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Pancreatitis

On this page:

Acute Pancreatitis
Chronic Pancreatitis
Pancreatitis in Children
Points to Remember
Hope Through Research
For More Information

Pancreatitis FAQ's

Pancreatitis is an inflammation of the pancreas. The pancreas is a large gland behind the stomach and close to the duodenum. The duodenum is the upper part of the small intestine. The pancreas secretes digestive enzymes into the small intestine through a tube called the pancreatic duct. These enzymes help digest fats, proteins, and carbohydrates in food. The pancreas also releases the hormones insulin and glucagon into the bloodstream. These hormones help the body use the glucose it takes from food for energy.

Normally, digestive enzymes do not become active until they reach the small intestine, where they begin digesting food. But if these enzymes become active inside the pancreas, they start "digesting" the pancreas itself.

Acute pancreatitis occurs suddenly and lasts for a short period of time and usually resolves. Chronic pancreatitis does not resolve itself and results in a slow destruction of the pancreas. Either form can cause serious complications. In severe cases, bleeding, tissue damage, and infection may occur. Pseudocysts, accumulations of fluid and tissue debris, may also develop. And enzymes and toxins may enter the bloodstream, injuring the heart, lungs, and kidneys, or other organs.

Acute Pancreatitis

Some people have more than one attack and recover completely after each, but acute pancreatitis can be a severe, life-threatening illness with many complications. About 80,000 cases occur in the United States each year; some 20 percent of them are severe. Acute pancreatitis occurs more often in men than women.

Acute pancreatitis is usually caused by gallstones or by drinking too much alcohol, but these aren't the only causes. If alcohol use and gallstones are ruled out, other possible causes of pancreatitis should be carefully examined so that appropriate treatment—if available—can begin.

Symptoms

Acute pancreatitis usually begins with pain in the upper abdomen that may last for a few days. The pain may be severe and may become constant—just in the abdomen—or it may reach to the back and other areas. It may be sudden and intense or begin as a mild pain that gets worse when food is eaten. Someone with acute pancreatitis often looks and feels very sick. Other symptoms may include

swollen and tender abdomen
nausea
vomiting
fever
rapid pulse
Severe cases may cause dehydration and low blood pressure. The heart, lungs, or kidneys may fail. If bleeding occurs in the pancreas, shock and sometimes even death follow.

Diagnosis

Besides asking about a person's medical history and doing a physical exam, a doctor will order a blood test to diagnose acute pancreatitis. During acute attacks, the blood contains at least three times more amylase and lipase than usual. Amylase and lipase are digestive enzymes formed in the pancreas. Changes may also occur in blood levels of glucose, calcium, magnesium, sodium, potassium, and bicarbonate. After the pancreas improves, these levels usually return to normal.

A doctor may also order an abdominal ultrasound to look for gallstones and a CAT (computerized axial tomography) scan to look for inflammation or destruction of the pancreas. CAT scans are also useful in locating pseudocysts.

Treatment

Treatment depends on the severity of the attack. If no kidney or lung complications occur, acute pancreatitis usually improves on its own. Treatment, in general, is designed to support vital bodily functions and prevent complications. A hospital stay will be necessary so that fluids can be replaced intravenously.

If pancreatic pseudocysts occur and are considered large enough to interfere with the pancreas's healing, your doctor may drain or surgically remove them.

Unless the pancreatic duct or bile duct is blocked by gallstones, an acute attack usually lasts only a few days. In severe cases, a person may require intravenous feeding for 3 to 6 weeks while the pancreas slowly heals. This process is called total parenteral nutrition. However, for mild cases of the disease, total parenteral nutrition offers no benefit.

Before leaving the hospital, a person will be advised not to drink alcohol and not to eat large meals. After all signs of acute pancreatitis are gone, the doctor will try to decide what caused it in order to prevent future attacks. In some people, the cause of the attack is clear, but in others, more tests are needed.

Complications

Acute pancreatitis can cause breathing problems. Many people develop hypoxia, which means that cells and tissues are not receiving enough oxygen. Doctors treat hypoxia by giving oxygen through a face mask. Despite receiving oxygen, some people still experience lung failure and require a ventilator.

Sometimes a person cannot stop vomiting and needs to have a tube placed in the stomach to remove fluid and air. In mild cases, a person may not eat for 3 or 4 days and instead may receive fluids and pain relievers through an intravenous line.

If an infection develops, the doctor may prescribe antibiotics. Surgery may be needed for extensive infections. Surgery may also be necessary to find the source of bleeding, to rule out problems that resemble pancreatitis, or to remove severely damaged pancreatic tissue.

Acute pancreatitis can sometimes cause kidney failure. If your kidneys fail, you will need dialysis to help your kidneys remove wastes from your blood.

Gallstones and Pancreatitis

Gallstones can cause pancreatitis and they usually require surgical removal. Ultrasound or a CAT scan can detect gallstones and can sometimes give an idea of the severity of the pancreatitis. When gallstone surgery can be scheduled depends on how severe the pancreatitis is. If the pancreatitis is mild, gallstone surgery may proceed within about a week. More severe cases may mean gallstone surgery is delayed for a month or more.

After the gallstones are removed and inflammation goes away, the pancreas usually returns to normal.

For more information about gallstones, please see the Gallstones fact sheet from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

Chronic Pancreatitis

If injury to the pancreas continues, chronic pancreatitis may develop. Chronic pancreatitis occurs when digestive enzymes attack and destroy the pancreas and nearby tissues, causing scarring and pain. The usual cause of chronic pancreatitis is many years of alcohol abuse, but the chronic form may also be triggered by only one acute attack, especially if the pancreatic ducts are damaged. The damaged ducts cause the pancreas to become inflamed, tissue to be destroyed, and scar tissue to develop.

While common, alcoholism is not the only cause of chronic pancreatitis. The main causes of chronic pancreatitis are

alcoholism
blocked or narrowed pancreatic duct because of trauma or pseudocysts have formed
heredity
unknown cause (idiopathic)
Damage from alcohol abuse may not appear for many years, and then a person may have a sudden attack of pancreatitis. In up to 70 percent of adult patients, chronic pancreatitis appears to be caused by alcoholism. This form is more common in men than in women and often develops between the ages of 30 and 40.

Hereditary pancreatitis usually begins in childhood but may not be diagnosed for several years. A person with hereditary pancreatitis usually has the typical symptoms that come and go over time. Episodes last from 2 days to 2 weeks. A determining factor in the diagnosis of hereditary pancreatitis is two or more family members with pancreatitis in more than one generation. Treatment for individual attacks is usually the same as it is for acute pancreatitis. Any pain or nutrition problems are treated just as they are for acute pancreatitis. Surgery can often ease pain and help manage complications.

Other causes of chronic pancreatitis are

congenital conditions such as pancreas divisum
cystic fibrosis
high levels of calcium in the blood (hypercalcemia)
high levels of blood fats (hyperlipidemia or hypertriglyceridemia)
some drugs
certain autoimmune conditions

Symptoms

Most people with chronic pancreatitis have abdominal pain, although some people have no pain at all. The pain may get worse when eating or drinking, spread to the back, or become constant and disabling. In certain cases, abdominal pain goes away as the condition advances, probably because the pancreas is no longer making digestive enzymes. Other symptoms include nausea, vomiting, weight loss, and fatty stools.

People with chronic disease often lose weight, even when their appetite and eating habits are normal. The weight loss occurs because the body does not secrete enough pancreatic enzymes to break down food, so nutrients are not absorbed normally. Poor digestion leads to excretion of fat, protein, and sugar into the stool. If the insulin-producing cells of the pancreas (islet cells) have been damaged, diabetes may also develop at this stage.

Diagnosis

Diagnosis may be difficult, but new techniques can help. Pancreatic function tests help a doctor decide whether the pancreas is still making enough digestive enzymes. Using ultrasonic imaging, endoscopic retrograde cholangiopancreatography (ERCP), and CAT scans, a doctor can see problems indicating chronic pancreatitis. Such problems include calcification of the pancreas, in which tissue hardens from deposits of insoluble calcium salts. In more advanced stages of the disease, when diabetes and malabsorption occur, a doctor can use a number of blood, urine, and stool tests to help diagnose chronic pancreatitis and to monitor its progression.

For more information about ERCP, please see the ERCP fact sheet from the NIDDK.

Treatment

Relieving pain is the first step in treating chronic pancreatitis. The next step is to plan a diet that is high in carbohydrates and low in fat.

A doctor may prescribe pancreatic enzymes to take with meals if the pancreas does not secrete enough of its own. The enzymes should be taken with every meal to help the body digest food and regain some weight. Sometimes insulin or other drugs are needed to control blood glucose.

In some cases, surgery is needed to relieve pain. The surgery may involve draining an enlarged pancreatic duct or removing part of the pancreas.

For fewer and milder attacks, people with pancreatitis must stop drinking alcohol, stick to their prescribed diet, and take the proper medications.

Pancreatitis in Children

Chronic pancreatitis is rare in children. Trauma to the pancreas and hereditary pancreatitis are two known causes of childhood pancreatitis. Children with cystic fibrosis, a progressive, disabling, and incurable lung disease, may also have pancreatitis. But more often the cause is not known.

Points To Remember

Pancreatitis begins when the digestive enzymes become active inside the pancreas and start "digesting" it.

Pancreatitis has two forms: acute and chronic

Common causes of pancreatitis are gallstones or alcohol abuse.

Sometimes no cause for pancreatitis can be found.

Symptoms of acute pancreatitis include pain in the abdomen, nausea, vomiting, fever, and a rapid pulse.

Treatment for acute pancreatitis can include intravenous fluids, oxygen, antibiotics, or surgery.

Acute pancreatitis becomes chronic when pancreatic tissue is destroyed and scarring develops.

Treatment for chronic pancreatitis includes easing the pain; eating a high-carbohydrate, low-fat diet; and taking enzyme supplements. Surgery is sometimes needed as well.

Hope Through Research

NIDDK's Division of Digestive Diseases and Nutrition supports basic and clinical research into gastrointestinal diseases, including the causes of pancreatitis and mechanisms of cell injury in the gastrointestinal tract. In addition, researchers are studying the genetics of hereditary pancreatitis, as well as risk factors such as cystic fibrosis.

For More Information
American Gastroenterological Association
4930 Del Ray Avenue
Bethesda, MD 20814
Phone: 301–654–2055
Fax: 301–654–5920
Email: info@gastro.org or webmaster@gastro.org
Internet: http://www.gastro.org/

Pancreatitis FAQ's

What is pancreatitis?

The pancreas is an organ that sits just beneath the stomach and the first part of the small intestine. It is responsible for producing enzymes that aid in digestion and is also the source of insulin production. Pancreatitis refers to an inflammation of this organ. It can happen to dogs and cats of any age, breed or sex. If severe, pancreatitis can lead to irreversible changes in the pancreas and impaired function long term.

The cause of pancreatitis in dogs and cats is not very well understood. There are a few things that we know can predispose to the development of pancreatitis such as fatty diets, certain drugs, underlying diseases, parasites and trauma however, there is also some research that indicates there are genetic factors at play as well.

What are the signs of pancreatitis?

Dogs with pancreatitis may be depressed, lose their appetite, have vomiting or diarrhea. They may also exhibit pain in the abdomen – this may be manifested as restlessness, panting or unwillingness to lie down. Cats can be a little more vague with signs ranging from poor appetite and fever to an elevated heart rate. Unlike dogs, they are less likely to have abdominal pain and vomiting.

Pancreatitis is often divided into acute or chronic cases. Acute cases are usually more severe and may be associated with more dramatic signs. Chronic pancreatitis, which is more common in cats, may have more subtle symptoms and may often be associated with or mistaken for other illnesses.

How do we diagnose pancreatitis?

The diagnosis of pancreatitis can be a bit difficult as there is no one test that is specific for this problem. Generally your veterinarian will start with a suspicion of pancreatitis based on history, symptoms or physical exam findings. However, since pancreatitis can mimic numerous gastrointestinal or metabolic problems, further testing is generally required. Abdominal radiographs and routine blood tests are usually the first step in obtaining a diagnosis. There are certain signs that may be seen on radiographs that would increase the index of suspicion for pancreatitis however patients with this disorder can have completely normal radiographs. Other supportive clues may be found in routine blood tests. Elevation in pancreatic enzyme levels may be supportive of a diagnosis but these values may be normal in patients with pancreatitis. Pancreatic enzymes may be elevated due to other diseases such as kidney disease. Blood tests will also allow your veterinarian to make sure there are no other metabolic problems.

Another diagnostic test that can prove to be very useful in the diagnosis of pancreatitis is abdominal ultrasound. This allows us to directly visualize the pancreas and other abdominal organs. It may be possible to see changes within the pancreas that indicate inflammation.

Your veterinarian may choose to do a blood test that is a bit more specific to the pancreas called a TLI (trypsin-like immunoreactivity). This may help aid in a diagnosis in those cases in which the answer is unclear. One disadvantage of this test is that it may take 5-10 days to receive the results. In some situations, biopsy of the pancreas may be required as it is difficult to differentiate pancreatitis from pancreatic cancer without a biopsy.

How do we treat pancreatitis?

The treatment of pancreatitis can vary greatly depending on the severity and duration of the illness. Patients with mild pancreatitis may be treated conservatively at home while those with severe disease will require hospitalization and intensive care.

One of the mainstays of therapy in dogs with this disease is to rest the GI system and pancreas by withholding food. In patients with severe signs where there may be a need for prolonged fasting, other routes of nutritional support may be required. For example, intravenous feeding (total parenteral nutrition) or feeding through a tube placed in the lower intestine. Cats may develop other problems if fasted for too long so nutritional support is generally needed sooner in these patients.

Intravenous fluid therapy, antibiotics and anti-nausea medication are also used as part of the therapeutic regime. Because pancreatitis can sometimes be very painful, pain medication may be needed as well to help keep your pet comfortable during treatment.

Dogs with severe pancreatitis may also benefit from a plasma transfusion. Plasma contains factors that help ameliorate severe inflammation. These may become depleted in severe cases and can be replaced with plasma transfusions aiding in recovery and potentially reducing the amount of time your pet will need to stay in the hospital.

Unfortunately, these cases can be very unpredictable and despite aggressive therapy severe cases may not respond to any form of therapy. This seems to be particularly true of cats with severe acute pancreatitis. It is difficult to predict at the onset of treatment which patients will respond and which won’t respond.

What are the long term effects of pancreatitis?

In some instances, if the pancreatitis is severe or longstanding, there can be long term side effects. The one seen most often is diabetes mellitus. Because insulin is produced in the pancreas, severe disease and subsequent scarring of this organ may result in insufficient insulin production which leads to diabetes.

Animals that have recovered from pancreatitis are also more prone to developing it again in the future. For this reason your veterinarian will help develop a long term diet plan that will help minimize the risk of this occurring.