PANCREATITIS

 

The gland that sits behind your stomach is called the pancreas and it plays a key role in the digestive system: its juices join bile from the liver and gallbladder to drain into the small intestine. Specifically, the pancreas:

  • Secretes digestive juices enzymes and a substance called sodium bicarbonate into the small intestine.
  • Produces the hormones, including insulin and glucagon, that control your body’s ability to use sugar (glucose).

The digestive juices of the pancreas split your diet’s fats, proteins and carbohydrates into digestible molecules.

 

Acute Pancreatitis

This condition can occur suddenly, soon after the pancreas becomes damaged or irritated by its own enzymes. Its causes are usually gallstones or alcohol abuse. When gallstones pass through the bile duct, they may become stuck, causing normally produced pancreatic enzymes to build up in the pancreas and ultimately damage the pancreas.

In the case of alcohol, the pancreas may be sensitive to the effects of excessive alcohol. An attack may occur anywhere from a few hours to one to two days after drinking alcohol. The amount of alcohol that needs to be consumed to cause pancreatitis will vary from person to person; it usually occurs after a pattern of excessive abuse, such as from binge drinking or excessive daily alcohol use.

Other less common causes of this condition are:

  • Excessive levels of fat particles in the blood  (triglycerides).
  • Some medications.
  • Pancreatic cancer.
  • Certain surgical procedures.
  • Heredity.
  • Idiopathic (unknown causes).

Acute pancreatitis affects about 80,000 Americans every year.

 

Chronic Pancreatitis

This stage of pancreatitis begins as acute pancreatitis and becomes chronic when the pancreas becomes permanently injured or scarred from repeated attacks of pancreatitis. Rarely, chronic pancreatitis may develop after one severe attack of acute pancreatitis.

Chronic pancreatitis is usually due to years of excessive alcohol consumption, but may also develop from other causes of pancreatitis.

With chronic pancreatitis, the pancreas may eventually stop producing the enzymes that are necessary for your body to digest and absorb nutrients. This is called exocrine pancreatic failure. Dietary fat and protein may be poorly digested or absorbed, which can result in persistent diarrhea and weight loss. When chronic pancreatitis is advanced, the pancreas can also lose its ability to make insulin; this is called endocrine failure and may result in the development of diabetes mellitus.

Management of pancreatitis focuses on treating the acute condition and making certain the underlying cause is found and steps are taken to prevent repeat attacks. When alcohol is the cause, treatment relies on resting the pancreas by limiting diet and supportive care with IV fluid resuscitation. Alcohol cessation can prevent future attacks. Most patients will recover either in the hospital or outside the hospital with conservative measures, occasionally severe attacks will need surgery to manage the complications that can occur with pancreatitis. Our doctors work closely with surgeons and radiologists to manage all patients with pancreatitis. Nutrition plays a key role, all of our physicians can manage the nutrition needs of our patients including patients that require long-term IV nutrition or enteral (feeding tube) nutrition.

Gallstone-induced pancreatitis is often manifested as an acute episode of pancreatitis with elevations in the liver enzyme blood tests because of the connection of the bile duct and pancreatic duct. A gallstone that escapes the gallbladder and blocks the pancreas will often block the bile duct and therefore lead to liver enzyme elevation from backup pressure.

Our physicians will perform endoscopic retrograde cholangiopancreatography (ERCP) when necessary to remove the obstructing stone. ERCP is a sub-specialty procedure in gastroenterology, this is performed by Dr. Khaghan and Dr. Schamberg who have had additional training in this procedure. After ERCP, patients will recover in the hospital and elective surgery to remove the gallbladder will be recommended to prevent future gallbladder attacks.

 

Idiopathic Pancreatitis

Idiopathic pancreatitis means that an acute attack of pancreatitis has occurred but the cause is not initially apparent. This occurs in approximately 5% of cases. Many of these episodes are from tiny stones that are not readily apparent on radiology scans or from medications. Endoscopic ultrasound (EUS), is a procedure that takes advantage of the close proximity of the pancreas, bile duct and gallbladder to the stomach and small intestine. By advancing an endoscope (with an ultrasound built into the scope) through the mouth to the stomach and small intestine, zoomed in ultrasound imaging can be obtained of the pancreas, bile duct and gallbladder. Small stones can be found using this technology. Small tumors or cysts of the pancreas can also be discovered, allowing for early detection and diagnosis of cancers of the pancreas.

 

Dr. Schamberg performs EUS at both Greenwich Hospital and Stamford Hospital. Many patients have had their cause of pancreatitis elucidated by having EUS performed.