Pancreatitis, Chronic

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KEY POINTS

• Pancreatitis is swelling and irritation of the pancreas, which is an organ behind the stomach. It makes digestive enzymes and the hormones insulin and glucagon. Pancreatitis may be painful and can damage the pancreas.
• You will need to stay in the hospital to receive IV fluids and pain medicine. You may not eat or drink anything for a few days. You may need surgery. Pancreatitis may keep coming back.
• Follow the instructions your healthcare provider gives you when you go home. Do not drink alcohol. Ask if you need to be on a special diet.

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What is chronic pancreatitis?

Pancreatitis is a swelling and irritation of the pancreas. The pancreas is an organ behind the stomach. It makes digestive enzymes and the hormones insulin and glucagon. The digestive enzymes flow into the small intestine to help break down food. Insulin and glucagon are released into the blood to control the level of glucose (sugar) in the blood.

Pancreatitis can be acute or chronic. Acute pancreatitis occurs as a sudden attack. Chronic pancreatitis usually doesn’t go away, or it keeps coming back and damages the pancreas. The damaged pancreas gradually becomes unable to make digestive enzymes and insulin. Chronic pancreatitis can be life-threatening.

What is the cause?

Chronic pancreatitis is most often caused by a blockage in the pancreas and the tubes that carry enzymes to the intestines. Blockages may result from:

• Gallstones, which can block the flow of digestive enzymes into your intestines. The buildup of enzymes can irritate your pancreas and cause scar tissue.
• Scar tissue from repeated attacks of acute pancreatitis. The attacks may be caused by alcohol use, too much fat in your blood, or other problems.
• Tumors in the pancreas

Other causes are:

• Damage from surgery in nearby organs, such as the stomach or intestines
• Injury, such as a hit in the belly
• Side effects from some medicines
• Smoking

Sometimes the cause of pancreatitis is not known.

In rare cases, pancreatitis results from a genetic condition, like cystic fibrosis, or occurs with autoimmune diseases, like inflammatory bowel disease. It may also happen after radiation treatment of cancer if your belly was exposed to the radiation.

What are the symptoms?

The main symptom of chronic pancreatitis is pain in your upper belly. You may also have pain in your back. The pain may be constant and dull, or quite severe, and it gets worse when you try to eat or drink. You may notice that it’s worse when you drink alcohol. You may have less pain when you sit up and lean forward.

Attacks may last a few hours or as long as several weeks. As the disease gets worse, the attacks last longer and happen more often.

Other symptoms of chronic pancreatitis may include:

• Nausea, vomiting, and diarrhea
• Weight loss

As your pancreas gets more damaged, it makes fewer digestive enzymes. This makes it harder for you to digest food and get nutrients from your food. Your bowel movements will get more frequent, get oily, and smell worse.

If your pancreas stops making the hormone insulin, you can get diabetes and have these additional symptoms:

• Increased thirst
• Increased appetite
• Increased urination
• Blurred vision

How is it diagnosed?

Your provider will ask about your symptoms and medical history and examine you. Tests may include:

• Blood and urine tests
• X-rays of your belly and chest
• An ultrasound, which uses sound waves to show pictures of the pancreas and gallbladder
• CT scan, which uses X-rays and a computer to show detailed pictures of the pancreas
• ERCP, which uses X-rays and a flexible, lighted tube to see the inside of the stomach and the first part of the small intestine
• MRCP, which uses a strong magnetic field and radio waves to show detailed pictures of the pancreas and gallbladder

How is it treated?

The treatment for pancreatitis depends on its cause, your symptoms, and any other health problems you may have. If you have a severe attack of chronic pancreatitis, you may need to be treated in the hospital.

If you have gallstones, you may need surgery to remove them. If you are very ill, gallstones may not be removed until you are feeling better. In some cases, your healthcare provider may recommend surgery to help the digestive enzymes drain better and decrease the pain.

If you have pancreatitis caused by drinking too much alcohol, you need to stop drinking to prevent more damage to your pancreas.

How can I take care of myself?

• Follow the full course of treatment prescribed by your healthcare provider.
• Eat a healthy diet. Ask your provider about the benefits of talking to a dietitian to learn what you need in a healthy diet. Ask if you need to take enzymes to help digest your food.
• If you smoke, try to quit. Talk to your healthcare provider about ways to quit smoking.
• Stay fit with the right kind of exercise for you. Exercise according to your healthcare provider's instructions.
• Learn ways to manage stress.
• Try to get at least 7 to 9 hours of sleep each night.
• Ask your healthcare provider:
  • How and when you will get your test results
  • How long it will take to recover
  • If there are activities you should avoid and when you can return to your normal activities
  • How to take care of yourself at home
  • What symptoms or problems you should watch for and what to do if you have them
• Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

How can I help prevent chronic pancreatitis?

To help prevent an attack of pancreatitis:

• Avoid drinking alcohol. If you need help to quit drinking, talk to your healthcare provider about referral to an alcohol treatment center or a group like Alcoholics Anonymous.
• Drink lots of liquids.
• Eat small frequent meals.
• Work with your provider to keep your blood fats normal.