Pancreatitis Can Be Serious

with Jeffrey Schenck, M.D., gastroenterologist, Columbia St. Mary’s

Last Updated: June 1, 2003

It’s estimated that approximately 70 million Americans cope with digestive disorders. Pancreatitis is a particularly painful one that could lead to life-threatening complications, according to Dr. Jeffrey Schenck, a gastroenterologist with Madison Medical Associates in Mequon. “People with even mild pancreatitis are very ill and in moderate or severe cases it’s not unusual for hospitalization to be required for weeks or even months.”

The pancreas is a digestive gland that’s located behind the stomach in the upper abdomen, he explained. Its function is twofold. It produces hormones, including insulin and glycogen, that control the body’s ability to use sugar; and it makes digestive enzymes, which are proteins that chemically break down fats, proteins and carbohydrates, so the body can absorb them.

“Pancreatitis literally means inflamed pancreas,” said Dr. Schenck. In this condition, the enzymes that usually aid in digestion begin to digest the pancreas. As its own enzymes digest the pancreas, more enzymes are released and continue to inflame the organ and cause complications.

There are two main types: acute and chronic. Pancreatitis usually begins at an acute stage, and in some cases may become chronic after a severe or recurrent attack. The acute stage, which may be related to alcohol abuse, gallstones, medications or surgery, can occur suddenly soon after the pancreas becomes damaged or irritated by its own enzymes. It lasts for a short period of time, and usually resolves itself. Some people with the acute form of the disease may have more than one attack and recover completely after each. But it can be serious, and needs medical attention. Statistics show that about 80,000 cases occur in the United States each year and about 20% are severe.

Chronic pancreatitis occurs over a long period of time after there have been repeated injuries to the pancreas. It needs medical intervention because it results in the slow destruction of the pancreas. “Infections and hemorrhage are two additional problems we see,” Dr. Schenck said.

“There are a number of causes of this disease, but by far the most common cause is the passage of gallstones. They form in the gall bladder and pass out into the bile duct and then are squeezed by the opening to the pancreas.”

He explainsed that the most common symptoms of pancreatitis include severe pain in the mid- to upper-abdomen. “The pain will often penetrate into the back because the pancreas lies right across the front of the spine, close to the back. That’s actually a characteristic feature of the disease because other abdominal pains usually don’t penetrate into the back.”

Other symptoms include nausea and vomiting, fever, jaundice due to blockage of the bile duct from the inflamed pancreas, shock, weight loss and symptoms of diabetes.
“People should see their doctor because of the terrible pain that persists,” he said. “The doctor will take a medical history, ask about alcohol consumption, and do blood tests for pancreatic enzymes.

“The treatment is mostly supportive: Pain medication, lots of intravenous fluids required to maintain kidney function, close monitoring for respiratory failure and support of the lungs if that is happening. Antibiotics are usually needed in the more serious cases because of the risk of infection. And you can’t feed patients while they’re being treated. Any eating stimulates the pancreas and causes the disease to flair. They have to be fed intravenously.”

Putting the pancreas to rest helps stop further neurologic and endocrine stimulation and gives the pancreas the opportunity to repair itself and stop the inflammation and digestion.

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