The pancreas is a glandular organ that operates in relative anonymity compared to its neighboring organs in the abdominal cavity. However, it performs two very important functions: it releases enzymes that facilitate digestion, and it also helps to regulate blood sugar.
If the chemicals secreted by the pancreas to enable digestion do not properly exit the organ into the intestine, they can cause inflammation of the pancreas, a condition known as pancreatitis. This condition can be both acute and chronic – and either way, it is very serious.
On this episode of Kentucky Health, Dr. Wayne Tuckson speaks with a Louisville gastroenterologist about the causes and symptoms of pancreatitis, and about the most effective methods of treating the disease.
Dr. William Evans III practices with Midwest Gastroenterology Associates in Louisville.
The pancreas is located behind the stomach and below the liver, and crossing over the middle portion of the spine. “The pancreas gland regulates glucose, or blood sugar control, but it also makes about a liter of fluid a day, which contains little fluids called enzymes,” Evans says. “These are going to help digest proteins and fats that we consume when we eat meals.”
Causes of Pancreatitis: Gallstones, Alcohol, and Others
The enzymes travel down one main duct in the pancreas and empty into the small intestine, Evans says. This happens constantly, but is increased when a person prepares to eat and also when digestion begins in the stomach.
While the enzymes are in the pancreas, they are not acidic, Evans notes. But once they are secreted into the small intestine, they are activated by other chemicals and become caustic in order to break down fats and proteins. This enables the body to better absorb nutrients.
“If we took the pancreas out of people – which can be done – then they will have what we call a malabsorptive state,” Evans says. “They will not be able to absorb proteins and fats, they would lose weight, and have other symptoms like diarrhea.”
Acute pancreatitis occurs when the enzymatic fluid – or “juice,” as Evans calls it – cannot fully exit the duct out of the pancreas but still becomes activated and begins its digestive process. This will result in severe inflammation of the pancreas.
“In acute pancreatitis, the inflammation can be so profound that the organ can digest itself, and then cause more of what we refer to as a systemic inflammatory response,” he says. “So, a lot of chemicals are released by your body’s defense system that can alter other organ function throughout the body.”
The most common causes of acute pancreatitis are gallstones. These are formed in the gallbladder near the pancreas, which stores bile, the alkaline also used to aid digestion. Bile, created in the liver and stored in the gallbladder, can solidify into stones, which then travel down a duct that empties next to the pancreatic duct.
The gallstones “get trapped just at the end of that duct where it meets the small intestine,” Evans says. “That stone will block the flow of pancreatic juice, and then that juice gets activated, and it auto-digests the gland, causing pancreatitis.”
Evans says that gallstone-induced acute pancreatitis represents the majority of the roughly 200,000 pancreatitis hospitalizations per year. Other causes are excessive and regular alcohol use, and, less commonly, high lipid levels in the blood, infectious diseases, trauma, and some medications. Women are more susceptible to gallstone-induced pancreatitis due to their hormonal differences, while men are more likely to develop pancreatitis due to alcohol use, Evans says.
While acute pancreatitis can happen to almost anyone, Evans says that chronic pancreatitis is a slow progression of the disease caused mainly by alcohol and tobacco use. Over time, regular alcohol and tobacco intake “causes scar tissue to get laid down in the pancreas,” Evans says. “That scar tissue builds up and starts surrounding the nerves in the pancreas, creating pain. And chronic pancreatitis can lead to a lot of problems as well.”
Without medical intervention and a cessation of smoking and/or drinking, the condition worsens and the patient will eventually lose function of the pancreas. This can lead to digestive problems and weight loss, as well as diabetes.
Diagnosis and Treatment Options
Patients who present with pancreatitis usually complain of pain in the upper part of their stomach, Evans says. More specifically, the pain will extend from their stomach to their mid-back region. “Although I’ve never had pancreatitis, most of my patients say that it’s the worst pain they’ve ever had,” he adds.
Diagnosis is made after symptoms are compiled, a patient’s medical history is assessed, and lab tests are conducted. Two enzymes are checked for high levels: amylase and lipase. If they are present at three times the normal level, this is a positive indicator for pancreatitis, Evans says.
A CT scan is then ordered, which can confirm diagnosis and also enable the gastroenterologist to determine if and where any gallstones are present. If they are detected, then an endoscopic surgery is performed to further pinpoint their location, and to remove them.
“In patients who are having a more significant episode of pancreatitis, the sooner we can do a procedure like that, the more effective we can be in helping their outcome and actually detouring them,” Evans says.
Once gallstones are removed, patients will be consulted about possibly removing the gallbladder, since the chances of more gallstones being created and causing problems are high. Perhaps most importantly, Evans says that he will order ultrasound imaging tests for any person who is diagnosed with pancreatitis to determine whether a tumor is present in the pancreas.
Pancreatic cancer is the fourth-leading cause of cancer deaths in the U.S., Evans says. It is difficult to detect early before it spreads to other organs, and is also resistant to most current therapies.
Only patients who have chronic pancreatitis are at increased risk for pancreatic cancer, Evans explains. “If I developed gallstone-induced pancreatitis and was put in the hospital, and received treatment and had my gallbladder removed, my pancreas would return to normal in a few weeks, and that does not increase my risk for pancreatic cancer.”
