Pancreatitis

What is the difference between acute and chronic pancreatitis?
Acute pancreatitis is an acute inflammatory process that affects the pancreas and may also impact other body systems such as the lungs, kidneys, etc. In acute pancreatitis, amylase and lipase levels are usually elevated and symptoms can be resolved with bowel rest. Acute relapsing pancreatitis means acute pancreatitis keeps recurring. Acute relapsing pancreatitis can evolve to chronic pancreatitis.

Chronic pancreatitis is the scarring of the pancreas from repeated episodes of pancreatitis. With chronic pancreatitis, the amylase and lipase levels can stay within normal ranges due to the enzyme producing portion of the pancrease has been so damaged by the inflammation of the gland. Frequently, CP is not understood, even in emergency rooms, and the proper diagnosis of pain due to CP is missed because the enzymes are normal.

How do you diagnose pancreatitis?
Pancreatitis is a diagnosis of exclusion. The most common form of diagnosis for acute pancreatitis is amylase and lipase measurements. For chronic pancreatitis, imaging studes such as endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) can show changes in the pancreas from CP. There is a condition of minimal change pancreatitis where the findings are minimal, but the pain is severe.

How do you determine the path of treatment for pancreatitis?
Pancreatitis is a very heterogenerous disease and there are numerous treatment options which are chosed based on each individual patient's specific constellation of symptoms and/or local complications. For acute pancreatitis, not eating and taking Intravenous fluids seems to work until the symptoms have simmered down. For CP, it may be secondary to sphincter of oddi dysfunction or pancreatic divisums where the duct from the pancreas to the intestine is partially blocked. Then endoscopic cutting of the sphincter of putting a stent in the duct may help. If not, then pancreatectomy to relieve the pain should be considered, with an islet autotransplant to prevent and minimize diabetes.

What are the symptoms of pancreatitis and when should you consult a doctor?
The main symptom is abdominal pain, but in chronic pancreatitis, patients may also develop jaundice (yellow eyes and skin, itching) from bile duct obstruction, as well as malabsorption, which manifests as diarrhea.

What causes the pain from pancreatitis?
It is multifactorial. Increased pressure in the duct may cause pain. That is why duct drainage procedures are done. But pain can also occur independent of duct pressure and occurs when the duct pressure is normal. Inflammation can cause pain, and it can be right in the nerves within the pancreas. Or the pancreas can get so hard that is presses like a rock in the abdomen.

Should you treat pancreatitis at home or at the hospital?
Acute pancreatitis usually requires hospitalization. CP usually does not, the main issue is pain control. CP may require hospitalizaion if pain management is not controlled.

What can I do to prevent another attack of pancreatitis?
Avoid alcohol Intake. Avoid fatty, greasy foods and stay hydrated. Dehydration is key to pancreatitis and its recovery.

I don't have elevate amylase and lipase levels, but was diagnosed with pancreatitis. I thought these had to be elevated to have pancreatitis?
Particularly in the situation with chronic pancreatitis, the pancreas may "burn out" and lose the ability to make amylase and lipase, therefore, not causing elevated levels.

Is it true that ERCPs can cause pancreatitis?
Yes, if dye is injected into the duct the pressure can precipitate pancreatitis. Placing a stent of cutting the sphincter can cause pancreatitis. ERCP implies that dye was injected to visualize the duct. Endoscopy with RCP part woudl not precipitate pancreatitis since duct pressure is not increased, but ERCP mean the duct was manipulated.

Can you be born with pancreatitis? Is it hereditary?
This would be rare, even hereditary pancreatitis is usually not manifest at birth, but it can manifest in childhood or adulthood. Is it presumed hereditary? Most of it is not, but we really do not know how much is hereditary since not all are tested for gene mutations. It may be causing more cases than we think. The gene mutation causes a defect in the pancreatic enzyme production, and the enzymes become activated within the pancreas (rather than after secretion into the intestine) and thus damages the pancreas.

Pancreatic Cancer

What are the symptoms of pancreatic cancer and when should you consult a doctor?
Pancreatic cancer may present without symptoms, or patients may experience painless jaundice, decreased appetitie, weight loss, or abdominal pain. Many patients with pancreatic cancer will develop diabetes.

What is the likelihood that if I have pancreatic cancer, it has spread?
Unfortunately, high. The onset of pain or jaundice, the main symptoms, often occurs late in the course of the disease.

Are there any screenings for pancreatic cancer that can be done?
One of the major problems with pancreatic cancer is that there is no good screening test for the disease yet. Cancer antigens can be measured in the blood. Periodic CT scans may pick up the disease. The screenings tends to miss early cancer, so that is one reason the probabilitity of cure is low. Tendency for hereditary pancreatitis, which is associated wiht a cancer risk, can be detected by gene testing.