Pancreatitis

Overview: What is pancreatitis?

Pancreatitis is a disease of the pancreas, as the gland is also medically called. We therefore also call the clinical picture pancreatitis. The pancreas has a wide variety of tasks. Among other things, it produces the vital blood sugar-lowering hormone insulin and important enzymes for fat digestion.

Pancreatitis – frequency and age

Acute pancreatitis is a relatively common condition. It is not possible to put a precise figure on how many people are affected in Switzerland. But study data from the United Kingdom come to the following figures: Approximately 30 out of 100,000 inhabitants develop pancreatitis per year. These figures can also be roughly applied to other European countries.

In recent years, the incidence of the disease has risen sharply, especially among young people who use nicotine and alcohol. Overall, men are more likely than women to suffer from both forms – acute and chronic pancreatitis.

Pancreatitis: causes and risk factors

Pancreatitis has many different causes. Also known are some risk factors that increase the risk for the disease. The main reasons for acute pancreatitis are:

Gallstones

Together with high alcohol consumption, they are considered the main triggers and can cause acute inflammation. A gallstone can block the orifice of the common bile duct and pancreatic duct. Then the digestive juices can no longer flow into the intestine and accumulate in the gland. Digestive enzymes of the pancreas are already activated in the organ itself and thus set a kind of self-digestion in motion. Other diseases of the bile ducts (for example, stenosis) are also considered causes.

High alcohol and nicotine consumption

Alcohol is considered the number two cause of acute pancreatitis. Those who regularly drink alcohol in excessive quantities risk pancreatitis. Exactly how alcohol damages the gland is still unclear. However, this acute form can progress to chronic pancreatitis if you continue to consume large amounts of alcohol over a long period of time. If nicotine is consumed at the same time, the risk also increases sharply. Persistent alcohol and nicotine abuse is considered the main reason for the development of chronic pancreatitis.

Triglycerides

Highly elevated triglycerides in the blood.

Calcium values

Increased calcium levels in the blood, such as in hyperparathyroidism.

Medication

Medications, for example diuretics, drugs for high blood pressure (beta blockers, ACE inhibitors), antibiotics, cytostatics (for cancer) or drugs for HIV.

Injuries

Injuries in the abdominal cavity, such as after a surgical procedure, accident or diagnostic procedure (for example, endoscopy of the pancreas, ERCP).

Other possible causes

• Autoimmune diseases
• (Rare) infections, for example, mumps, liver inflammation (hepatitis), mononucleosis, HIV, infections with other viruses or bacteria.
• (Rare): Congenital malformations of the pancreas
• (Rare): Genetic causes

Despite the large number of possible triggers – we do not always find the cause of pancreatitis and it remains in the dark.

Symptoms: Pancreatitis is very painful

Both acute pancreatitis and an inflammatory flare-up associated with the chronic form result in severe abdominal pain. In addition, there may be many other complaints.

Acute pancreatitis: symptoms

Common signs of acute pancreatitis:

• Severe pain in the upper abdomen, usually very sudden and abrupt onset.
• The pain may radiate to other areas of the body, often to the chest and back. Radiating pain is also typical in the case of a heart attack and other diseases in the abdominal cavity. There is a risk of confusion here and we must exclude these and other diseases during diagnosis.
• Most describe the pain as extremely intense, and it can last for several days. Most people are helped by lying down or sitting down and tightening their legs – this often makes the pain a little more bearable.
• Nausea and vomiting
• Circulatory problems
• Fever
• Bloated and distended abdomen

Without treatment, pancreatitis may continue to progress. Then other complaints may be added.

Therefore, it is important that you see a doctor quickly and get adequate treatment for acute pancreatitis.

Chronic pancreatitis: symptoms

The following warning signs indicate chronic pancreatitis:

• Pain in the upper abdomen that keeps recurring
• The pain can last for hours or days and radiate to other areas of the body.
• Nausea and vomiting after consuming fatty foods
• Flatulence, distended abdomen
• Diarrhea
• Fatty stool – the stool is shiny and sticky, floats in the toilet bowl
• Weight loss
• Signs of diabetes mellitus
• Sometimes jaundice

If pancreatitis continues to progress, the important organ suffers permanent damage. When the inflammatory episodes subside in the meantime, the pain and other complaints often subside as well. But the gland is not healthy again because of that.

Pancreatitis: Diagnosis

Always consult a doctor immediately if you notice alarm signs of pancreatitis in yourself, because it must be treated immediately. We will start by asking you some questions about your medical history (anamnesis). Some examples:

• What exactly are your symptoms? Stomach ache?
• How long have you had the symptoms and how intense are they?
• Are there situations in which the stomach pain improves or intensifies?
• Do you drink alcohol? How often and how much? (Answer honestly!)
• Do you smoke? If yes: How much and since when?
• Do you have any known underlying diseases, for example gallstones?
• Are you taking any medications? If yes: Which ones and since when?

Their answers already provide us with initial clues as to whether pancreatitis could be behind the symptoms. This is followed by a physical examination, during which we palpate the abdomen. We can thus feel the size and position of organs, but also whether the abdomen is sensitive to pressure and pain.

As part of a blood test, laboratory physicians determine various blood values. These include:

• Pancreatic enzymes: The enzyme lipase or amylase, which are elevated in pancreatitis, are determined. The pancreas produces both enzymes.
• Inflammation levels, for example C-reactive protein (CRP). This is a general inflammatory marker. It only says that there is inflammation somewhere in the body, but not at which site.
• Calcium: sometimes calcium levels are elevated or decreased in pancreatitis
• Levels of gamma-GT, bilirubin, and alkaline phosphatase (AP) are elevated when gallstones obstruct the bile ducts.

Further information in the diagnosis of pancreatitis is provided by imaging techniques.
These include, for example:

• Ultrasound (sonography)
  We pass a transducer over the abdomen, which emits and receives sound waves. In this way, we obtain images of the gallbladder and can make statements about the cause of pancreatitis. Ultrasound is the method of choice for imaging the gallbladder and gallstones. The pancreas itself can rarely be well assessed in the acute stage.
• Biliary endoscopy for suspected gallstones
  This method has the complicated name “Endoscopic Retrograde Cholangiopancreatography, abbreviated ERCP. During this procedure, we carefully advance a flexible tube with a camera (endoscope) down the esophagus and stomach to the pancreas. By means of X-ray images are made. During ERCP, gallstones present in the bile duct (not in the gallbladder) can be removed at the same time.
• Computed tomography (CT) or magnetic resonance imaging (MRI or MRI, magnetic resonance imaging)
  A CT works with X-rays, the MRI with magnetic fields. We image the body slice by slice to obtain detailed cross-sectional images. It is visible whether and how much tissue of the pancreas has been destroyed, how far the inflammation has spread or whether there is bleeding and dead tissue. Often the cause of the inflammation also becomes visible.

It is always important that we exclude other causes for the complaints with the help of diagnostics. Because there are some diseases that cause very similar symptoms – first of all abdominal pain. These include, for example, appendicitis, gynecological diseases (ovaries, fallopian tubes), kidney and biliary colic, gastric or intestinal rupture, heart attack or intestinal obstruction.

Pancreatitis: prevention, early detection, prognosis

There are some known risk factors for pancreatitis that promote the disease. You can prevent pancreatitis by minimizing or eliminating these risk factors. So you can also do something yourself to protect the sensitive gland. Some tips for prevention:

• Watch your alcohol consumption: The World Health Organization (WHO) recommends no more than 24 grams of alcohol per day for men, and only half that for women, i.e. 12 grams. And, take a break several times a week and don’t drink alcohol at all.
• Reduce or stop your nicotine consumption, as this potentiates the harmful effects from alcohol consumption.
• Eat a healthy, balanced diet and put as much variety on your plate as possible. Pay special attention to fat consumption. Reach for low-fat foods instead.
• If you have elevated blood lipids (cholesterol, triglycerides): Have them adequately treated. A blood test will tell you how your blood lipids are doing.
• Have underlying conditions treated, for example, hyperparathyroidism.

Course and prognosis in pancreatitis

Acute pancreatitis is a very painful condition that you should not take lightly. It is important that the treatment starts as soon as possible. We usually treat them in the hospital to quickly relieve the symptoms and get the inflammation to subside quickly. After about one to two weeks, most have overcome acute pancreatitis and the prognosis is good. But sometimes healing can take weeks or months if complications arise.

Once pancreatitis has become chronic, the disease usually cannot be cured. In this case, the damage to the organ is irreversible and permanent. Nevertheless, you can positively influence the course with a change in your lifestyle. This is especially true for alcohol consumption and smoking. In this way, you spare and relieve the attacked pancreas to a certain extent.

Acute pancreatitis – these complications are possible

Acute pancreatitis does not always take a favorable course; complications may occur, for example:

• Infections with bacteria up to blood poisoning – the pathogens then spread throughout the body via the bloodstream, this is a life-threatening situation
• Abscess on the pancreas – purulent inflammation
• Large fluid collections along the pancreas or in the abdomen; which can compress vital organs or the gastrointestinal tract (gastric emptying disorder or intestinal obstruction)
• Bleeding from the pancreas or surrounding vessels (for example, the splenic artery)
• Increase in blood glucose due to lack of insulin production by the pancreas.
• Decrease in calcium levels
• Blood clotting disorders
• Circulatory shock
• Failure of heart, circulation, kidneys and lungs
• Large collections of water between the pleura and the lung, called pleural effusions.

With such complications, pancreatitis can also be life-threatening. Timely treatment is therefore all the more important.

Chronic pancreatitis – possible consequences

The organ damage in chronic pancreatitis cannot be reversed and remains permanent. The course can be described roughly like this:

• Initially, most experience recurrent periods of severe pain. They then subside again.
• Larger calcifications can develop in the pancreas itself, but also in the surrounding tissue.
• The ducts narrow and pancreatic stones can form, the digestive juices cannot drain and accumulate.
• Digestive problems, weight loss, deficiency symptoms or diabetes follow when the disease is very advanced.
• Lastly, pancreatic cancer may develop, pancreatic carcinoma.

Pancreatitis: Treatment often required in hospital

Acute pancreatitis is a very serious disease that we usually treat in hospital, often even in intensive care. This also applies to people with chronic pancreatitis who have a disease flare-up – the inflammation then flares up again. The following treatment options are available for pancreatitis.