Chronic and Acute Pancreatitis

Chronic Pancreatitis

Chronic pancreatitis is characterized by intermittent or constant upper abdominal pain. Other features of chronic pancreatitis include greasy or oily stool as well as difficulty controlling diabetes. The diagnosis of chronic pancreatitis is made by a combination of clinical symptoms and imaging studies such as abdominal CT scan, magnetic resonance imaging (MRI), endoscopic ultrasound (EUS) and/or endoscopic retrograde cholangiopancreatography (ERCP).

What are the Symptoms of Chronic Pancreatitis?

  • Recurrent abdominal pain (intermittent or constant)
  • Greasy or oily stools (steatorrhea)
  • Weight loss

Acute Pancreatitis

The diagnosis of acute pancreatitis is made by a combination of symptoms, physical exam findings, and laboratory tests including amylase and lipase. If the diagnosis is uncertain, abdominal imaging studies such as a computed tomography (CT) scan may also be necessary.

What are the Symptoms of Acute Pancreatitis?

  • Gradual or sudden onset of severe pain in the upper abdomen that may radiate to the back and usually persists for several days.
  • Nausea and vomiting
  • Fever

What Should I Do If I Think I Have Pancreatitis?

If you are experiencing severe abdominal pain, call your doctor or go to the nearest emergency room. The doctor will take a medical history, perform a physical examination, and draw blood to tests for pancreatic enzymes (amylase and lipase). An ultrasound of the abdomen may be performed to exclude the presence of gallstones. Other abdominal imaging tests such as a CT scan or MRI may also be performed. Endoscopic procedures such as ERCP or EUS may also be warranted in some patients.

Treatment

What is the Treatment for Pancreatitis?

The principles for the treatment of acute pancreatitis are:

  • Rest the pancreas by restricting oral intake of food
  • Administer intravenous fluids to maintain an adequate blood volume
  • Pain Medication

If alcohol is the cause of pancreatitis, strict abstinence from alcohol is recommended. Surgical removal of the gallbladder is indicated when the pancreatitis results from gallstones or gallbladder sludge. If the bile duct is blocked by a gallstone, an ERCP may be required to remove the gallstone.The most important goal in the treatment of chronic pancreatitis is to provide pain relief and prevent progression of disease. If pain is difficult to control, you may be referred to a chronic pain specialist. At times, relief of pain may require endoscopic, radiologic, or surgical treatment.

If your pancreas is found to be unable to provide sufficient enzymes for adequate digestion, you may benefit from enzyme supplements. Also, if your blood sugar level is very high and not controlled by diet or oral medications, insulin may be required. It is important to avoid alcohol. Complete cessation of smoking is recommended as it is a risk factor for progression of chronic pancreatitis and pancreatic cancer. In a few select patients, there is also the option of surgically removing the pancreas to reduce pain and transplanting the islets from the pancreas into the liver to potentially prevent diabetes. Since chronic pancreatitis is also a risk factor for pancreatic cancer, you should speak to your provider about ways to help reduce your risk of developing pancreatic cancer.

Prevention of Pancreatitis

  • Gallstone Pancreatitis – surgical removal of the gall bladder
  • Alcohol/tobacco induced Pancreatitis – strict abstinence from alcohol and/or tobacco
  • Drug Induced Pancreatitis – avoid offending medication
  • Hypertriglyceridemia – aggressive lipid-lowering agents
  • Avoidance of high fat foods, consuming diets rich in vegetables, and maintaining adequate fluid intake

Dr. Arturo Bravo is a digestive disease specialist trained in the most advanced endoscopic techniques. He is a diplomat of the American Board of Gastroenterology, the American Board of Transplant Hepatology and the American Board of Internal Medicine. And an Assistant Professor at Texas A&M University College of Medicine in the Department of Medicine. For more information on treatment options, or to schedule a consultation, call us at 281.970.6027.

We are conveniently located within driving distance of Cypress TX, Katy TX, Spring TX, Tomball TX, The Woodlands TX, and Houston TX.

Author(s) and Publication Date(s)

Vikesh K. Singh, MD, MSc, Pancreatitis Center, Division of Gastroenterology, Johns Hopkins Hospital and Bechien U. Wu, MD, MPH, Division of Gastroenterology, Kaiser Permanente Southern California – Updated December 2012.

Peter A. Banks, MD, MACG, Brigham & Women’s Hospital, Boston, MA – Updated April 2007.

Peter A. Banks, MD, FACG and Saleem A. Desai, MD, Brigham & Women’s Hospital, Boston, MA – Published October 2002.

Source:http://patients.gi.org/topics/pancreatitis-acute-and-chronic/