Pancreatitis

Pancreatitis is inflammation of the pancreas. It happens when digestive enzymes start digesting the pancreas itself.

• Pancreatitis can be acute or chronic.
• Mild cases may go away without treatment, but severe case can lead to life-threatening complications.

The pancreas is a large gland behind the stomach and close to the first part of the small intestine. The pancreas produces enzymes that help digestion and hormones that help regulate the way the body processes sugar (glucose).

Acute pancreatitis occurs suddenly and usually goes away in a few days with treatment. It is often caused by gallstones. Common symptoms are severe pain in the upper abdomen, nausea, and vomiting. Treatment is usually a few days in the hospital for intravenous (IV) fluids, antibiotics, and medicines to relieve pain.

Chronic pancreatitis does not heal or improve. It gets worse over time and leads to permanent damage. The most common cause is heavy alcohol use. Other causes include cystic fibrosis and other inherited disorders, high levels of calcium or fats in the blood, some medicines, and autoimmune conditions. Symptoms include nausea, vomiting, weight loss, and oily stools. Treatment may also be a few days in the hospital for intravenous (IV) fluids, medicines to relieve pain, and nutritional support. After that, you may need to start taking enzymes and eat a special diet. It is also important to not smoke or drink alcohol.

Symptoms

• Signs and symptoms of pancreatitis may vary, depending on which type you experience.
• Acute pancreatitis signs and symptoms include:
  • Upper abdominal pain
  • Abdominal pain that radiates to your back
  • Abdominal pain that feels worse after eating
  • Fever
  • Rapid pulse
  • Nausea
  • Vomiting
  • Tenderness when touching the abdomen
• Chronic pancreatitis signs and symptoms include:
  • Upper abdominal pain
  • Losing weight without trying
  • Oily, smelly stools (steatorrhea)

Causes

Pancreatitis occurs when digestive enzymes become activated while still in the pancreas, irritating the cells of your pancreas and causing inflammation. In many cases, doctors can’t find the cause of pancreatitis. This is called idiopathic pancreatitis.

With repeated bouts of acute pancreatitis, damage to the pancreas can occur and lead to chronic pancreatitis. Scar tissue may form in the pancreas, causing loss of function. A poorly functioning pancreas can cause digestion problems and diabetes.

Conditions that can lead to pancreatitis include:

• Abdominal surgery
• Alcoholism
• Certain medications
• Cystic fibrosis
• Gallstones
• Genetic disorders of the pancreas
• High calcium levels in the blood (hypercalcemia), which may be caused by an overactive parathyroid gland (hyperparathyroidism)
• High triglyceride levels in the blood (hypertriglyceridemia)
• Infection
• Injury to the abdomen
• Some Medications
• Obesity
• Pancreatic cancer
• having a procedure called endoscopic retrograde cholangiopancreatography (ERCP) to treat another condition
• Hereditary pancreatitis may be present in someone under 30 years old but may go undiagnosed for several years. Brief periods of abdominal pain and diarrhea may come and go and eventually lead to chronic pancreatitis.
  • Hereditary pancreatitis is more common for people who have two or more family members that have pancreatitis across more than one generation.

Complications

• Pseudocyst. Acute pancreatitis can cause fluid and debris to collect in cystlike pockets in your pancreas. A large pseudocyst that ruptures can cause complications such as internal bleeding and infection or be fatal if untreated.
• Infection. Acute pancreatitis can make your pancreas vulnerable to bacteria and infection. Pancreatic infections are serious and require intensive treatment, such as surgery to remove the infected tissue.
• Kidney failure. Acute pancreatitis may cause kidney failure, which can be treated with dialysis if the kidney failure is severe and persistent.
• Breathing problems. Acute pancreatitis can cause chemical changes in your body that affect your lung function, causing the level of oxygen in your blood to fall to dangerously low levels.
• Diabetes. Damage to insulin-producing cells in your pancreas from chronic pancreatitis can lead to diabetes, a disease that affects the way your body uses blood sugar.
• Malnutrition. Both acute and chronic pancreatitis can cause your pancreas to produce fewer of the enzymes that are needed to break down and process nutrients from the food you eat. This can lead to malnutrition, diarrhea and weight loss, even though you may be eating the same foods or the same amount of food.
• Pancreatic cancer. Long-standing inflammation in your pancreas caused by chronic pancreatitis is a risk factor for developing pancreatic cancer.

Statistics & Morbidity

• According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), around 275,000 Americans are admitted to the hospital for acute pancreatitis every year.
• The mortality rate ranges from less than 5 percent to over 30 percent, depending on how severe the condition is and if it has reached other organs beyond the pancreas.
• Acute pancreatitis is estimated to affect between 4.5 and 35 in every 100,000 individuals per year. However, this figure may not include the many mild cases that resolve without medical evaluation or treatment (NCBI – The epidemiology of Pancreatitis & Pancreatic Cancer)
• The overall mortality in patients with acute pancreatitis is 10%-15%. Patients with biliary pancreatitis tend to have a higher mortality than patients with alcoholic pancreatitis. This rate has been falling over the last 2 decades as improvements in supportive care have been initiated. Type 2 diabetes mellitus has also been associated with higher severity and mortality in the setting of acute pancreatitis. In patients with severe disease (organ failure), who account for about 20% of presentations, mortality is approximately 30%. This figure has not decreased in the past 10 years. In patients with pancreatic necrosis without organ failure, the mortality approaches zero. (Medscape – What is the mortality rate associated with acute pancreatitis? By Jeffrey CF Tang, MD; Jul 25,2019)
  • In the first week of illness, most deaths result from multiorgan system failure. In subsequent weeks, infection plays a more significant role, but organ failure still constitutes a major cause of mortality. Acute respiratory distress syndrome (ARDS), acute renal failure, cardiac depression, hemorrhage, and hypotensive shock all may be systemic manifestations of acute pancreatitis in its most severe form. (Medscape – What are the most common causes of death in patients with acute pancreatitis? By Jeffrey CG Tang, MD; Jul 25, 2019)

Notable who died from Pancreatitis

1. Ranker – Famous People Who Died of Pancreatitis (21people listed)
2. Wikipedia – Category: Deaths from pancreatitis (43 people listed)

• Stuart Roosa (1933-1994) – American aeronautical engineer, NASA astronaut; (Wikipedia – Stuart Roosa)
• Matthew Garber (1956-1977) – British actor; (Wikipedia – Matthew Garber)
• Franz Bardon (1909-1958) – Czech occultist ;(Wikipedia – Franz Bardon)
• Paul Hindemith (1895-1963) – German composer, violinist; (Wikipedia – Paul Hindemith)
• Ken Kostick (1953-2011) – Canadian Chef, TV & radio personality; (Wikipedia – Ken Kostick)
• George W Mason (1891-1954) – American industrialist; (Wikipedia – George W Mason)

Resources & Additional Reading

• MedlinePlus – Pancreatitis
• Mayo Clinic – Pancreatitis
• NIH – Pancreatitis – Symptoms & Causes of Pancreatitis
• Healthline – Everything You Need to Know About Pancreatitis
• Medical News Today – All about acute pancreatitis
• Gastroenterology Consultants of San Antonio – Pancreatitis
• Pancreatitis – By Ankita Priydarshini, 21 Jul 2016; Published in: Health & Medicine (Slides 1-42) (Image slide 1)