Pancreatitis

What is pancreatitis?

Pancreatitis is the redness and swelling (inflammation) of the pancreas. This happens when digestive juices or enzymes attack the pancreas.

The pancreas lies behind your stomach on the left side of your belly. It is close to the first part of your small intestine (the duodenum).

The pancreas is a gland. It does 2 main things:

• It makes enzymes and sends them into your small intestine. These enzymes help break down food.
• It makes the hormones insulin and glucagon and sends them into your bloodstream. These hormones control your body's blood sugar level.

Pancreatitis may be sudden (acute) or ongoing (chronic).

Acute pancreatitis

• Is a sudden inflammation
• Lasts for a short time
• Lets the pancreas return to normal afterward
• May cause serious problems or be deadly in severe cases

Chronic pancreatitis

• Is a long-lasting inflammation that comes and goes over time
• Causes permanent damage to the pancreas
• Often causes scarring of pancreatic tissue
• May cause the pancreas to stop making enzymes and insulin in severe cases

What causes pancreatitis?

The most common causes of pancreatitis include:

• Alcohol abuse in adults
• Lumps of solid material (gallstones) found in the gallbladder. Gallstones block the pancreatic duct so the enzymes can't get out of the pancreas.

Other causes of pancreatitis include:

• Belly injury or surgery
• High levels of fat particles (triglycerides) in the blood
• Very high levels of calcium in the blood
• Certain medicines, such as estrogens, steroids, and thiazide diuretics
• Infections, such as mumps, hepatitis A or B, or salmonella
• Cystic fibrosis
• A tumor
• Certain genetic defects
• Congenital abnormalities in the pancreas
• Trauma to the pancreas
• Cigarette smoking

What are the symptoms of pancreatitis?

Symptoms differ for each child but may include:

• Severe belly pain, typically above the belly button, that may spread to the back or chest. The pain is typically worse after eating.
• Nausea
• Vomiting
• Rapid heart rate
• Fever
• Lowered blood pressure
• Yellowing of the skin and eyes (jaundice)

How is pancreatitis diagnosed?

Your healthcare provider will look at your past health. He or she will give you a physical exam. You may have some blood tests done. You may also have some imaging tests including:

• Belly X-ray. Makes images of internal tissues, bones, and organs.
• Ultrasound (also called sonography). Uses sound waves to see the internal organs of the belly. It also checks how blood is flowing through different blood vessels.
• EUS (endoscopic ultrasound). This is an internal type of ultrasound done through a flexible tube (endoscope) inserted through the mouth while you are sleeping.
• ERCP or endoscopic retrograde cholangiopancreatography. This is used to find and treat problems in your liver, gallbladder, bile ducts, and pancreas. It uses X-ray and a long, flexible tube with a light and camera at one end (an endoscope). The tube is put into your mouth and throat. It goes down your food pipe (esophagus), through your stomach, and into the first part of your small intestine (duodenum). A dye is put your bile ducts through the tube. The dye lets the bile ducts be seen clearly on X-rays.
• CT scan (computed tomography scan). This imaging test shows detailed images of any part of the body such as the bones, muscles, fat, and organs. CT scans are more detailed than regular X-rays.
• MRCP (magnetic resonance cholangiopancreatography). This uses MRI (magnetic resonance imaging) to make detailed images of your pancreas, gallbladder, and pancreatic and bile ducts. A dye is shot (injected) into your vein so that the images can be seen more clearly.

How is pancreatitis treated?

The treatment goal is to rest the pancreas and let it heal. If the pancreatitis is moderate to severe, you can expect that your child will be in the hospital for a few days, be given intravenous fluids, pain medications, and possibly antibiotics to fight infection. If the pancreatitis is mild and your child can tolerate some oral fluids, then your child will be allowed to eat clear liquids or a low-fat diet.

Pancreatitis often gets better in a few days.

If any problems happen, treatment may include:

• NG tube (nasogastric tube). This is a thin tube passed down your nose and into your stomach. It is used if vomiting is a problem. The tube can be used for a few weeks. It can be used to remove fluid and air and give your pancreas more time to heal. It can also be used to put liquid food into your stomach as you heal.
• ERCP (endoscopic retrograde cholangiopancreatography). This is used to find and treat problems in your liver, gallbladder, bile ducts, and pancreas. It uses X-ray and a long, flexible, lighted tube (an endoscope). The tube is put into your mouth and throat. It goes down your food pipe (esophagus), through your stomach, and into the first part of your small intestine (duodenum). A dye is injected into the bile ducts through the tube. The dye lets the bile ducts be seen clearly on X-rays. The tube has tools in it. The tools can remove fluid and blockages and take out gallstones. They can also put stents (firm tubes) in the ducts to keep them open.
• Surgery to remove gallstones or your gallbladder. This is done if gallstones or your gallbladder are causing pancreatitis.

If your child has chronic pancreatitis, then your child may:

• Have to avoid alcohol and smoking
• Need enzyme supplements to help digest your food
• Need insulin if your child develops diabetes
• Need to eat small high-protein, low-fat meals

What are the complications of pancreatitis?

Acute pancreatitis usually gets better on its own over time. Most people recover without any problems. A small number of cases end up with fluid collections around the pancreas that require drainage.

Chronic pancreatitis may also get better on its own. But that can take longer, after a few attacks. Chronic pancreatitis has a greater risk of long-term problems such as:

• Diabetes
• Chronic pain
• Diarrhea
• Weight loss
• Low vitamin levels from malabsorption
• A collection of fluid (pseudocyst) around the pancreas
• Bile duct blockages
• Permanent pancreas damage
• Pancreatic cancer

Key points about pancreatitis

• Pancreatitis is the redness and swelling (inflammation) of the pancreas.
• It may be sudden (acute) or ongoing (chronic).
• The most common causes are alcohol abuse and lumps of solid material (gallstones) in the gallbladder.
• The goal for treatment is to rest the pancreas and let it heal.
• Your child may need to be in the hospital for a few days.
• In severe cases, your child may need drainage of abnormal fluid collections, imaging tests to evaluate the pancreas for disease and, rarely, surgery on the permanently damaged part of the pancreas.