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Pancreatitis

Pancreatitis

Pancreatitis occurs when the pancreas becomes inflamed, causing pain in the abdomen (or tummy) which can be very severe.

There are two types of pancreatitis, acute pancreatitis, where the pancreas becomes inflamed temporarily, usually getting better within a few days and chronic pancreatitis, where inflammation remains for many years, causing more and more damage. Chronic pancreatitis can develop after many episodes of acute pancreatitis.

Acute pancreatitis

Acute pancreatitis is less common than chronic pancreatitis, with slightly more men than women affected. However, the number of cases has risen significantly over the past 40 years or so, possibly due to an increase in alcohol consumption, especially binge drinking. Alcohol is thought to account for over a third of cases; gallstones are also thought to account for over a third of cases. The average age for alcohol-related acute pancreatitis is 38 while the average age for developing gallstone-related acute pancreatitis is 69.

Uncommon causes include autoimmune diseases such as primary biliary cirrhosis; virus infections; rare side-effects to some medicines; parasite infections; injury or surgery around the pancreas; and high blood fat or calcium levels.

Symptoms

Most people who have pancreatitis experience abdominal pain, which can be severe. You may also experience vomiting, fever and feeling generally unwell and in some cases the abdomen may become swollen.

Diagnosis

Diagnosis can include blood tests, faeces sample test; urine sample test; chest X-rays, biopsy, CT scans, ERCP and MRI scans.

Treatment

Treatment depends on the severity of the condition. In most cases, acute pancreatitis will settle within a few days. However, treatment needs to be in hospital as you may need strong painkilling injections. In some cases a feeding tube may be passed into your stomach and a ‘drip’ may be necessary to rehydrate your body while your symptoms settle. You may also need a catheter so that doctors can accurately monitor how much urine you are passing.

Outlook/prognosis

In most cases people with acute pancreatitis will make a full recovery with no after-effects. However, in some cases there may be complications, in which case it can be very serious, even life-threatening. The best way to reduce your chances of developing acute pancreatitis is to avoid drinking large quantities of alcohol.

Chronic pancreatitis

Chronic pancreatitis is a persistent inflammation of the pancreas which causes scarring and damage. This can mean that not enough enzymes are produced, leading to poor food digestion, as well as too little insulin, resulting in diabetes.

Common causes include: alcohol (in most cases the person has been a heavy drinker for a number of years); genetic factors (including cystic fibrosis); and autoimmune diseases (where the autoimmune system attacks the pancreas, as in primary biliary cirrhosis). Other less common causes include abnormalities of the pancreas and rare hereditary conditions.

Symptoms

Symptoms vary but can include: nausea/sickness ; abdominal pain below the ribs, often spreading to the back; poor digestion, resulting in pale stools and weight loss; diabetes.

Alcohol-related chronic pancreatitis often begins with bouts of acute pancreatitis which may settle. However, prolonged heavy drinking damages the pancreas until chronic pancreatitis develops.

Diagnosis

Diagnosing chronic pancreatitis in its early stages can be difficult. However, once damage is more serious, X-rays and scans can detect the condition. By this time problems such as poor food digestion and diabetes may already have developed.

Tests may include: blood tests; X-rays or CT scans; cholangiogram using an MRI scan.

Treatment

The best treatment for chronic pancreatitis is to stop drinking alcohol, even if it was not the cause. You may also be prescribed painkillers and may even be referred to a pain clinic if necessary. Other treatments include: medicines to replace enzymes that are no longer being produced; restricting the fat in your diet; insulin (if you have diabetes); and vitamin supplements. If you smoke, you will also be advised to quit in order to minimise the risk of developing pancreatic cancer. In some cases surgery may be required, in which case your surgeon will discuss with you the type of operation you need.

Outlook/prognosis

The outlook for chronic pancreatitis varies depending on how old you are when you are diagnosed, your history of drinking and the extent to which your pancreas is damaged.