Acute or Chronic Pancreatitis

Overview

Pancreatitis is inflammation of the pancreas, which is a gland about six inches long that sits behind the stomach near the first part of the small intestine (A.K.A the duodenum).

The pancreas looks like a flattened, elongated pear. The wide end of the pancreas, called the “head,” points toward the right side of the abdomen. The central sections are known as the “neck” and “body.” The thinner end of the pancreas, which points toward the left side of the body, is called the “tail.”
The pancreas has two very crucial functions: making insulin, which helps the body regulate blood sugar, and making digestive juices called enzymes that help the body break down and digest food in the intestines. 

Pancreatitis begins when enzymes begin to damage the tissue of the pancreas, causing inflammation. While pancreatitis can sometimes happen for no reason at all, the most common causes of pancreatitis are gallstones and heavy alcohol use or binge drinking. Pancreatitis can also be caused by a number of other factors, including viral infections, certain genetic conditions or pancreatic cancer. Read more about gallstones and why they form. 

Acute vs. Chronic Pancreatitis

Pancreatitis can be either acute — meaning short term, with the pancreas eventually recovering from the inflammation — or chronic, which means a lifelong condition. Both acute and chronic pancreatitis can be serious, painful and life-threatening. Many severe pancreatitis cases may require a hospital stay. 

With most acute pancreatitis cases, symptoms usually go away after about a week, but recovery may take longer depending on the severity of the case and the patient’s overall health. You can have acute pancreatitis more than once. About 20% of acute pancreatitis cases result in severe and life-threatening complications, potentially including multiple organ failure. 

Chronic pancreatitis is characterized by recurring or constant inflammation of the pancreas, sometimes severe or prolonged abdominal pain, and fibrosis, in which the pancreas is damaged by the buildup of scar tissue due to the body’s attempts to heal tissue damage from chronic inflammation. Though the damage from chronic pancreatitis can potentially be slowed and the severity of symptoms reduced with medication and treatment, previous damage to the pancreas due to the condition is considered irreversible. 

Why Hoag for Acute or Chronic Pancreatitis Evaluation and Treatment? 

Both chronic and acute pancreatitis can be very painful and potentially life-threatening without prompt, knowledgeable and experienced diagnosis and treatment. When you need answers now for serious conditions of the pancreas, biliary system and gallbladder, the Hoag Digestive Health Institute is your best choice in Orange County for sound advice, accurate diagnosis and compassionate, next-generation care that you and your family can count on.  

Hoag’s comprehensive Midgut Program offers the most advanced diagnosis and treatment options in Orange County for conditions involving the gallbladder, pancreas and biliary system. Our world-class team of experts is leading the way in complex hepatobiliary care, with the accurate diagnostics you need for peace of mind and treatment options that can help you find relief.

Diagnosed with pancreatitis, or have symptoms that make you suspect that might be the case? Don’t wait, worry and hurt. Get the answers you need and the advanced care that can get you back to normal sooner, at Hoag.  Meet Program Director Dr. Robert R. Selby, MD. 

Symptoms and Causes of Pancreatitis

The symptoms of pancreatitis can be different for every patient. Known symptoms of chronic and acute pancreatitis include: 

Symptoms of Acute Pancreatitis

• Sudden, severe pain in the center of your abdomen, which may spread to your back or left shoulder
• Feeling sick or nauseous after eating or drinking, especially if you’ve eaten fatty foods
• Indigestion and diarrhea
• Infection and/or a high fever over 100.4F
• Recurring nausea and vomiting
• Rapid pulse rate
• Swelling or tenderness of the abdomen
• Jaundice, which is a yellowing of the whites of the eyes and skin
• Dehydration

Symptoms of Chronic Pancreatitis

• Recurring abdominal pain that can be almost unbearably severe
• Maldigestion, which means your body doesn’t digest food properly
• Malabsorption, which means your body has trouble absorbing nutrients from food
• Malnutrition, which means your body isn’t getting enough nutrients to maintain your weight
• Greasy, very odorous bowel movements
• Pancreatic scarring
• Pancreatic pseudocysts, which are fluid-filled sacs that are usually caused by a blockage of the ducts inside the pancreas due to damage or scarring. 
• Diabetes
• Pancreatic cancer
• Osteoporosis, which is a weakening of the bones

General Symptoms/Complications of Both Acute and Chronic Pancreatitis

• Heart, lung or kidney failure, or a combination (A.K.A. “Multi-organ failure”) 
• Pancreatic duct leakage
• Narrowing or blockage of the pancreatic duct or bile duct
• Damage or scarring of the pancreas

Risk Factors

Though both chronic and acute pancreatitis can sometimes happen for no discernable reason (A.K.A. “idiopathic pancreatitis”), there are a number of factors that are believed to increase your risk for developing the disease. These include: 

• Having gallstones, which can result in what’s called gallstone pancreatitis
• Heavy use of alcohol, alcoholism or binge drinking 
• Being male, as men are more likely to get pancreatitis than women
• Your race, as African Americans have a higher risk of pancreatitis than other racial groups
• Having had a procedure known as endoscopic retrograde cholangiopancreatography (ERCP) during the treatment of another condition
• Having a personal or family history of pancreatitis or gallstones
• Being diabetic
• Having high levels of triglycerides and lipids/fats in your blood
• Having certain genetic disorders and autoimmune conditions involving the pancreas
• Having Cystic Fibrosis
• Having high levels of calcium in the blood 
• Being obese
• Smoking

Diagnosis and Tests

If you visit a doctor or the emergency room while experiencing symptoms that suggest chronic or acute pancreatitis, you will likely be given a thorough medical exam. 

This will usually include blood testing for amylase and lipase, which are digestive enzymes produced by the pancreas. These enzymes are sometimes very elevated in the blood of a person suffering from pancreatitis, though that may not always be the case. Because one of the major contributing factors to pancreatitis is heavy drinking, the physician may also ask you about your recent alcohol use. 

Other diagnostic tests for pancreatitis include: 

• Transabdominal ultrasound, which is used to detect gallstones in the gallbladder. Gallstones are the most common cause of pancreatitis
• Endoscopic Ultrasound, in which a thin, flexible camera called an endoscope with an ultrasound source at the tip is passed down the throat and into the stomach. When activated, the ultrasound source allows doctors to get a better view of the pancreas, gallbladder and liver
• Magnetic Resonance Cholangiopancreatography (MRCP), which utilizes powerful magnetic fields, radio waves and advanced computing to evaluate the gallbladder and bile ducts without the use of ionizing radiation
• CT scans
• Biopsy, which is the collection of a small amount of tissue so it can be examined in a lab. This is usually accomplished by painlessly inserting a fine needle through the skin

Advanced Diagnosis of Midgut Conditions at Hoag

The Hoag Digestive Health Institute is Orange County’s recognized leader in the diagnosis and treatment of pancreatitis and other conditions involving the pancreas, liver, gallbladder and biliary system. We’re committed to using today’s best and most advanced techniques and technology to achieve hyper-accurate diagnosis of these challenging midgut afflictions. 

At Hoag, advanced diagnostics for conditions of the pancreas, liver, gallbladder and biliary system include: 

• Endoscopic retrograde cholangiopancreatography (ERCP), which is a diagnostic procedure that utilizes X-rays and a technique known as upper gastrointestinal endoscopy to view, diagnose and potentially treat issues associated with the bile ducts, including gallstones 
• Endoscopic Ultrasound (EUS), which is a diagnostic technique that combines ultrasound with the use of a thin, flexible camera called an endoscope that can be passed down the patient’s throat and into the upper gastrointestinal tract. This device then uses low-frequency sound waves to create detailed images of internal structures and tissues, including the pancreas and gallbladder, without radiation. 
• FibroScan^®, (AKA transient elastography), which is the first FDA-approved device in the U.S. that provides a painless, non-invasive method of testing for liver scarring without the side effects and complications of a needle biopsy.  Learn more about FibroScan®
• Hepatobiliary Iminodiacetic acid (HIDA) scanning, which is an advanced imaging technique that utilizes an injected radioactive tracer to diagnose issues with the liver, gallbladder and bile ducts
• Attenuation Imaging (ATI) for Fat Quantification, which is an imaging technique used to quantify fat deposits that may cause inflammation in the liver.
• Magnetic Resonance Cholangiopancreatography (MRCP), which utilizes powerful magnetic fields, radio waves and advanced computing to evaluate the liver and bile ducts for disease, without the use of ionizing radiation
• Magnetic Resonance Elastography (MRE), which is used to detect stiffening of the liver caused by scarring and inflammation. This technology combines MRI imaging with low-frequency vibrations to create a visual map called an elastogram that shows the degree of stiffness of body tissues. 
• Magnetic Resonance Multi-Echo Dixon Vibe Liver Iron Quantification, which is a 3D imaging technique used to simultaneously assess fatty liver disease (AKA steatosis) and abnormal iron levels in patients with chronic liver disease. 
• Magnetic Resonance Proton Density Fat Fraction (MRI-PDFF), which is an emerging imaging technique that accurately measures the amount of fat in liver tissue by correcting for factors that can degrade or skew magnetic resonance signal intensity

Management and Treatment for Chronic and Acute Pancreatitis

Acute Pancreatitis Treatment Options

Mild cases of acute pancreatitis, while potentially painful, usually go away in a week or less with rest, pain medication, hydration and treatment. Even mild or moderate cases often require hospitalization. Other treatment options for acute pancreatitis may include: 

• Pain medication
• Antibiotics
• Bed rest
• Cholecystectomy, which is the surgical removal of the gallbladder to treat gallstones
• Endoscopic retrograde cholangiopancreatography (ERCP), which is a procedure that utilizes X-rays and a technique known as upper gastrointestinal endoscopy to diagnose and treat narrowing or blockage of the pancreatic ducts, including breaking up and removing gallstones
• Insertion of a feeding tube through the nose and into the stomach (A.K.A. a nasogastric tube) to provide nutrition, in severe cases

Chronic Pancreatitis Treatment Options

The damage from chronic pancreatitis is usually permanent, and abdominal pain due to the condition can be long-lasting and severe. Treatment options for chronic pancreatitis are different for every patient, but may include: 

• Strong pain medications, or efforts to block certain nerves that receive pain signals from the pancreas
• Pancreatic enzyme supplementation, which replaces missing enzymes a healthy pancreas would produce so patients can better digest protein, carbohydrates and fats 
• Endoscopic drainage of pseudocysts or pancreatic or biliary ducts that may be blocked due to scarring or other issues

Next-Generation Pancreatic Surgery at Hoag

At the Hoag Digestive Health Institute, we’re committed to utilizing the latest treatment options to help patients live longer, fuller lives. Some of the advanced surgical options Hoag utilizes when treating serious issues involving the pancreas include:

• The Whipple Operation involves resection (removal) of the head of the pancreas, a portion of the bile duct, the gallbladder and the duodenum, which is the initial part of the small intestine. Occasionally, a portion of the stomach may also be removed. The Whipple Operation is often used to treat patients with adenocarcinoma of the pancreas, although it may be recommended for some patients with chronic pancreatitis or benign tumors of the head of the pancreas. Learn more about the Whipple Operation for chronic pancreatitis.  
• Duodenum Preserving Pancreatic Head Resection is offered primarily to patients with chronic pancreatitis, although the procedure may also be offered to some patients with neuroendocrine tumors who would otherwise require a Whipple Operation. In this procedure, the head of the pancreas is removed while preserving the bile duct and duodenum (the first part of the intestine). Hoag is one of the few centers in the U.S. to offer this innovative surgical procedure.
• Central Pancreatectomy, which may be recommended for patients who have low-grade malignant or benign tumors in the neck of the pancreas. Removal of tumors in this area often requires removing a large portion of the pancreas. However, Hoag offers a highly-specialized surgical procedure that removes only the tumorous portion of the neck of the pancreas, thereby preserving the head, body and tail of the pancreas for more normal function.
• Laparoscopic Robotic-Assisted Pancreatectomy, which is a minimally-invasive surgical procedure where the body and tail of the pancreas is removed along with the spleen. This procedure is most frequently performed in patients with adenocarcinoma of the pancreas. However, Hoag routinely provides laparoscopic spleen-preserving pancreatectomy for patients with cystic tumors and neuroendocrine tumors. Learn more about robotic-assisted surgical procedures at Hoag. 
• Enucleation of pancreatic islet cell tumors, which is a surgical procedure that carefully removes islet cell tumors without removing any pancreatic tissue. Pancreatic islet cell tumors (also called neuroendocrine tumors) are small tumors found on the surface of the pancreas. Hoag surgeons have developed a less-invasive laparoscopic technique for enucleation of pancreatic islet cell tumors, for a faster recovery and quicker return to daily activities  

Prevention of Pancreatitis

Both chronic and acute pancreatitis can sometimes develop for no discernable reason. However, there are certain conditions that are believed to increase your risk of developing pancreatitis. Ways to potentially reduce your risk of developing pancreatitis include: 

• Avoid developing gallstones — the most common reason for acute pancreatitis — by eating a healthy, balanced diet and avoiding fatty or high-cholesterol foods.
• Maintain a healthy weight by eating healthy and getting regular exercise
• Limit your intake of alcohol, especially if you’ve previously had pancreatitis related to drinking too much
• Get regular checkups, including blood work that can suggest changes in pancreatic function

Treatment for Alcoholism at Hoag

For those with alcohol addiction that may be contributing to recurring bouts of acute pancreatitis, Hoag is here for you. The longest-standing addiction treatment option in Orange County, Hoag Addiction Treatment Centers is an accredited program within the Pickup Family Neurosciences Institute that offers help, hope and healing for people facing addiction to alcohol and other drugs. For more information, visit this link, or call (949)764-6883.