T he pancreas is a gastrointestinal (GI) organ responsible for digesting foods and liquids. Along with the other gastrointestinal organs, the pancreas helps break down food contents, transforming them into molecules easily absorbed by the digestive system.
The pancreas also secretes hormones that regulate other body processes, such as glucose (sugar) uptake. Over time, a deficiency of these hormones, such as insulin, can lead to diabetes.
The pancreas secretes several enzymes to digest food. One common secretion is bicarbonate, a base that neutralizes the powerful acid secreted from the stomach and the first part of the small intestine, the duodenum. While food is still present in the duodenum, the pancreas will continue to secrete enzymes, leading to further digestion as the food traverses the remaining gastrointestinal tract. The process of digestion continues until the residual components are further metabolized by the colonic bacteria, which eventually is excreted in the form of feces.
Pancreatitis is an inflammation of the pancreas, which can no longer secrete the digestive enzymes. Many causes of acute pancreatitis exist. However, the most common ones in the United States include gallstones and alcohol use, accounting for 80%-90% of total cases. Lesser causes include complications from an ERCP procedure, high triglycerides, genetic deficiencies of proteins needed for pancreatic function and, very rarely, drugs.
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Patients will usually present with severe, unrelenting abdominal pain that is not easily resolved with over-the-counter medication. The pain is usually in the epigastric region, which is located in the upper middle region of the abdomen, and sometimes will radiate to the back. There is an inability to eat or drink, including water. Each time the patients attempt to drink or eat, they develop severe pain.
They may complain of nausea and vomiting. Patients usually “wait out the pain” before seeking emergency care, which often follows. Several blood tests can indicate acute pancreatitis in the emergency department (ED). The ED physician will establish whether or not sepsis is present, which, if so, will necessitate an ICU admission. Sometimes, an ultrasound in the ED is performed if gallstones are suspected. If ultrasound imaging is not emergently available, a CT scan will be performed. After the decision to admit, the admitting physician will determine if ICU or a medical surgical unit is needed.
The patient will receive treatment with intravenous (IV) fluids, pain medications and IV nausea medications. The patient may be instructed to withhold food or liquid, giving their GI system a “bowel rest.” The diet will be gradually re-introduced, often in liquid form, before transitioning to a solid, bland diet. Once the pain is improved and the patient can demonstrate eating without eliciting symptoms, they will be ready for discharge.
During the workup of acute pancreatitis, the physician may determine that your gallbladder is causing the problem. A consultation with surgery may be requested to determine if you need the gallbladder removed either during the hospital stay or afterward. The guidelines state that if the pancreatitis is of mild severity, the cholecystectomy, or gallbladder removal, should be performed before the patient leaves the hospital. Any patient with a more severe manifestation of the disease may warrant postponement of surgery.
Pancreatitis is a common diagnosis and is the most common reason for GI admissions to the hospital. Patients are usually in the hospital for an average of four days. There is a 1% risk of mortality. Risk factors for hospitalization include older age and male sex. A small percentage of patients will have a second episode; these episodes are usually prompted by alcohol use or gallstones.
If you drink alcohol heavily or have a history of gallstones, you are at risk for developing acute pancreatitis. Keep the symptoms in mind and don’t hesitate to go to the ED if the symptoms become severe.
Dr. Naznin Jamal is a Jefferson Regional Medical Center hospitalist.