Pancreatitis occurs when the pancreas becomes inflamed, causing pain in the abdomen 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 years, causing progressive damage.
Acute pancreatitis is less common than chronic pancreatitis, with slightly more men than women affected. The number of cases has risen significantly possibly due to an increase in alcohol consumption. Alcohol is thought to account for over a third of cases; gallstones are also thought to account for over a third of cases. 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.
Most people experience abdominal pain, which can be severe. Vomiting, fever, feeling generally unwell and in some cases the abdominal swelling may occur.
Diagnosis can include blood tests, faeces sample test; urine sample test; chest X-rays, biopsy, CT scans, ERCP and MRI scans.
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.
In most cases people with acute pancreatitis will make a full recovery with no aftereffects. In some cases there may be complications which can be very serious, even life-threatening. The best way to reduce chances of developing acute pancreatitis is to avoid drinking large quantities of alcohol.
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.
Causes of chronic pancreatitis:
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 may include: nausea ; 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.
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.
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.
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.
Pancreatic cancer is relatively uncommon and is particularly rare in people under the age of 50.The most common type is ductal adenocarcinoma and it starts in the cells in the inner lining of the pancreatic ducts. Other rarer types of pancreatic cancer include: neuroendocrine tumours; lymphoma; and pancreatic sarcoma. If pancreatic cancer is detected in the early stage, surgery can be done to remove the cancer. However, because it is difficult to detect, by the time your cancer is diagnosed it may already have spread to other parts of your body and may not be curable. In these cases, there are a number of treatments that can improve quality of life and help prolong life. The type of treatment will depend on which part of the pancreas is affected and how much the cancer has spread.
Risk factors for getting pancreatic cancer:
You are more likely to get pancreatic cancer if you:
• Are aged 60-80 although some rare types may affect younger people
• Smoke – around a third of pancreatic cancers are linked to smoking
• Have or have had pancreatitis (inflammation of the pancreas)
• Have diabetes (although most people with diabetes will not get pancreatic cancer)
Pancreatic cancer may not cause symptoms for a long time. The most common symptoms are pain in the upper abdomen, sometimes spreading to the back; weight loss; and jaundice. Other symptoms may include nausea, indigestion, bloating after meals and fatigue.
Diagnosis may be difficult because symptoms are not always obvious. The doctor may examine you for jaundice, test your urine for bile and do a blood test. Diagnostic tests include: CT scan, ultrasound, MRI scan, ERCP, EUS, biopsy and laparoscopy.
Treatment includes surgery to remove all or part of the pancreas if the cancer is small, and in the early stages. Chemotherapy is used to control the symptoms and make the patient feel more comfortable.Where surgery is not possible chemotherapy and radiotherapy is offered.
The outlook for pancreatic cancer depends on how far the cancer has progressed when it is diagnosed. If diagnosed early there is a better chance of successful treatment, which may be surgery. However, if cancer is diagnosed when it is advanced, and is not suitable for surgery, the chances of recovery are reduced. Other factors that may affect outlook include how good your general health is, and the ‘grade’ of cancer you have. This means the level of the abnormality of your cancer cells compared with normal cells. The higher the grade, the more quickly the cancer is likely to grow.