Pancreatitis

What is chronic pancreatitis?

Your pancreas is an organ with many important functions. It makes enzymes that help you digest food. It also makes insulin to keep your blood sugar levels under control.

Short-term (acute) pancreatitis is a sudden inflammation of your pancreas. This can be very painful. You may have nausea, vomiting, and fever. If your acute pancreatitis doesn’t get better and slowly gets worse, you may have chronic pancreatitis.

What causes chronic pancreatitis?

If you have chronic pancreatitis, the digestive enzymes that would normally travel by tubes inside your pancreas and empty into your upper intestine, become trapped inside your pancreas. This causes pain and scarring. The trapped enzymes slowly cause severe damage to your pancreas.

The most common cause of chronic pancreatitis is drinking a lot of alcohol over a long period of time. Other causes include:

• An attack of acute pancreatitis that damages your pancreatic ducts
• A blockage of the main pancreatic duct caused by cancer 
• Certain autoimmune disorders
• Cystic fibrosis
• Hereditary diseases of the pancreas
• Smoking
• Unknown cause in some cases

What are the symptoms of chronic pancreatitis?

Early symptoms of chronic pancreatitis are similar to acute pancreatitis. Symptoms are occasional and include:

• Pain in the upper belly that spreads into the back
• Pain in the belly that gets worse when you eat or drink alcohol
• Diarrhea or oily stools that are unusually foul smelling and light colored
• Nausea and vomiting
• Severe belly (abdominal) pain that may be constant or that comes back
• Weight loss

Chronic pancreatitis causes severe damage to your pancreas. This means that your body won't be able to make needed enzymes and hormones. This can result in malnutrition, because you won't be able to digest foods. Chronic pancreatitis can also cause diabetes. This happens because your pancreas can't make insulin. Insulin controls blood sugar.

How is chronic pancreatitis diagnosed?

Your healthcare provider will diagnose you with chronic pancreatitis if:

• You have a history of acute pancreatitis that comes back or doesn’t get better 
• You have symptoms of chronic pancreatitis

Your healthcare provider will examine your belly. You will also be asked about your drinking history and any family history of pancreatic disease or cystic fibrosis. Blood and imaging tests are an important part of your diagnosis. They can include:

• Blood tests.  They will look for high levels of two pancreatic enzymes, amylase and lipase. These may spill into your blood. Other tests may show blockage or damage of your gallbladder. They can also be used to check for certain inherited conditions. You may need vitamin levels and other lab tests.
• CT scan. This test creates a 3-D image of your pancreas, using X-rays and a computer.
• Abdominal ultrasound. This test uses sound waves to create an image of your pancreas.
• Endoscopic ultrasound. This test uses a long, thin tube (endoscope) that is put through your mouth and into your stomach and upper intestine. An ultrasound on the scope makes images of the pancreas and gallbladder ducts.
• ERCP. This test uses a long, thin tube (endoscope) that is put into the pancreas drainage area if treatment needs to be done.
• Magnetic resonance cholangiopancreatography. This test makes images using radio waves, a strong magnet, and a computer. In some MRI tests, you will need to have dye injected to show a more detailed image of your pancreas and the ducts of your gallbladder.

How is chronic pancreatitis treated?

Day-to-day treatment includes: 

• Pain medicine
• Pancreatic enzyme supplements with every meal
• Insulin, if you develop diabetes
• Vitamin supplements, if needed

For acute pancreatitis or a flare-up, you may need to stay in the hospital for treatment. Your exact treatment will depend on the cause of your chronic pancreatitis, how severe the symptoms are, and your physical condition. Acute treatments may include:

• Feeding through a tube through the nose into the stomach
• Fasting
• IV fluids
• Pain medicines

What are possible complications of chronic pancreatitis?

Chronic pancreatitis damages the insulin-producing cells of the pancreas. This may cause these complications: 

• Calcification of the pancreas. This means the pancreatic tissue hardens from deposits of calcium salts.
• Long-term (chronic) pain
• Diabetes
• Gallstones
• Kidney failure
• Buildup of fluid and tissue debris (pseudocysts)
• Pancreatic cancer
• Acute flare-ups that keep coming back

How can I help prevent chronic pancreatitis?

The best way to prevent chronic pancreatitis is to drink only in moderation or not at all. Moderate alcohol drinking is considered to be no more than 1 drink per day for women and 2 drinks per day for men. Quitting smoking is also very helpful. It eases pain and swelling.

Living with chronic pancreatitis

If you have been diagnosed with chronic pancreatitis, your healthcare provider may suggest these lifestyle changes:

• Don’t drink alcoholic drinks.
• Drink plenty of water.
• Don’t smoke.
• Steer clear of caffeine.
• Stick to a healthy diet that’s low in fat and protein.
• Eat smaller and more frequent meals.

When should I call my healthcare provider?

Call your healthcare provider when you start to have short-term (acute) symptoms, including:

• Severe pain that can’t be eased at home
• Vomiting and are unable to keep down fluids

Key points about chronic pancreatitis

• Acute pancreatitis is a sudden inflammation of your pancreas. If your acute pancreatitis doesn’t get better and slowly gets worse, you have chronic pancreatitis.
• If you have chronic pancreatitis, the digestive enzymes that would normally travel by tubes inside your pancreas and empty into your upper intestine become trapped inside your pancreas.
• Your healthcare provider will examine your belly. You will be asked about your drinking history and any family history of pancreatic disease or cystic fibrosis.

• Day-to-day treatment includes pain medicine, pancreatic enzyme supplements with every meal, insulin if you develop diabetes, and vitamin supplements if needed.

• If you have been diagnosed with chronic pancreatitis, your healthcare provider may suggest lifestyle changes.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your healthcare provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your healthcare provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your healthcare provider if you have questions.

What is acute pancreatitis?

Your pancreas is a hardworking organ. It makes enzymes that help you digest food. It also makes insulin to keep your blood sugar levels under control. Pancreatitis is an inflammation of your pancreas. This can be very painful. You may also have nausea, vomiting, and fever. Acute pancreatitis is an emergency that needs care right away. Acute pancreatitis is common and becoming more common.

What causes acute pancreatitis?

Among the many possible causes of acute pancreatitis are:

• Alcohol consumption
• Gallstones
• Genetic abnormalities of the pancreas
• High levels of triglycerides, a type of cholesterol
• Very high levels of calcium
• Infections
• Medicines
• Toxins
• Trauma or injury

Who is at risk for acute pancreatitis?

Anyone can develop acute pancreatitis. But certain people have a higher risk:

• People who have gallbladder disease
• People who drink a lot of alcohol

What are the symptoms of acute pancreatitis?

Symptoms of acute pancreatitis are:

• Fever
• Nausea
• Pain that follows a meal
• Pain that seems to move into other parts of your body, for example, from your upper abdomen to your back, chest, flanks, or lower abdomen
• Pain that may be eased somewhat if you lean forward over your knees
• Severe upper abdominal pain, which may come on slowly or quickly
• Throwing up, but without feeling better afterward

How is acute pancreatitis diagnosed?

To make a diagnosis, your healthcare provider will consider:

• Your overall health and medical history
• Your symptoms, including where the pain is, how intense it is, and when and how it started
• A physical exam
• Lab blood tests. Enzymes from the pancreas are often higher than normal.
• The results of imaging tests such as abdominal CT scan, ultrasound, and MRI

How is acute pancreatitis treated?

Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.

You may need a hospital stay for acute pancreatitis. Treatment may include:

• A procedure to remove a gallstone that’s blocking the bile duct from the pancreas
• Counseling, treatment, and therapy to quit drinking alcohol, if needed
• Limiting food and drink through your mouth to give your pancreas a chance to get better
• Medicines for pain
• Oxygen
• Fluids through a catheter into your vein
• A feeding tube to provide nutrition
• Surgery to take out your gallbladder, if needed
• Surgery, if needed, to remove damaged tissues

What are possible complications of acute pancreatitis?

Complications are problems caused by your condition. They may include:

• Another acute pancreatitis episode
• Development of a pancreatic pseudocyst (a fluid-filled sac)
• Infections
• Kidney failure
• Lung failure
• Shock
• Chronic (long-term) pancreatitis
• Death from multiple organs failing

Can acute pancreatitis be prevented?

Depending on the cause of your acute pancreatitis, your healthcare provider might recommend these steps to help you prevent another event:

• Not drinking alcohol at all
• Making lifestyle changes or taking medicine to lower your triglyceride level
• Removing your gallbladder if a gallstone caused your condition

Living with acute pancreatitis

Follow your healthcare provider’s recommendations for taking care of yourself after you’ve had acute pancreatitis. This might mean:

• Not drinking alcohol
• Stopping smoking
• Eating differently
• Reducing triglycerides through diet, exercise, weight loss, and medicines
• Getting your blood sugar levels tested regularly
• Having more surgery or treatment to reduce your risk

When should I call my healthcare provider?

Seek care right away if you have the symptoms of acute pancreatitis, especially severe abdominal pain, vomiting, and fever.

Key points about acute pancreatitis

• Acute pancreatitis is a medical emergency. 
• Gallstones, alcohol consumption, certain medicines, injury, infection, and genetic problems can cause acute pancreatitis.
• Symptoms include upper abdominal pain, pain after eating, nausea, and fever.
• You may need to be hospitalized to treat acute pancreatitis.
• Treatment includes oxygen, medicines, and possibly surgery.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your healthcare provider tells you.
• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your healthcare provider gives you.
• Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your healthcare provider if you have questions.

What is gallstone pancreatitis?

Pancreatitis is a disease that causes inflammation and pain in your pancreas. The pancreas is a small organ that makes hormones such as insulin. This helps control blood sugar. It also makes enzymes that help digest and break down the foods you eat. This is part of the digestive process. Sometimes a gallstone gets stuck in the common bile duct. This can block your pancreatic duct and cause pancreatitis. This is known as gallstone pancreatitis.

What causes gallstone pancreatitis?

Gallstones form in your gallbladder. In cases of gallstone pancreatitis, the stone leaves the gallbladder. It blocks the opening from the pancreas to the first part of the small intestine (duodenum). This causes a backup of fluid that can travel up both the bile duct and the pancreatic duct. Gallstone pancreatitis can be very painful and life-threatening if not treated. Gallstones are the leading cause of short-term (acute) pancreatitis.

What are the symptoms of gallstone pancreatitis?

Severe pain is the most common symptom of gallstone pancreatitis. But it's not the only symptom. You might also have: 

• Chills
• Fever
• Yellow color to the eyes, skin, or both (jaundice)
• Nausea
• Pain that feels sharp or a “squeezing” in your center or left upper belly (abdomen) or in your back
• Pain that travels from the original site up to the shoulder or chest
• Vomiting

How is gallstone pancreatitis diagnosed?

Gallstone pancreatitis is diagnosed by using a combination of tools. The most common are blood tests and different types of body scans. Blood tests can find inflammation in the pancreas. A CT scan, MRI scan, or ultrasound can give a clearer picture of how severe the pancreatitis is. It can also tell if a gallstone is stuck inside the pancreatic duct and needs to be removed.

How is gallstone pancreatitis treated?

Gallstone pancreatitis usually needs to be treated in the hospital. During this time, healthcare providers will give you fluids through an IV (intravenous) line. In cases where you may not be able to eat for a long time, you may be fed through a special tube and sometimes into your vein. Healthcare providers will also treat any pain and nausea with IV medicines. Often this will be enough to get your stone to pass through your body and ease the pancreatitis.

In more severe cases, your surgeon will likely remove the gallstone. This will be done through surgery or with a special tool (endoscope) during a procedure called ERCP (endoscopic retrograde cholangiopancreatography). Depending on your condition, you may need to have your gallstone removed right away. You might be able to wait until after about 48 hours of getting fluids directly into your vein. This allows your inflammation to ease first. Your healthcare provider may advise that your gallbladder also be removed. This will be done after your pancreatitis has eased. Sometimes it's done in the hospital during the same stay. This will greatly reduce your chances of getting gallstone pancreatitis in the future.

What are possible complications of gallstone pancreatitis?

If gallstone pancreatitis goes untreated, the complications can be very serious. Digestive fluids from the liver, gallbladder, and pancreas may back up into your body. This can cause an infection called cholangitis. You may also develop yellowish eyes and skin (jaundice). The tissue of your pancreas itself can even begin to die in a condition called pancreatic necrosis. Gallstone pancreatitis can be fatal if not treated.

How can I prevent gallstone pancreatitis?

It’s not possible to fully prevent gallstone pancreatitis. This is because it may not be possible to fully prevent gallstones from forming. You can take steps to reduce your gallstone risk by eating a healthy diet, staying at a healthy weight, keeping your cholesterol levels within a normal range, and managing diabetes if you have it. If you are taking a medicine that contains estrogen, ask your healthcare provider how this might add to your risk of developing gallstones. Once you have had gallstone pancreatitis, it is important to have your gallbladder removed to keep this condition from coming back.

When should I call my healthcare provider?

Gallstone pancreatitis symptoms, especially severe pain, are clear warning signs. If you have any of the symptoms, get medical help right away.

Key points about gallstone pancreatitis

• Gallstone pancreatitis occurs when a gallstone blocks your pancreatic duct, causing inflammation and pain in your pancreas.
• Gallstone pancreatitis causes severe belly pain, nausea, vomiting, fever, chills, and jaundice.
• If untreated, gallstone pancreatitis can cause serious complications.
• Gallstone pancreatitis will usually need to be treated in the hospital.
• You may need surgery or an endoscopic procedure (ERCP) to remove the gallstone.
• You may need to have your gallbladder removed to reduce your risk of further problems.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your healthcare provider tells you.
• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your healthcare provider gives you.
• Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your healthcare provider if you have questions.