American Medical Association Family Medical Guide - American Medical Association [527]
Symptoms
The primary symptom of acute pancreatitis is severe pain in the center of the upper abdomen. It often begins 12 to 24 hours after eating a large meal or drinking an excessive amount of alcohol. The pain seems to bore through to the back and is accompanied by vomiting. In severe cases, a person can become extremely ill and feverish and have bruise marks on his or her abdomen from internal bleeding around the pancreas. Cystlike blisters (pseudocysts) sometimes form on the pancreas after an attack. If they cause symptoms such as pain, they may need to be removed surgically or drained.
Diagnosis
If you have symptoms of acute pancreatitis, your doctor will admit you to the hospital. To make a diagnosis, the doctor will order a CT scan (see page 112) to examine the pancreas and blood tests to measure levels of some pancreatic enzymes and other proteins that are linked to acute pancreatitis.
Treatment
If you have acute pancreatitis, you will probably be given a pain reliever and should not eat or drink (fasting reduces the levels of pancreatic juices). Shock is treated with fluids given intravenously (through a vein). If you have a bacterial infection, you will be given antibiotics. As you recover, you can gradually start eating and drinking again. Your doctor will tell you to avoid alcohol to prevent chronic pancreatitis (see below). After you have recovered from the attack of acute pancreatitis, your doctor will recommend an ultrasound scan (see page 111) to look for gallstones to determine if they were the cause of the attack. If you have gallstones, the doctor may recommend having them removed (see page 795). If pancreatitis is severe, debridement (removal) of part of the inflamed tissue of the pancreas may be required.
Chronic Pancreatitis
Chronic pancreatitis is a disease of the pancreas that develops gradually, usually after several years of alcohol abuse (see page 733). Chronic pancreatitis occurs when digestive enzymes attack and destroy the pancreas and nearby tissues, causing scarring. As the disease progresses, the pancreas eventually loses its ability to supply digestive juices and hormones (such as insulin). The resulting lack of digestive fluids can reduce the body’s ability to absorb nutrients from food. If insulin is not available to push glucose into cells, glucose can build up in the blood, causing diabetes (see page 894).
Alcohol-related chronic pancreatitis is more common in men than in women and usually develops between ages 30 and 40. The condition can sometimes be triggered by one attack of acute pancreatitis (see previous page), especially if the pancreatic ducts are damaged; this damage can cause inflammation in the pancreas that can kill pancreatic cells and lead to scarring. The pancreatic ducts can be damaged or blocked by an injury or by pseudocysts (cystlike accumulations of pancreatic fluid) that form in the duct.
People with the inherited genetic disorder cystic fibrosis (see page 958) are at risk of developing chronic pancreatitis because the defective gene that causes cystic fibrosis makes a protein that plugs up the pancreatic ducts (which normally deliver digestive enzymes to the intestine). The buildup and activation of digestive enzymes in the pancreas cause the pancreas to digest itself, damaging tissue and causing severe pain. An inherited form of pancreatitis has the same progression as the noninherited forms, but people with inherited pancreatitis have a 50-fold increased risk of eventually developing pancreatic cancer (see next page). In many cases, the cause of chronic pancreatitis cannot be determined.
Symptoms
Pain is the major symptom of chronic pancreatitis, although 10 percent of affected people do not have any pain. The pain, which occurs primarily in the abdomen and back, is dull and cramping, usually worsens when you drink alcohol or eat, and is relieved when you sit up and lean forward. As the disease progresses, the pain becomes constant.
People often lose weight, even when eating normally, because their body is not absorbing nutrients