Pancreatitis refers to inflammation of the pancreas, the organ responsible for producing digestive enzymes and the hormone insulin that regulates blood sugar levels. The pancreas is a long, leaf-shaped gland that sits in the upper portion of the abdomen, in front of the spine and behind the stomach.
Pancreatitis can occur as an acute or chronic illness. In acute pancreatitis, symptoms appear suddenly due to temporary inflammation of the organ and the illness is short-term. Mild cases of acute pancreatitis may resolve independently, without requiring any treatment, but severe cases can lead to dangerous and life-threatening complications. The main causes of acute pancreatitis are alcohol abuse and gallstones.
Chronic pancreatitis is a long-term illness that eventually causes permanent and irreversible damage to the pancreas. Around half of patients with acute pancreatitis caused by alcoholism experience recurrent episodes in the future. Ongoing drinking is a risk factor for pancreatitis recurrence, with the risk becoming greater, the more alcohol is consumed. Prolonged exposure of the pancreas to the damage caused by alcohol eventually leads to chronic pancreatitis.
About 45,000 people are currently living with chronic pancreatitis in the UK and around 12,000 cases of acute pancreatitis are diagnosed every year. The disease is more common among men than women.
The symptoms of acute pancreatitis can occur suddenly or they may develop over several days. The condition can be life-threatening and lead to serious complications. Some of the main symptoms of acute pancreatitis are described below.
- Severe upper abdominal pain
- Nausea and sickness
- Fever or temperature higher than 37.5˚C
- Loss of appetite
- Fast pulse
- In severe cases, dehydration may develop and lead to hypovolemic shock
Some of the complications associated with acute pancreatitis are described below:
Fluid and debris accumulating in the pancreas may form cyst-like pockets referred to as pseudocysts.
Bleeding and infection
Large pseudocysts can rupture and cause internal bleeding and infection. In severe cases, infected tissue may need to be surgically removed.
Chemical changes can occur that disrupt lung function and cause the blood oxygen to fall dangerously low.
In severe cases, parts of the pancreas die, a condition referred to as necrotizing pancreatitis. This can cause pancreatic fluid and blood to leak into the abdominal cavity, decreasing the blood volume and blood pressure. This can lead to hypovolemic shock.
The abdomen may become swollen and painful due to the stomach being distended or misplaced by a mass in the pancreas. Swelling may also be caused by abnormal movement of the intestinal contents.
If the inflammation that occurs in acute pancreatitis is severe or recurrent, the pancreas may become permanently damaged and chronic pancreatitis develops. In chronic pancreatitis, symptoms are often similar to those seen with the acute form of the illness, but they tend to fall into two characteristic patterns.
In one symptom pattern, upper abdominal pain is ongoing, but varies in intensity and complications such as abscess, cyst or pancreatic cancer are more likely. With the other symptom pattern, features of the disease come and go in “flare-ups” and are similar to those seen in mild-to-moderate cases of acute pancreatitis. For example, severe pain may suddenly develop, but it only lasts for up to a few days.
Regardless of the symptom pattern a patient has, as chronic disease progresses, the cells responsible for secreting digestive enzymes are eventually destroyed and pain is alleviated. The absence of digestive enzymes means food is no longer adequately broken down, a condition referred to as pancreatic insufficiency. This leads to the production of foul-smelling, oily, pale stools and poor food absorption causes the patient to lose weight.
Eventually, the cells in the pancreas responsible for secreting insulin are also destroyed, and the patient develops type 1 diabetes. The persistent inflammation seen in chronic pancreatitis is also a risk factor for the development of pancreatic cancer.