Every year approximately 200,000 Americans are admitted to a hospital with pancreatitis. This condition of the pancreas is seen throughout the world but is more prevalent in the United States and Finland than in other countries. In the United States, acute pancreatitis is largely associated with alcohol consumption. Death occurs in approximately 10% to 15% of acute pancreatitis cases.
What Happens in Pancreatitis?
The pancreas is a large and important gland located in the upper abdomen. Most of us know the pancreas because of one hormone that it secretes – insulin. This hormone, insulin, is responsible for lowering blood glucose levels. It is also the problem in diabetes, which has become a very common condition throughout the globe. Insulin is either deficient (type 1 diabetes) or the body becomes unresponsive to insulin (type 2 diabetes).
However, the pancreas also secretes other hormones as well as a range of digestive enzymes. These powerful enzymes are produced and stored in the pancreas until it has to be released during digestion. In order to prevent these enzymes from digesting the tissue of the pancreas, there are mechanisms that keep these enzymes inactive while it is in the pancreas.
In pancreatitis, these mechanisms fail and the digestive enzymes within the pancreas are prematurely active. As a result the digestive enzymes inflame and damage the pancreatic tissue. This inflammation is known as pancreatitis. It is acute when it arises suddenly, especially in a person without any history of pancreas disease. However, it can also be chronic where it occurs repeatedly and this may be a risk factor for pancreatic cancer.
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How To Spot Pancreatitis
Although most cases of pancreatitis seen in the United States are associated with alcohol, acute pancreatitis can also arise for other reasons, particularly gallstones. Acute pancreatitis should be suspected when the following signs and symptoms are seen after heavy alcohol consumption. Alcoholics are at greater risk. However, when these signs and symptoms are seen in people with known gallstones or abdominal injury then pancreatitis should also be suspected.
Upper Abdominal Pain
The main symptom of acute pancreatitis is abdominal pain. It also occurs with chronic pancreatitis but may not always be as severe. The pain is usually located in the upper middle area of the abdomen (epigastric) but can be felt slightly to the left or right, depending on which part of the pancreas is affected. In chronic pancreatitis, there may be episodes of pain which lasts for hours that may sometimes be triggered by eating but can occur intermittently.
This pain arises suddenly in acute pancreatitis, gradually worsens and may become severe. Most of the time this pain is described as dull ache. It tends to last for more than a day and there is temporary relief from sitting up and leaning forward in contrast to lying flat. The pain also raidates to the back in most cases of acute pancreatitis. This radiation to the back may also be seen in chronic pancreatitis as well as radiating pain in a band around the abdomen.
Abdominal Enlargement and Tenderness
Abdominal enlargement (distension) is present in most cases of acute pancreatitis. It is accompanied by abdominal tenderness. This means that there is pain when the abdomen is pressed, especially around the area of the pancreas. Another accompanying feature is guarding. This is tensing of the abdominal muscles when pressure is applied to the affected region of the abdomen. In addition there is diminished bowel sounds. These symptoms may not as prominent in chronic pancreatitis.
Nausea, Vomiting and Diarrhea
Nausea and vomiting are common signs of pancreatitis. The nausea may be persistent and the vomiting episodic over long periods. Sometimes there may be blood in the vomit (hematemesis). There is also accompanying loss of appetite. Eating and sometimes even drinking may aggravate symptoms like abdominal pain. Diarrhea is less common but may also occur in acute pancreatitis. Depending on the severity, the stool may appear greasy in consistency and have an uncharacteristic foul smell.
Unintentional Weight Loss
Weight loss may be observed in chronic pancreatitis. There is a gradual weight loss over months and years. It is partly due to the reduced appetite as eating can trigger pain after meals in chronic pancreatitis. The weight loss in chronic pancreatitis is also due to the problems with digestion.
The insufficient pancreatic enzymes means that ingested food cannot be properly digested and the the nutrients are therefore not properly absorbed from the gut. Unintentional weight loss may also be a sign of cancer, especially pancreatic cancer which is a possible complication of chronic pancreatitis.
Oily, greasy or fatty stools, known as steatorrhea, is more often seen in chronic pancreatitis. It is due to undigested fat being retained in the bowels and eventually mixing with stool in the large intestine. This undigested fat is a result of insufficient lipase (fat-digesting enzyme) which is normally secreted by the pancreas. Apart from the greasy feeling after a bowel movement and sometimes the oily appearance of stools which tend to float, the stool also has an uncharacteristic foul odor.
Other Signs and Symptoms
Some of the following signs and symptoms may also be present, although not in every case of either acute or chronic pancreatitis.
- High heart rate (tachycardia)
- Low blood pressure (hyptension)
- Tarry, black stools due to degraded blood (melena)
- Yellow discoloration of the skin and eyes (jaundice)
- Shortness of breath (dyspnea)
- Paleness, excessive sweating and listlessness in severe acute pancreatitis.
Death Due To Pancreatitis
Acute pancreatitis causes death in about 1 in 10 cases. People with type 2 diabetes who develop pancreatitis are generally at greater risk of sevee pancreatitis and death. However, early diagnosis and proper management of acute pancreatitis drastically improves chances of survival. Acute pancreatitis should always be treated as a medical emergency and immediate medical attention is necessary.
Read more on pancreatitis vs pancreatic cancer.
With chronic pancreatitis the survival rate is about 70% at 10 years and 45% at 25 years. People with chronic pancreatitis who continue using alcohol or who have liver cirrhosis tend to have a poorer prognosis. Tobacco smoking and age are two other factor that may worsen the prognosis. The risk of pancreatic cancer is approximately 4% at 20 years in chronic pancreatitis.