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What are the common causes of acute pancreatitis?

In the United States and in many parts of the world, alcohol and gallstones are

the two most common causes of acute pancreatitis. Other causes include drugs,

infectious agents, hypertriglyceridemia, trauma, and pancreatic duct

obstruction.

How frequently is there no clear cause for acute pancreatitis?

In approximately 10-20% of cases of acute pancreatitis, there is no readily

identifiable cause and it is termed idiopathic.

I have recurrent acute idiopathic pancreatitis. Why should I have my gallbladder

removed?

This is because many patients in your condition are eventually found to have

microlithiasis (sludge or very small stones). Some patients have genetic

mutations in the trypsinogen gene or the cystic fibrosis gene.

I was diagnosed with chronic pancreatitis 2 years ago, now my duct is dilated

and my gastroenterologist is recommending the Puestow surgery. Will my pain go

away?

The Puestow procedure, also known as a lateral pancreaticojejunostomy, is a

surgical procedure where the pancreatic duct is exposed and attached to the

jejunum to allow adequate drainage of the pancreas. The surgery has been

reported to relieve pain initially in approximately 80% of patients. Only about

40% of patients remain pain free after one year.

What is the function of the pancreas?

The pancreas is an organ that has two different functions in assisting the

processing of the food that we eat. First, the pancreas has an exocrine function

that produces many enzymes that help to break down fat and protein in food.

Second, the pancreas produces the hormones insulin and glucagon which help

regulate blood sugar.

Diseases of the pancreas may affect either of these functions causing specific

disease states. When the endocrine function is altered, diabetes mellitus may

develop. When the exocrine function is affected, malabsorbtion of fat or protein

may occur.

What is pancreatitis?

Pancreatitis as defined by Stedmans Medical Dictionary is the " inflammation of

the pancreas. " There are several different types of pancreatitis, including

acute pancreatitis, and chronic pancreatitis.

Acute pancreatitis is a condition in which the pancreas becomes inflamed

suddenly. The pancreas actually digests itself by autoactivation of digestive

enzymes. When this occurs, the patient develops a sudden onset of symptoms

including nausea, vomiting, and abdominal or back pain. The symptoms can be mild

to severe and in rare instances, life-threatening. The usual causes of acute

pancreatitis are alcohol use and gallstones which migrate into the common bile

duct. Other causes of acute pancreatitis include medications, infection (virus,

bacteria), abdominal trauma and post ERCP (Endoscopic retrograde

cholangiopancreatography) pancreatitis. Often times patients are hospitalized

for treatment. This treatment includes " putting the pancreas to rest " by not

feeding the patient, pain medications and intravenous fluids. At this time there

is no specific treatment for acute pancreatitis. Most patients recover

completely from an episode of pancreatitis. If the cause of the pancreatitis is

found and corrected the pancreatitis will not recur. Rarely, complications

develop after an episode of acute pancreatitis. The most common of these

complications include formation of a pancreatic pseudocyst. This is a collection

of fluid around the pancreas. These generally resorb after several weeks without

any intervention.

Chronic pancreatitis is the inflammation of the pancreas that does not resolve

after the cause of the pancreatitis is removed. Persistant damage occurs over

long periods of time. Symptoms may include constant or intermittent pain coming

in discrete attacks. Nausea, weight loss, lack of appetite and foul-smelling

diarrhea may occur. In the later stages of the disease, diabetes may develop.

The causes of chronic pancreatitis include alcohol, cystic fibrosis and other

hereditary diseases.

What is the pancreas divisum?

Pancreas Divisum is the most common congenital abnormality of the pancreas. It

occurs in approximately 7% of the general population. This condition is caused

by the failure of the fusion of pancreatic ducts during embryologic development

(within the mother's womb).

Pancreas divisum is diagnosed at the time of a pancreatography. In the past,

this was only accomplished by an ERCP (Endoscopic retrograde

cholangiopancreatography). Currently, MRCP (magnetic resonance

cholangiopancreatography) can also be used to diagnose this condition.

Pancreatitis is a complication of Pancreas divisum. Approximately 20% of the

causes of idiopathic pancreatitis are due to pancreas divisum. Most patients

with Pancreas divisum have no symptoms of pancreatitis. Pancreas divisum is

believed to cause pancreatitis due to having the majority of the pancreatic

secretions drain through a very small opening (the accessory ampulla). This

condition may cause relapsing pancreatitis and eventually chronic pancreatitis.

It is rare that this is a life-threatening problem.

The treatment of Pancreas divisum, which causes pancreatitis, is individualized

to the patient. In most instances the treatment is medical. A low fat, low

protein diet is encouraged. Patients are advised not to drink alcohol. In some

instances pancreatic enzyme supplementation is provided to the patient. On

occasion the therapy will include endoscopic sphicterotomy or surgical

sphincteroplasty. These procedures are done to widen the small opening of the

pancreatic duct.

What causes the amylase level to increase?

Amylase is an enzyme that is produced mainly by the pancreas and the salivary

glands. Amylase is often elevated in acute and chronic pancreatitis. Several

other conditions can cause the amylase to become abnormal, and as a result, it's

elevated state is not a specific indicator for a disease of the pancreas.

A test to measure the level of amylase is often ordered by a physician in

patients whom are experiencing abdominal pain. The conditions which cause this

to be elevated include acute pancreatitis, chronic pancreatitis, pancreatic

pseudocyst, ischemic bowel (a condition in which blood flow is interrupted to

the small or large intestine), or a ruptured viscus (i.e. perforated ulcer). The

amylase may be elevated in patients with other non gastrointestinal disorders

such as macroamylasemia, and renal failure.

How serious is an enlarged pancreas if I have no pancreatic symptoms?

If the enlarged pancreas is an incidental finding in an abdominal CT scan or

ultrasound, there are no lesions like masses or cysts, and the pancreatic duct

is normal size, it is a normal pancreas.

I had ¾ of my pancreas removed. Fortunately, I only need pancreatic enzymes.

Will I develop diabetes?

It is possible that you may develop Diabetes Mellitus. It is important to know

the signs and symptoms of Diabetes. Excessive thirst, frequent urination, blurry

vision and frequent infections may be signs. Notify your physician if any of

these develop. Your blood should be checked by your physician for an elevated

blood sugar on a biannual basis.

Can you die if you have your pancreas removed?

Total pancreatectomy is a procedure that involves intraoperative and

postoperative risks. Long term complications are usually related to glucose

control. Currently, many surgeons will perform a pancreatic auto transplantation

in order to prevent or decrease the severity of diabetes.

Under what conditions is a pancreatic transplant performed?

Pancreatic transplantation is indicated in diabetic type 1 patients who have, or

are likely to develop the secondary lesions of diabetes like retinopathy

(problems with vision that may lead to blindness), nephropathy (problems with

the kidneys that may lead to hemodialysis), and neuropathy (problems with the

nerves that may lead to altered sensation, impotence, incontinence to urine

and/or stool). It is a major operation and there is the need for

immunosuppression.

Is it possible to get a pancreas transplant for the treatment of chronic

pancreatitis?

Not at the present time.

Can I drink one glass of wine a week if I have chronic pancreatitis?

Alcohol even in small amounts is absolutely contraindicated if you have chronic

pancreatitis.

I have chronic pancreatitis. Do vitamins work to prevent the pain? Which ones

should I take?

There are reports in the medical literature on vitamins that relieve oxidative

stress in the pancreas (antioxidants), thus improving and/or preventing the pain

in chronic pancreatitis. Vitamins that have been used include: vitamin E 400

IU/day and vitamin C 500mg/day. Selenium (trace element) and methionine

(essential aminoacid) have shown good results as well.

Can a bite from a poisons snake cause pancreatitis?

No. The only venom known to produce pancreatitis is from the scorpions Tityus

trinitatis and Tityus serrulatus, found in South America.

I have recently been diagnosed with duodenal stenosis and following a CT scan

have been told that this may be due to an annular pancreas. Is there anything

non-surgical I can do to prevent further complications or reverse those that I

have?

In symptomatic patients, treatment of annular pancreas is surgical alleviation

of the obstruction. Division of the annulus is not recommended because of the

high incidence of pancreatitis and pancreatic fistulas complicating that

procedure. Bypass of the obstructed intestinal segment is the preferred

procedure.

What does an elevated gastrin level indicate?

Gastrin is a hormone produced by G cells in the stomach that stimulate the

production of gastric acid. Different conditions may result in increased levels

of gastrin: e.g. patients with pernicious anemia, atrophic gastritis, renal

insufficiency, gastric outlet obstruction, medications that block gastric acid

production (H2 blockers and proton pump inhibitors), and a neuroendocrine tumor

called Zollinger Ellison that may be located in the pancreas.

What causes pancreatitis?

The major causes of pancreatitis in developed countries include: 1) alcohol, 2)

gallstones, 3) medications, 4) hyperlipidemia (elevated triglycerides). Less

frequent causes included 1) hypercalcemia (elevated calcium in the blood), 2)

genetic mutations, i.e. Cystic fibrosis, 3) infections (mumps, CMV), 4) HIV

infection, 5) trauma, 6) pancreas divisum and 7) post ERCP.

As far as I know, about a hundred years ago it was discovered that the loss of

pancreas caused sugar to appear in urine, like with diabetics. A tried cure for

diabetes was to give patients pancreas extracts but it was unsuccessful. Could

you please explain why?

The extract was insulin. The insulin given orally is broken down by digestive

enzymes.

On Thursday, July 26th, my father was diagnosed and admitted to the hospital

with acute pancreatitis. He died on July 28th, 30 hours after admission. Can one

die from acute pancreatitis?

Most attacks of acute pancreatitis are mild. Patients will generally improve

after 3-5 days. Ocassionally, however, pancreatitis may become severe and life

threatening. In these cases mortality rate can be quite high.

I recently had a CT Scan and the doctor said the pancreas was somewhat atrophic.

What does that mean?

The CT scan of the abdomen is a very good test to evaluate the pancreas. It can

demonstrate many abnormalities, specifically it looks at the substance of the

pancreas, the duct within the pancreas and the blood vessels and other

structures adjacent to the pancreas. Atrophy refers to reduction in size of the

pancreas. It is very common with advancing age.

My father and his brother died of pancreatic cancer. Each were in their 60's. I

am a female, 65 years old. I have recently had a heart and lung CT scan. The

lung screen impression states that there is some " punctate pancreatic

calcifcations " . My doctor cannot answer this question, " If calcium deposits in

the breast are warnings of breast cancer, are calcium deposits in the pancreas a

warning of pancreatic cancer?

Calcium deposits within the pancreas are commonly seen in patients with chronic

pancreatitis. Calcium deposits within the pancreas are not commonly known as a

marker for pancreatic cancer. There is however a slight increased risk of

developing pancreatic cancer inpatients with chronic pancreatitis. The symptoms

of pancreatic cancer can be quite vague. Symptoms can include: 1) upper

abdominal pain, which may or may not radiate to the back, 2) pain after eating,

3) weight loss, 4) loss of appetite, loss of energy, sense of not being able to

finish a meal, 5) onset of newly diagnosed diabetes mellitus, 6) Jaundice, which

includes eyes and skin turning yellow, stool turning tan in color and urine

darkening to a tea color.

What is the life expectancy for someone with chronic pancreatitis?

The life expectancy is not changed just because of chronic pancreatitis.

Is cigarette smoking a risk factors for Pancreatic Cancer?

Cigarette smoking is a strong risk factor for pancreatic cancer (among others)

that can be eliminated. Other identified risk factors are advanced age, male

gender, black ethnicity, Type-1 diabetes mellitus, chronic pancreatitis,

hereditary or familial pancreatitis, and pancreatic cancer in close relatives.

How is the diagnosis of Pancreatic Cancer made?

The clinical symptoms depend on the location of the tumor. Tumors in the body or

tail of the pancreas tend to give symptoms in advanced stages (when the tumor is

big or has seeded other organs). When located in the head of the pancreas,

painless jaundice (yellow coloration of the skin or eyes) is usually present.

Independent of the location, weight loss and anorexia (lack of appetite) are

frequent complaints. The most frequently used radiological test is the abdominal

computer tomography scan.

Can birth control pills trigger pancreatitis?

There is no evidence that a healthy woman may develop pancreatitis due to birth

control pills. Patients with hypertriglyceridemia (elevated triglycerides) or a

history of pancreatitis should avoid BCP with high doses of estrogen. Estrogen

may further increase blood levels of lipids (specifically triglycerides) that

may trigger pancreatitis.

What medications are associated with pancreatitis? Can you mention which ones?

Pancreatitis due to medications is very unusual. Over 55 drugs have been

implicated as triggers of pancreatitis. In order to correlate a drug as having

an association with pancreatitis it should:

(1) Pancreatitis develops during treatment with the drug.

(2) Other likely causes of pancreatitis are not present.

(3) Pancreatitis resolves upon discontinuing the drug.

(4) Pancreatitis usually recurs upon readministration of the drug.

The following drugs have been shown to have a strong correlation with

pancreatitis:

(1) Medications to treat AIDS: didanosine and pentamidine.

(2) Antimicrobial (antibiotics): metronidazole, sulfonamides, and tetracycline.

(3) Diuretics (to treat fluid overload): furosemide and thiazides.

(4) Drugs used in Inflammatory bowel disease: Sulphasalazine.

(5) Immunosuppressive agents: Azathioprine.

(6) Others: Estrogen and sulindac.

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