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Pancreatitis in Children
Points to Remember
Hope Through Research
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
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.
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 treatmentif availablecan begin.
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 constantjust
in the abdomenor 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
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.
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
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
If pancreatic pseudocysts occur and are considered large enough to interfere
with the pancreas's healing, your doctor may drain or surgically remove
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.
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
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
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
blocked or narrowed pancreatic duct because of trauma or pseudocysts have
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
Other causes of chronic pancreatitis are
congenital conditions such as pancreas divisum
high levels of calcium in the blood (hypercalcemia)
high levels of blood fats (hyperlipidemia or hypertriglyceridemia)
certain autoimmune conditions
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 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
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
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
Email: email@example.com or firstname.lastname@example.org
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 wont 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