The pancreas is located at the level of the abdomen, behind the stomach, and participates in the processes of metabolism (endocrine function) and digestion (exocrine function).
The organ is responsible for the secretion of hormones called insulin and glucagon – which assist in the regulation of blood sugar and in obtaining energy – and for the release of pancreatic juice – which helps in the digestion of fats and carbohydrates .
Changes in its functioning are very harmful to the rest of the organism, representing risks to the patient’s health.
Among the complications or changes that can manifest is pancreatitis, an inflammation of the pancreas. Find out more about her:
Pancreatitis is characterized by severe inflammation of the pancreas , which can be divided into chronic or acute. The most common symptoms include abdominal pain, nausea, swelling and bloating in the belly, vomiting, intestinal changes and fever .
Genetic factors, infections and the use of medications can trigger inflammation, however, approximately 80% of diagnoses result from the abuse of alcohol and stones in the gallbladder.
Briefly, the pancreas secretes pancreatic juice (which is rich in digestive enzymes) to the duodenum, which is the initial part of the intestine. Among the pathways that connect the pancreas and duodenum is the Wirsung channel, which is the main route of pancreatic juice forwarding.
This fluid filled with enzymes makes up a necessary part for the digestion of carbohydrates, fats and proteins , aiding in the absorption of nutrients and neutralization of stomach acids.
When there are obstructions or changes in the conduction channels of the pancreas (pancreatic ducts), preventing the release of pancreatic juices, these substances accumulate in the organ and start to damage its functioning.
The condition, when left untreated, tends to be progressive because the pancreas starts to accumulate more and more enzymes that, instead of being released, are concentrated in the region and start to damage the organ, which can cause edema , hemorrhage and even necrosis.
At ICD-10, the disease can be classified under the codes:
- K85.0 – Idiopathic acute pancreatitis;
- K85.1- Acute biliary pancreatitis;
- K85.2 – Alcohol-induced acute pancreatitis;
- K85.3 – Drug-induced acute pancreatitis;
- K85.8 – Other acute pancreatitis;
- K85.9 – Acute pancreatitis, unspecified;
- K86.0 – Alcohol-induced chronic pancreatitis;
- K86.1 – Other chronic pancreatitis.
Pancreatitis can be classified as acute or chronic, according to the manifestation of symptoms and the patient’s history. Learn more about each one:
Acute pancreatitis is characterized by the sudden onset of the dysfunction, in which a healthy person begins to show intense symptoms, but which in general are quickly stabilized with treatment.
With the obstruction of the pancreatic duct, digestive enzymes accumulate in the pancreas and affect its functioning, generating inflammation that tends to be extremely painful.
The condition can be caused, for example, by drug use, alcohol abuse, trauma or not yet having a known cause. But gallstones and alcohol are the major causes of the pathology, accounting for about 80% of diagnoses.
Severe acute pancreatitis
The acute type that presents complications or high risks to the patient’s life can be classified as severe acute pancreatitis.
In general, it is associated with dysfunctions of the organism with high impairment of the organic system and the presence of complications such as necrosis, abscesses or pseudocysts (nodules that concentrate pancreatic cells loaded with enzymes, necrotic tissue and blood).
Basically, it is an accentuated or complicated picture of acute pancreatitis.
In chronic pancreatitis, the patient has probably experienced other episodes or manifested symptoms prior to the diagnosis, but the mechanism of the disease is quite similar in both: something triggers an obstruction of the pancreatic duct and starts inflammation of the organ.
The organ is gradually and persistently affected, causing the formation of scar tissue, resulting from the hardening of the pancreas tissues. Gradually, the cells that produce pancreatic juice are being destroyed and, therefore, there is a loss of functionality.
With the least amount of digestive enzymes, there is a greater likelihood of problems related to digestion, especially of fats.
In the chronic type, hereditary factors or the presence of cancer may be involved in the pathology, and, in addition to abdominal pain, it is common for the patient to develop type 2 diabetes and intestinal malabsorption syndrome.
Therefore, if there are cases in the family, attention must be paid to the health of the pancreas.
In general, people over 40 are the most affected by the chronic type, but the pathology can also present in children, especially if there is the presence of cystic fibrosis .
Pancreatitis is an inflammation of the pancreas due to the obstruction of channels that lead to secretions into the duodenum (the initial part of the intestine). Without being able to eliminate the fluids produced, the organ begins to ignite due to the action of digestive enzymes.
In a healthy organism, they are secreted by the pancreas and sent to the small intestine in a state of inactivation.
In other words, it is as if they still need a command to start performing their functions. Only when they reach the duodenum (the initial part of the intestine) will they undergo activation processes and begin digestive action.
However, in patients with pancreatitis, the enzymes start to act in the pancreas, due to the dysfunction of the organic system that activates them before the right time. The result is irritation and inflammation of the organ, triggering the symptoms of pancreatitis.
The enzymes then attack the tissues of the pancreas and damage its functioning, promoting the production of cytokines (which are substances related to inflammation).
Enzymes and cytokines can cause processes similar to chemical burns (that is, destruction of tissue) and generate accumulation of fluids and fluids in the pancreas (which causes swelling of the organ).
In some cases, cytokines are released and spread throughout the body, which can cause lung damage and kidney failure.
It is not always possible to determine the causes of pancreatitis, but among the factors involved are:
Alcohol abuse (alcoholic pancreatitis)
Alcohol abuse is among the most frequent causes of acute and chronic pancreatitis. Constant or exaggerated consumption can cause damage to pancreatic tissues, causing changes and obstructions in organ functions.
It is estimated that it is necessary to drink 100g of alcohol daily so that the risks of pancreatitis are imminent (to reach this amount, it is necessary to drink about 8 cans of beer or 800mL of wine per day).
On average, it takes between 3 and 5 years for injuries and symptoms resulting from alcohol abuse to begin to manifest.
In addition, the recurrence of acute conditions can evolve to a chronic manifestation, with prolonged damage from the disease.
Gallstones (biliary pancreatitis)
Gallstones or gallstones are characterized by the formation of small masses that are formed by the solidification of bile, inside the gallbladder (organ close to the liver).
Although the mechanism is not completely understood, in some cases, these stones can obstruct or clog the pancreas secretion channels, causing acute pancreatitis.
Medicines (medicated pancreatitis)
Among the drugs most related to acute pancreatitis are diuretics, anticonvulsants and some used after organ transplantation, such as sulfasalazine , azathioprine , metronidazole , tetracycline , pentamidine, valproic acid , tamoxifen .
Injuries, injuries and traumas (which can cause the organ to be perforated or not) in the region of the pancreas can result in persistent damage to organ function, leading to acute pancreatitis.
In addition to medications, acute pancreatitis can be due to intoxications of the organism that result in altered pancreatic functions. Intoxications include scorpion venom and insecticide inhalation.
Mumps and hepatitis are among the infections that, when they present complications or worsening, can trigger acute pancreatitis.
Tumors and genetic abnormalities of the pancreas
Hypercalcemia (high concentrations of calcium in the blood), hyperlipidemia (high concentrations of lipids, such as cholesterol and triglycerides, in the blood) can damage the tissues of the pancreas and cause inflammation.
Examinations, surgeries and postoperative
Especially surgeries performed on the stomach and biliary tract can trigger acute inflammation in the pancreas.
In addition to them, some tests can cause pancreatitis, such as endoscopic retrograde cholangiopancreatography or ERCP, which is indicated to diagnose diseases that affect the biliary and pancreatic channels.
In the examination, a contrast is introduced (a substance that makes it easier to assess organ images) in the ducts to be examined. This substance can leak and reach the pancreas, and in about 3% of patients an episode of acute pancreatitis may occur.
Autoimmune conditions can cause chronic pancreatitis, being more frequent in men (about 80% of diagnoses).
As the autoimmune aspects are quite diverse, not all are completely clarified, but it is attributed to the formation of infiltrations and fibrosis in the tissues, causing an obstruction of the pancreas ducts.
That is, in these cases, the organism causes the cells themselves to attack the organ, generating dysfunctions.
As with other autoimmune conditions, it is difficult to define what causes the organism’s wrong behavior, but it is known that this type of pancreatitis occurs due to inflammatory processes in the pancreas, which lead to tissue fibrosis and organ dysfunction.
Genetic aspects are closely related to the chronic manifestation of pancreatitis, and changes or mutations in specific genes (CFTR, PRSS1 and SPINK) may indicate predisposition to inflammation.
Smoking is among the behaviors that can lead to pancreatitis due to direct and indirect mechanisms. On average, people who smoke 20 packs of cigarettes or more a year are already at greater risk of suffering from functional changes in the pancreas.
Cigarettes contain nicotine and approximately 400 other substances that are toxic to the body. In addition to the various harms that these components – many of them carcinogens – can bring, nicotine has a direct association with pancreatic mechanisms.
Research published in 2013 in the medical journal Jornal de Terapia para o Câncer indicates that animals exposed to cigarette smoke showed lesions in the pancreas and alteration of a gene related to the secretion of pancreatic enzymes.
It should also be considered that the risks of cancer are higher, allowing pancreatitis to be a consequence of tumors in the organ.
In addition to the direct relationship between smoking and pathology, cigarette consumption is associated with the habit of drinking, leading to a reinforcement cycle: the person ingests alcohol and feels like smoking, further elevating the risks to the pancreas.
Among the aspects that can favor pancreatitis are:
- Alcohol abuse;
- High levels of triglycerides;
- Abdominal surgery;
- Pancreatic cancer;
- Use of some medications;
- Hypercalcemia (high calcium in the blood);
- Cases of pancreatitis in the family;
- Injury, trauma or injury to the abdomen;
The abdominal pain is prevalent in both types of pancreatitis, usually in moderate or intense. When severe, the pain can reach extreme levels, becoming disabling.
In general, it tends to radiate to the back and gets worse when the patient eats (especially when the meal is greasy).
Some patients, especially those who have pancreatitis due to alcohol, may experience milder and milder pain, although it is also constant.
In acute cases, pancreatitis tends to cause a distended and sensitive abdomen, in which the patient presents with swelling in the belly region, fever, malaise, pressure drops and dehydration.
As the functions of the pancreas are affected, with no correct enzyme release, digestion is compromised and consequent symptoms of this can manifest:
- Nausea and vomiting;
- Weight loss without apparent cause;
- Alteration of the color and consistency of the stools (presence of fat and yellowish color);
In addition to the symptoms resulting from poor digestion, it is important to pay attention to the possibility of malnutrition in cases of prolonged pancreatitis, as food degradation and absorption are compromised, allowing nutritional deficiencies and deficiencies to settle.
Other symptoms and conditions that can also manifest are:
- Jaundice (yellowish color of the skin);
- Acceleration of heart rate (acute pancreatitis);
- Pancreatic insufficiency;
- Intestinal malabsorption;
- Elevated blood glucose;
- Splenic vein thrombosis (obstruction of the vein that carries blood from the spleen);
- Biliary or duodenal obstruction;
- Isolated hyperbilirubinemia (increased bilirubin in the blood, a substance resulting from the metabolism or destruction of red blood cells);
- Ascites (accumulation of fluid in the tissues of organs in the abdomen, causing swelling);
- Pleural effusion (accumulation of fluid between the lung and the membrane that covers it).
To make the diagnosis of pancreatitis, the doctor will make a survey of the symptoms and the patient’s history. Severe pain is usually quite characteristic, which allows suspicions of inflammation to be raised quickly.
The doctor can physically assess the patient to identify signs of abdominal swelling, but it is through clinical examinations of serological markers (amylase or lipase enzymes) and the exclusion of other conditions that may have similar symptoms that the diagnosis is confirmed.
To treat pancreatitis, the most recommended professional is the gastroenterologist .
To confirm the diagnosis of pancreatitis, tests are requested and must be evaluated with the patient’s history, such as:
Blood tests are quite common and help to detect various changes, dysfunctions or conditions of the organism. To help diagnose pancreatitis, the most common are:
- FBC : able to assess the amount of leukocytes (white blood cells or defense cells), which are usually elevated in an attempt to fight inflammation;
- Electrolytes, calcium, magnesium, glucose, urea, creatinine : changes in the results of these tests usually indicate dysfunctions in the body, but should not be analyzed in isolation. Therefore, the tests only help to make the diagnosis of pancreatitis;
- Amylase and lipase : are digestive enzymes responsible for the breakdown of starches and fats, respectively. In general, concentrations are quite high in cases of pancreatitis, especially in the first 12 hours after the attack.
Through liver function tests, also performed through normal blood collection, it is possible to measure the concentrations of:
- AST (Aspartate aminotransferase) : an enzyme found in the muscles, pancreas and kidneys, which, if elevated, may indicate acute pancreatitis;
- Bilirubin : result of the metabolism of red blood cells (blood cells) and fat digestion aids, if elevated, may indicate obstruction by gallstones or pancreatitis due to other causes.
Urine and stool tests
Urine and stool tests are usually requested when chronic pancreatitis is suspected. The urine test can detect the presence of elevated amylase, an enzyme that presents greater contractions in the urine when there is pancreatitis.
It is also possible that imaging tests of the abdominal region may be requested in order to check the size of the pancreas or possible changes in its structure. Between them:
Endoscopic retrograde cholangiopancreatography or ERCP
It is indicated both to assess and to treat diseases or changes that may occur in the bile ducts or in the Wirsung duct (main pancreatic canal).
The test requires general anesthesia and is carried out by introducing a small flexible cannula, which runs from the mouth to the duodenum (initial part of the small intestine).
In order for the professional to be able to properly assess the region, contrast is injected (a substance that makes it easier to obtain images) and then the radiographs are taken.
The examination facilitates the identification of possible gallstones or local obstructions, assisting in the evaluation of the abdominal region as a whole. For the procedure, there is no need for sedation or local anesthesia.
Like the ultrasound exam, tomography can help to identify gallstones or obstruction of the pancreatic ducts, however, it allows a more specific assessment of the region.
Using X-ray waves , the procedure does not require sedation or anesthesia.
Pancreatitis has treatment and control, preventing the progression of the disease or avoiding new obstructions depending on the triggering factors. The acute type is curable and the chronic type requires individual evaluation .
The treatment of acute or chronic pancreatitis usually requires hospitalization to control inflammation, but the first and main measure is to start fasting , which is necessary for the recovery and stabilization of the pancreas.
Despite being more common due to the ease in evaluating and monitoring the patient, uncomplicated conditions, with mild symptoms and recent manifestation, may not require hospitalization. Know more:
The patient receives intravenous serum, antibiotics and analgesic drugs to relieve pain, as needed in each case. However, the main procedure to be adopted is to suspend the consumption of food or drinks until the pancreas recovers.
When vomiting occurs, it may be necessary to empty the fluids and air that are in the stomach. For this, a very thin probe is inserted through the nose, up to the stomach.
In cases without aggravating factors, it takes a few days for the patient to recover, but if the condition is prolonged, it may be necessary to resort to nasoenteral tube feeding (a tube is introduced through the nose, which leads the liquid diet to the small intestine, supplying the needs of the organism).
Patients with acute pancreatitis of biliary origin (caused by gallstones) undergo cholecystectomy with laparoscopic cholangiography, in which small incisions (4 cuts) are made in the abdomen to remove the gallbladder.
For cases of severe acute pancreatitis, in addition to the basic procedures (fasting, hydration and follow-up), it is necessary to schedule parenteral nutrition (glucose, fats and proteins, electrolytes, minerals and vitamins administered by serum), as the fasting period will be longer (between 7 and 11 days).
The use of antibiotics should be evaluated, as it still generates controversies regarding the ability to prevent necrosis of infected tissues.
If the patient has obstructions or fibroses that are causing acute pancreatitis, surgical procedures may be necessary, removing the affected tissue.
In addition to the initial treatments, common to both types of pancreatitis, the chronic type needs to investigate the causes of the dysfunction so that a therapy focused on the source of the problem can be made.
Called endoscopic treatment, the method is more recurrent in the chronic type and aims to relieve pain and reduce the risk of complications. For this, drains of the accumulated fluid in the pancreas are made, eliminating obstructions and gallstones.
The use of pancreatic enzymes and replacement of substances that are not being correctly produced by the body is also part of the treatment to stabilize digestive and endocrine functions.
Drugs such as meperidine or fentanyl can be used, if necessary, for pain relief.
It is also possible to resort to the placement of prostheses capable of dilating the secretion channels of the pancreas. However, these cases must be carefully evaluated due to the risks of the procedure, which mainly include obstructions after 1 year of the procedure.
Surgical treatments are indicated for patients who have little risk of complications and the results demonstrate important improvements in the short and long term.
The treatment of pancreatitis, whether acute or chronic, is always initiated by clinical therapy, prioritizing non-surgical measures. However, in cases where there are complications, especially in chronic pancreatitis, or severe pain that does not improve, surgery may be necessary.
In general, it is recommended when the patient has:
- Pancreatic necrosis with infections;
- Perforation or obstruction of ducts;
In general, it is not recommended that the intervention be performed within the first 2 weeks after diagnosis (early surgery), as soon as the patient possibly still has a very unstable condition and it becomes difficult to accurately delimit the necrotic tissue.
After the second week, the patient usually tends to have more stability in the body, making the surgery less risky.
In general, surgery can be divided into 3 stages, which include opening or incising, removing the affected tissue and, if necessary, removing part of the pancreas.
New, less invasive techniques are being recommended, wherever possible. An article published in the medical journal Archives Brasileiros de Cirurgia Digestiva, in 2010, points out that drainage and debridement by endoscopic procedures have shown new surgical pathways to pancreatitis.
Among the most frequent surgical options are:
The surgical procedure can proceed in a minimally invasive manner (called percutaneous approaches, in which no cuts or openings are made in the area) or through laparotomy , which consists of opening the abdomen. The cut can be varied in size, according to each case.
Then, the necrotic tissue is removed ( debridement ), preventing the condition from worsening, but without resolving the damage already installed. That is, if the necrosis affected the partial functioning of the pancreas, removal of the tissue is not able to reverse the condition.
There is resection of the pancreatic head , in which a complete or partial removal of part of the pancreas (called the head of the pancreas), part of the bile duct, gallbladder duodenum and the final part of the stomach is done.
Then connections are made between the pancreas, bile duct and stomach to the part of the intestine, maintaining digestive functions.
Endoscopic retrograde cholangiopancreatography or ERCP
The CPRE procedure, also used in the diagnosis, is performed under general anesthesia and consists of the introduction of a device (endoscope) through the mouth to the duodenum, the initial part of the intestine.
Then, a process called papillotomy can be done , in which gallstones are removed (if any) and / or the ducts that may be narrow or glued are dilated.
Probes or balloons may be necessary to keep the region enlarged.
On average, the procedure takes 60 minutes and recovery tends to be quick when the patient has no complications.
Patients who manifest episodes or chronic cases of pancreatitis should reinforce their care with food and health in general. It is essential to eliminate the consumption – even small – of alcohol and cigarettes.
Food deserves attention, especially when there is fat intake, and it is necessary to carry out nutritional monitoring with professionals so that meals are scheduled without any deficiencies in the body.
Along with food, it is important to pay attention to the consumption of fluids to maintain proper hydration and functioning.
Patients with chronic pancreatitis or associated diseases must undergo constant medical monitoring, performing tests and following the recommendations for each case.
In general, pancreatitis has a mortality rate of up to 5% in mild cases of the disease, that is, when there is no necrosis or hemorrhage in the pancreatic tissue.
If the disease worsens, such as the involvement of other organs or the spread of inflammation, the risks to life vary between 10% and 50%.
Deaths from acute pancreatitis in the first days after diagnosis are usually caused by heart, respiratory or kidney failure.
Deaths after the first week of the acute crisis are more related to necrosis, pancreatic infections or hemorrhages.
In general, the prognosis is established according to the characteristics of each case, in which patients over 55 years old, with glycemia (blood sugar) above 200mg / dL, high cholesterol and high white blood cell count present greater risks to life.
Complications of pancreatitis are more common in patients who do not adopt medical recommendations, especially in chronic cases. The following may occur:
- Pancreatic lesions : hindering proper functioning, leading to hyperglycemia (increased blood sugar levels);
- Pancreatic necrosis : the pancreas tissue may develop necrosis due to the action of enzymes or reduced blood supply, causing an irreversible loss of function (that is, tissue death);
- Abdominal compartment syndrome : an increase in intra-abdominal pressure occurs, which may impact renal, intestinal and cardiac function.
- Vascular complications : changes in circulation may occur, including bleeding;
- Pulmonary complications : these are the most common complications of pancreatitis, involving acute respiratory distress and hypoxemia (lack of oxygen in the blood);
- Renal insufficiency : about 15% of patients with the acute type and up to 43% with severe acute pancreatitis have renal insufficiency, which occurs due to the dissemination of cytokines accumulated in the pancreas;
- Pseudocyst : consists of the formation of a capsule loaded with blood, a fluid rich in pancreatic enzymes and necrotic tissue, causing increased pain and the possibility of rupture and hemorrhage;
- Type 2 diabetes : pancreatitis can affect the insulin secretion by the pancreas, raising blood glucose levels and triggering type 2 diabetes;
- Nutritional dysfunctions : due to enzymatic changes, the body may have its digestive functions affected and not be able to absorb nutrients properly, causing malnutrition;
- Pancreatic cancer : Prolonged inflammation in the pancreas can affect tissues and increase the risk of organ cancer.
To prevent pancreatitis, it is necessary to be aware of risk factors, which include, above all, avoiding the abusive use of alcohol and cigarettes.
Care with food can help to reduce the risks of the disease. Therefore, prioritize light meals, without too much fat. Get tested for blood triglyceride rates and gallstones.
Maintaining health and controlling other diseases is also important. But it is worth remembering that pancreatitis tends to be a multifactorial manifestation, possibly with genetic and behavioral aspects involved.
Thus, maintaining medical monitoring, taking care of your health as a whole and being attentive to the body’s signals is fundamental.
Patients who suffer from chronic pancreatitis or experience an acute episode must undergo nutritional care as part of the treatment, so that the diet is properly planned according to individual needs.
Among the general options that patients can include or should avoid in their diet are:
It is necessary to prioritize a lighter and more natural diet, opting for fruits and vegetables, low-fat dairy products, lean meats (such as fish and chicken) and whole carbohydrates.
Always remember that meals should be planned in a healthy way and aiming to maintain the balance of the body. So, among the options to include in the meal are:
- Skimmed milk products, such as skim milk and white cheese;
- Egg white cooked or prepared without oil;
- Whole grains, such as chia, flaxseed, oats and amaranth;
- Lean meats, such as fish and chicken breast;
- Fruits, vegetables, legumes, vegetables and derivatives (such as homemade fruit jellies);
- Good carbohydrates, such as brown rice and sweet potatoes.
In general, it is recommended that the patient completely eliminate the intake of alcoholic beverages and reduce the consumption of:
- Fried foods;
- Soda and industrialized juices;
- Embed, processed and canned products, such as sausages, ham, semi-finished and breaded soups;
- Fast foods.
Although several diseases or conditions have multifactorial causes, dietary and behavioral care helps to maintain the health of the body as a whole.
Preferring healthier foods, maintaining a good intake of water, avoiding the use of chemicals and controlling alcohol consumption are measures that promote more health and well-being, helping to reduce various diseases such as pancreatitis.
Remember to keep your health up to date with regular appointments with your doctor and check out more information in the Healthy Minute!