What is pancreatitis?

Pancreatitis means inflammation of the pancreas and is usually divided into acute or chronic pancreatitis.

The pancreas is located deep in the abdomen behind the stomach and intestines. It cannot be felt on abdominal examination and is not seen on regular X-rays. It has two very different and separate functions: one, to make digestive enzymes and sodium bicarbonate, which are secreted into the intestine to aid in digestion, and second, to make insulin and another hormone named glucagon, which are important for the regulation of sugar levels in the blood.

There are many causes of acute pancreatitis, but perhaps the most common are alcoholism, some viral infections including mumps, many commonly used drugs, very high triglyceride levels in the blood, and gallstones. Experts believe that the causative agent somehow allows the powerful digestive enzymes secreted by the pancreas to begin digesting the gland itself. In a normal person, these enzymes are not active until they are secreted into the intestine, where they help digest the carbohydrates, fats, and proteins in food. If they are activated before they leave the pancreas, however, they can digest the pancreatic tissue itself, causing pancreatitis.

Acute pancreatitis almost always causes abdominal pain, which can be very severe. Nausea, vomiting, and abdominal bloating are also common. The digestion of pancreatic and surrounding tissues can release enormous amounts of fluid into the abdomen, and fluid replacement is an important treatment. If the pancreatitis is caused by a gallstone, this must be removed promptly. If it is not, pain control and fluid replacement are the most important treatments. Antibiotics are not helpful except in the few cases where a bacterial infection settles in the inflamed tissues.

If enough pancreatic tissue is destroyed, the gland will be unable to make the digestive enzymes and insulin. The person will therefore become diabetic and will require insulin treatments to replace the missing hormone. Replacement of the missing digestive enzymes is easily done with oral medication.

Chronic pancreatitis may develop as repeated episodes of inflammation similar to bouts of acute pancreatitis, or may be a steady, chronic, painful inflammation. Again, alcoholism is the most common cause of the condition in the U.S. With chronic or repeated bouts of inflammation, the function of the gland is often impaired; the loss of digestive enzymes causes a type of abnormal bowel movement called steatorrhea. Steatorrhea stools are soft, bulky, greasy appearing (since the fat has not been digested), foul smelling, and will float in the toilet. The appearance of such stools in an alcoholic who has had off-and-on abdominal pain may be the first sign that the person has been having attacks of pancreatitis.

The treatment of chronic pancreatitis involves avoidance of the cause, if it is alcohol or a drug. There are also quite a few inherited conditions that can lead to chronic pancreatitis, and the cause of some cases is never discovered.

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