Pancreatitis is an inflammation of the pancreas, spongy, a tube-shaped organ approximately six inches long located behind the stomach. The pancreas is connected to the upper end of the small intestine and makes pancreatic juices and hormones such as insulin, which controls the amount of sugar in the blood.
Pancreatitis can be acute or chronic. During acute attacks, high levels of a digestive enzyme produced in the pancrease called amylase are found in the blood. There may also be changes in blood levels of sodium, potassium, calcium, magnesium, bicarbonate, glucose, and lipids. The blood levels of these substances usually return to normal after the pancreas recovers.
Attacks of acute pancreatitis can reoccur, but when the inflammation of the pancreas becomes persistent, it is classified as chronic pancreatitis. The chronic form of the condition can cause progressive fibrosis and destruction of the pancreas. The resulting reduction of pancreatic enzymes and insulin can interfere with the digestion of fat and lead to diabetes respectively. Recurrent attacks of acute pancreatitis often occur on top of the chronic course.
Beyond the acute and chronic versions of the disease, there are many different sub-types of pancreatitis depending on its causes. Each sub-type also has its own set of symptoms. Most forms usually begin with upper abdominal pain that may spread to the back and other areas. Both the heart and respiratory rates tend to be elevated and the blood pressure tends to be high. There may be low blood pressure, however, if dehydration or internal bleeding has occurred. Other symptoms may include abdominal swelling, fever, nausea, and vomiting.
The most common of the diverse causes of pancreatitis are gallstones and alcohol abuse. Other causes include surgery or trauma to the abdomen, infections such as the mumps, hormones, chemicals, and the use of drugs and medications. In rarer cases, causes include congenital abnormalities of the pancreas or intestine, hypertriglyceridemia, hypercalcemia, vasculitis, autoimmune pancreatitis, and cancer. In some cases, especially those involving chronic pancreatitis, the cause is unknown.
Following are some of the drugs and medications that have been linked or known to cause pancreatitis:
- Didadosine (DDI – used to treat AIDS)
- Pentamidine (used to treat AIDS)
- Isotretinoin (Accutane)
- Furosemide (Lasix – diuretic used to treat congestive heart failure and edema)
- Hydrochlorothiazide (Dichlotride, Apo-Hydro, Hydrodiuril, HydroSaluric, Aquazide H, Oretic, Microzide – diuretic used to treat various conditions)
- L-asparaginase (Elspar – used to treat lukemia)
- Azathioprine (Azasan, Imuran – immunosupressant)
- Estrogen (by raising blood triglyceride levels)
- Statins (Lipitor, Crestor, Zocor, Vytorin, Baycol – as porphyrinogenic agents)
Treatment depends on the severity of the condition. Acute pancreatitis often improves on its own, in which case only supportive treatment, such as pain relief and IV hydration, may be needed. In some cases, solid food intake, especially fats, will need to be limited. In case of infection or when necrotizing pancreatitis ensues, antibiotics may be indicated. In yet other cases, surgery of the bile duct or removal of cysts, the gallbladder, or dead tissue may be required.