|Also Listed As:
|| Pancreas, Inflammation
Pancreatitis is inflammation of the pancreas, a glandular organ that produces
several enzymes to aid in the digestion of food, as well as the hormone insulin,
which controls the level of sugar (glucose) in the blood. The pancreas is
located in the upper abdomen, behind the stomach; a duct connects it to the
duodenum, the first part of the small intestine. Pancreatic enzymes and bile
produced by the liver enter the duodenum at the same location.
Pancreatitis may be either acute (sudden and severe) or chronic. Both acute
and chronic pancreatitis can cause bleeding and tissue death in or around the
pancreas. In a single episode of acute pancreatitis, the gland usually heals
without causing functional or structural changes, but in the case of recurring
pancreatitis, long-term damage is common. In chronic pancreatitis, smoldering
attacks result in a slow deterioration of the structure of the pancreas and loss
of pancreatic function.
Necrotizing pancreatitis (which involves death of pancreatic tissue) can lead
to cyst-like pockets and abscesses. Because of the location of the pancreas,
inflammation spreads easily. In severe cases, fluid containing toxins and
enzymes leaks from the pancreas through the lining of the abdomen. This can
damage blood vessels and lead to internal bleeding, which may be life
|Signs and Symptoms|
Common signs and symptoms of pancreatitis include the
- Severe, ongoing, sharp abdominal pain, often radiating to the
- Nausea and vomiting
- Abdominal tenderness
- Rapid heart rate
- Rapid breathing
|What Causes It?|
There are several possible causes of pancreatitis:
- Disease of the biliary tract. The biliary tract is the system of
organs and ducts (including the liver, gallbladder, and bile ducts) that
creates, transports, stores, and releases bile into the duodenum for digestion.
The formation of stones in the biliary tract can block the main duct of the
pancreas as it enters the duodenum.
- Heavy alcohol use over a long period of time, which can raise protein
levels in pancreatic juices. Over time, the protein can form plugs, blocking
small pancreatic ducts. Alcohol also allows enzymes to pass more easily through
duct walls and damage the pancreas. Biliary tract stones and alcoholism are the
most common causes of pancreatitis.
- The drugs azathioprine, sulfonamides, corticosteroids, nonsteroidal
anti-inflammatories (NSAIDs), and tetracyclines
- Infection with mumps, hepatitis virus, rubella, Epstein-Barr virus
(the cause of mononucleosis), and cytomegalovirus
- Abnormalities in the structure of the pancreas or the pancreatic or
bile ducts, including pancreatic cancer
- High levels of triglycerides (fats) in the blood
- Surgery to the abdomen, heart, or lungs that temporarily cuts off
blood supply to the pancreas, damaging tissue
- Injury resulting in compression of the pancreas against the
|Who's Most At Risk?|
These conditions or characteristics increase the risk for
- Biliary tract disease
- Binge alcohol use and chronic alcoholism
- Recent surgery
- Family history of high triglycerides
- Age (most common between ages 35 and 64)
African-Americans are at higher risk than Caucasians and Native Americans.
|What to Expect at Your Provider's Office|
Your healthcare provider will examine you for signs and symptoms of
pancreatitis. He or she may also perform blood tests, take X rays, and use
ultrasound, computed tomography (CT) scans, and other procedures to determine
the severity of your condition and decide which treatment options are most
Mild edematous pancreatitis (marked by buildup of fluid in the pancreas) can
usually be treated with intravenous fluids and by fasting, along with careful
monitoring by the healthcare provider. Nasogastric suction (suction of the
stomach using a tube inserted through the nose) reduces stomach secretions and
prevents stomach contents from reaching the small intestine. This procedure is
sometimes used although there is no proven benefit. Parenteral nutrition
(nutrients given through the veins, muscles, or skin rather than orally) may be
needed if the patient does not adequately recover within several days. For those
with low blood pressure, low urine output, low levels of oxygen in the blood, or
increased levels of red blood cells, more aggressive therapy may be required.
For pancreatitis from high triglycerides, treatment includes weight loss,
exercise, fat-restricted diet, control of blood sugar for diabetics, and
avoidance of alcohol and medications that can raise triglycerides, such as
thiazide diuretics and beta-blockers.
Painkillers such as meperidine may be prescribed. Antibiotics, such as
ampicillin, ceftriaxone, and imipenem, may be given to treat or prevent
infection in some cases.
|Surgical and Other Procedures|
Different types of surgical procedures may be necessary, depending on the
cause of the pancreatitis. With infected pancreatic necrosis (tissue death),
surgery is virtually always required to remove damaged and infected tissue.
Surgery may also be required to drain an abscess. For hemorrhagic (bleeding)
pancreatitis, surgery will stop the bleeding and help restore pancreatic
function. For chronic pancreatitis with pain that won't respond to treatment, a
section of the pancreas may need to be removed. If the pancreatitis is a result
of gallstones, a procedure called endoscopic retrograde cholangiopancreatography
(ERCP) may be necessary. In ERCP, a specialist inserts a tube-like instrument
through the mouth and down into the duodenum where he or she can gain access to
the pancreatic and biliary ducts.
|Complementary and Alternative Therapies|
A number of studies have explored the role of oxidative stress in
pancreatitis. Oxidative stress results from the production of free radicals,
which are by-products of metabolism that are harmful to cells in the body.
Several ways to neutralize these deleterious effects have evolved over time.
Antioxidants, for example, help rid the body of free radicals. Insufficient
antioxidant levels in the blood (including reduced amounts of vitamin A, vitamin
E, selenium, and carotenoids), though, may lead to chronic pancreatitis due to
the destructive effects of increased free radical activity. Antioxidant
deficiency and the risk of developing pancreatitis may be particularly relevant
in areas of the world with low soil concentrations or low dietary intake of
antioxidants. In addition, the cooking and processing of foods may destroy
antioxidants. Alcohol-induced pancreatitis is linked to low levels of
antioxidants as well. There is also some evidence that antioxidant supplements
may eliminate or minimize oxidative stress and help alleviate pain from chronic
As explained, low levels of antioxidants in the blood may make an individual
more prone to develop pancreatitis; at the same time, someone who already has
pancreatitis is more likely to develop deficiencies of the following nutrients:
- Magnesium - particularly in the case of
- Vitamin A
- Vitamin C
- Vitamin E
Some studies do suggest that taking these nutrients mentioned, particularly
the latter five each of which has antioxidant properties, can reduce the pain
from which people with pancreatitis suffer and recover more readily from the
condition. Other potentially valuable supplements to take
- Vitamin B12; levels may be low with pancreatitis; works best in this
case if given by injection.
- Soybeans; extracts of soybeans known as polyunsaturated
phosphatidylcholines (PCs) work as antioxidants and have demonstrated prevention
of damage to the pancreas in animal studies.
- Emblica officinalis (Indian gooseberry) is a traditional
Ayurvedic medicinal plant used to treat pancreatic disorders. It is the richest
natural source of vitamin C. Animal studies further suggest that this herb can
be used to prevent development of pancreatitis.
Individual case reports suggest that traditional Chinese medicines are
effective for the prevention and treatment of pancreatitis including the
following which are also used commonly as both Western and Ayurvedic treatments
of gastrointestinal disorders:
- Licorice root (Glycyrrhiza glabra)
- Ginger root (Zingiber officinale)
- Asian ginseng (Panax ginseng),
- Peony root(Paeonia officinalis)
- Cinnamon Chinese bark (Cinnamomum
Animal studies further suggest the value of using these herbs in combination
along with the following herbs:
- Bupleurum (Bupleri falcatum L)
- Pinelliae tuber (Pinelliae ternata)
- Chinese skullcap (Scutellariae baicalensis)
- Jujube (Zizyphi jujuba)
To determine the regimen for each individual, it is best to see a skilled
herbalist or licensed and certified practitioner of traditional Chinese
medicine, particularly because these herbs often work best in combination.
The value of acupuncture for treating pancreatitis is controversial. There
are case reports stating that acupuncture has helped relieve pain from
pancreatitis and pancreatic cancer. But a review of several studies finds that
results of acupuncture and electroacupuncture (small electrical currents applied
through acupuncture needles) for pancreatitis are mixed with some concluding
that there is no benefit with the addition of either of these modalities for
people with pancreatitis.
Possible complications of pancreatitis include infection of the pancreas;
cyst-like pockets that can become infected, bleed, or rupture; the failure of
several organs (heart, kidney, lungs) and shock due to toxins in the blood; and
diabetes. In mild edematous pancreatitis, with inflammation in the pancreas
alone, the prognosis is excellent. Fewer than 5% of people with this form die.
With severe tissue death and bleeding, or where inflammation is not confined to
the pancreas, the death rate is 10 to 50% or higher, due to infection and other
serious complications. In chronic pancreatitis, recurring attacks tend to become
Patients with chronic pancreatitis should eat a low-fat diet, abstain from
alcohol, and avoid abdominal trauma to prevent acute attacks and further damage.
Those with high triglyceride levels should lose weight, exercise, and avoid
medications, such as thiazide diuretics and beta-blockers, that increase
triglyceride levels. Given the recent reports suggesting that oxidative stress
may contribute to the development of pancreatitis and that antioxidant
supplementation may be of some benefit, healthcare providers may begin
recommending antioxidant nutrients to their patients with
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|Review Date: December 2000|
|Reviewed By: Participants in the review process include: Richard Glickman-Simon, MD,
Department of Family Medicine, New England Medical Center, Tufts University,
Boston, MA; Jacqueline A. Hart, MD, Department of Internal Medicine,
Newton-Wellesley Hospital, Harvard University and Senior Medical Editor
Integrative Medicine, Boston, MA; Richard A. Lippin, MD, President, The Lippin
Group, Southampton, PA.|
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