstones can cause pancreatitis and they usually require surgical removal. Ultrasound or a CT 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.

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:

  • alcoholism
  • blocked or narrowed pancreatic duct because of trauma or pseudocysts have formed
  • heredity
  • 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 it 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 two days to two weeks.

Some cases of chronic pancreatitis are idiopathic, meaning that the cause is unknown.

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 hypertriglyceridemia), some drugs, and certain autoimmune conditions.

Symptoms

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

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 CT 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.

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 blood glucose.

In some cases, surgery is needed to relieve pain. The surgery may involve draining an enlarged pancreatic duct or removing part of the pancreas.

For fewer and milder attacks, people with pancreatitis must stop drinking alcohol, stick to their prescribed diet, and take the proper medications.

Points to Remember

  • 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 abuse.
  • 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.

For More Information

For more information on this topic, visit:

American Gastroenterological Association

The Pancreas Center

Overview | Causes | Genetics | Symptoms | Diagnosis | Treatment | Auto Islet Transplants | Diet | Prognosis | FAQ

Diet

Am I allowed to drink alcohol once I have been diagnosed with pancreatitis?

If pancreatitis was caused by excess alcohol use, you should abstain from alcohol. If other causes of acute pancreatitis have been addressed and resolved (such as via gallbladder removal) and the pancreas returned to normal, you should be able to lead a normal life, but alcohol should still be taken only in moderation (maximum of 1 serving/day). In chronic pancreatitis, there is ongoing inflammation and malabsorption — patients gradually lose digestive function and eventually lose insulin function — so regular use of alcohol is unwise.

What kind of diet is recommended to avoid flareups of pancreatitis?

In chronic pancreatitis, the pancreas gradually loses its ability to function properly, and endocrine function will eventually be lost. This puts patients at risk of type 1 diabetes. Patients should avoid refined sugars and simple carbohydrates, and instead consume complex carbohydrates and whole grains. High protein, moderate fat balanced diets are best in general.

  • More on the Pancreatitis Diet

Why is it that sometimes I can eat certain foods and other times those same foods cause problems?

Many people experience this phenomenon, although it is not well understood and there is no clear answer. It is important to remember to regularly take pancreatic enzymatic supplements to be sure a lack of enzymes is not the cause.

Do I have to take my pancreatic enzymes even if I’m feeling good?

Yes. As the function of the pancreas decreases , it is important to have the enzymes for nutrition. In addition, your doctors will often prescribe the enzymes to avoid stimulation of the pancreas and therefore pain. The pancreas is stimulated to release pancreatic enzymes when there is undigested food in the intestine. The enzymes start predigesting while food is in the stomach, so it gives the pancreas a break.

Are there other vitamins or supplements I can take?

Patients with chronic pancreatitis are at risk for chronic malabsorption, so they must be tested regularly for nutritional deficiencies. Vitamin therapies should be based on these annual blood tests. In general, multivitamins, calcium, iron, folate, vitamin E, vitamin A, vitamin D, and vitamin B12 may be supplemented, depending on the results of blood work.

Pain Management

What types of pain management are available?

The goal is to keep living life not in the hospital, but to be awake and functioning. Many patients take a regimen of more than one kind of medication. Oral medications include narcotics such as Percocet and oxycodone, and these may be used in conjunction with non-narcotic medicines such as muscle relaxants and antidepressants. Once an oral regimen is established, acute flareups can be managed by adding medications. If oral medicines can’t be tolerated, you may need to be admitted to the hospital for intravenous medications. Nerve blocks may be used to manage pain for several months at a time: nerve blocks entail the insertion of a needle through the skin in the back to block the main nerves going to the pancreas. This procedure can also be done endoscopically, in which the bundle of nerves to pancreas is injected (through an endoscope in the stomach) with long-acting pain medication that lasts several months. Nerve blocks destroy the nerves, but in time they grow back so patients need repeated treatments. Another approach to managing pain is the use of implantable pain pumps in the spine. Most implantable pumps deliver constant low doses to keep pain manageable, and they may be used in conjunction with oral medications. Oral methadone is a very good medication for managing chronic pain.

If I take prescription drugs long term, will I become addicted?

Physiological addition and psychological addiction are two different things. The layperson’s concept of addiction refers to the psychological addiction. However for patients with pancreatitis, severe ongoing pain needs to be addressed, and the need for pain medication does not constitute a psychological addiction. Some patients must always use medications, because chronic pancreatitis does not go away and the pain needs to be managed in order for them to function. If the body becomes accustomed to a certain pain medication, you can’t just stop it suddenly: it will need to be withdrawn slowly and under close supervision of your physician. If the issue with chronic pancreatitis is ongoing microscopic inflammation of the pancreas, pain is always going to be there, and managing the pain does not constitute a social addiction, but rather it is a needed therapy like taking blood pressure medication. Our team tries to use constellations of different medications in order to keep narcotic dosages as low as possible.

If the pain from my disease becomes more than my pain medications can handle, what other options will I have?

Other options include pain pumps, implantable nerve stimulators, and in some cases, surgical strategies. The best approach is determined according to each person’s specific disease process and anatomy.

One surgical option is stenting, which can be done endoscopically. With chronic inflammation, parts of the pancreatic duct can become strictured or narrowed. When the pancreas is stimulated by food in the intestine, it works hard to pump the digestive juices past that narrowing, causing pain and exacerbation. Placing a stent in the duct can keep the narrowed area more open, preventing or reducing pain.

In extreme cases, removal of the entire pancreas (pancreatectomy) may be performed in order to reduce or eliminate the pain associated with pancreatitis. Pancreatectomy relieves pain in 90% of cases, but causes patients to become diabetic. To address this, the Pancreatitis Program now offers an innovative process of extracting the patient’s own insulin-producing cells and then reinjecting them into the liver after removal of the pancreas. Called autologous islet cell transplantation, this procedure allows patients to retain some of their insulin-producing function, preventing the difficult-to-treat form of diabetes known as brittle diabetes.

Everyday Life

Will I be able to do normal activities?

You may need an array of maintenance medicines, but if pain and other symptoms are properly managed, you should be able to live a normal life.

Will daily stress have an impact on my disease?

We do not have conclusive data on this, but experience suggests that stress does exacerbate symptoms of chronic pancreatitis.

Does the Pancreas Center offer a support system to patients suffering from chronic pancreatitis?

Our center will connect patients who are at different stages of disease, as there are patients who are willing to talk with others about coping strategies.

Will smoking impact my disease?

Yes. In general, smoking is bad for our health as we all know. Smoking increases risk of pancreatic cancer, and pancreatitis increases the risk of pancreatic cancer, so we want to minimize risk factors.

Pancreatitis Episodes

How long does an episode last?

Acute episodes may be as short as one day, while patients with chronic pancreatitis may experience episodes of pain that last for weeks or longer.

What can be done to prevent episodes?

Ability to prevent episodes will depend on the cause of each person’s disease. Possible approaches may include removal of the gallbladder, abstinence from alcohol, a low fat diet, stopping medicines that may cause pancreatitis, and more.

What can be done to limit the length of an episode?

The best way to minimize an episode includes hydration and nutritional support. Temporarily stopping oral intake of food will allow the pancreas to rest.

When I have an episode, will I be hospitalized?

Patients may be able to manage exacerbations at home with increased doses of pain medications or by taking a clear liquid diet for several days. If you are unable to manage the pain or to eat or drink anything, you need to be admitted to the hospital.

I have been having symptoms but am afraid to call the doctor because my tests are negative and I don’t want to bother him/her. What should I do?

You should call your doctor. Your doctor may need to alter your regimen of pain medications or enzymes.

I can handle the pain — do I really need to call the doctor?

You should call the doctor if the pain becomes intolerable, if you can not eat or drink, or if you develop fever or jaundice.

If the symptoms warrant a hospital stay, how long will I be in the hospital?

You may need to be in the hospital for a matter of days or weeks, depending on your situation.

How do I handle embarrassing situations like gas and diarrhea?

In addition to prescribing digestive enzymes, your doctor can suggest appropriate over-the-counter medications such as simethicone or lomotil to help with these kinds of symptoms.

All my diagnostic tests are normal, but my symptoms are there. Does it mean I don’t have pancreatitis anymore?

No. At some point, the pancreas may become scarred and stop producing enzymes, so blood tests appear normal despite having pancreatitis.

Why do I experience waves of nausea when I have no pain?

Alterations in your digestion can cause nausea, bloating, and other symptoms.

Other

Will I have to have surgery?

What kind of surgery? The most common procedures for pancreatitis include drainage procedures and removal of part or all of the pancreas. Whether or not you will need a procedure will depend on many factors and would need to be discussed individually with your doctor.

Does pancreatitis occur in children?

Pancreatitis is very rare in children. It is sometimes diagnosed in young adults who have a history of bellyaches. Usually, a stomachache is a stomachache — but in rare instances, could indicate pancreatitis, particularly when pain is associated with eating, occurs after eating fatty foods, if the location of pain radiates around to back around the shoulder blades, and if the child experiences recurrent episodes.

Next Steps

If you or someone you care for is dealing with pancreatitis, the Pancreas Center is here for you. Whether you need a diagnosis, treatment, or a second opinion, we have a dedicated Pancreatitis Program ready to help.

Call us at (212) 305-4795 or use our online form to get in touch today.

To keep learning about pancreatitis:

Overview | Causes | Genetics | Symptoms | Diagnosis | Treatment | Auto Islet Transplants | Diet | Prognosis | FAQ

Related Services

  • Pancreatitis Program
    See all Programs & Services ”

Related Topics

  • Pancreatic Cancer
  • Pancreatic Cysts
  • Pancreatectomy
  • Chemotherapy for Pancreatic Cancer
  • Endoscopic Treatment for Pancreatic Disease
  • Non-Invasive Tests for Pancreatic Cancer
  • Palliative Procedures
  • Surgery for Pancreatic Cancer
  • Whipple Procedure (Pancreaticoduodenectomy)
  • Total Pancreatectomy with Autologous Islet Cell Transplantation
    See all Related Topics ”

Pancreatic Cancer Symptoms

Jaundice

While many pancreatic cancer symptoms are first attributed to something else (e.g., gastrointestinal issues or stress), symptoms caused by jaundice usually can’t be ignored. Jaundice in pancreatic cancer is painless and occurs when the tumor in the head of the pancreas blocks the bile duct, causing symptoms such as:

  • Yellowing of the skin and eyes
  • Dark urine
  • Pale, greasy stools that float in the toilet
  • Pruritus (itchy skin)

Weight Loss

Unintentional weight loss or significant, unexplained weight loss is usually a sign that something is wrong in the body. Weight loss is one of the more common symptoms of pancreatic cancer.

Gastrointestinal (GI) Problems

Some GI-related pancreatic cancer symptoms can be caused by the tumor pressing on the stomach or other parts of the digestive system as the tumor spreads. These may include the following:

  • Loss of appetite
  • Indigestion
  • Nausea
  • Vomiting
  • Bloating or swelling in the abdomen

Fatigue

Extreme tiredness may be a sign of pancreatic cancer, but it’s also a common sign of other conditions. Either way, unexplained fatigue should not be ignored.

Diabetes

When an early diagnosis of pancreatic cancer does occur, it’s usually because it was caught by a medical imaging scan for another condition or another suspicious diagnosis such as diabetes.

Pancreatic cancer may trigger sudden onset diabetes unrelated to weight gain or late onset diabetes without an obvious cause. Pancreatic cancer can destroy the cells that make insulin, causing blood sugar levels to rise. While cancer is most likely not the culprit, a patient with a new and suspicious diabetes diagnosis should be evaluated to rule out pancreatic cancer.

About the author

Leave a Reply

Your email address will not be published. Required fields are marked *