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Severe upper abdominal pain is common in acute and chronic pancreatitis.
Your pancreas is a teardrop-shaped organ situated behind your stomach. It produces hormones, such as insulin and glucagon, which are essential for normal glucose metabolism. Your pancreas also produces and secretes digestive enzymes that break down food in your intestines. Pancreatitis is the medical term for inflammation of the pancreas. The condition can be acute -- abrupt in onset -- or chronic. The signs and symptoms of acute and chronic pancreatitis often overlap.
Digestive enzymes produced by your pancreas are normally activated following their release into your intestine. If activated too early, these enzymes damage your pancreas and trigger an episode of acute pancreatitis. Gallbladder disease and chronic alcohol consumption -- the principal causes of acute pancreatitis -- can prematurely activate pancreatic digestive enzymes. Other causes include infections, autoimmune diseases, medications and severely low body temperature.
Mild cases of acute pancreatitis are associated with abdominal pain and vomiting. Severe cases may lead to shock and possibly death. In nonfatal cases, pancreatic damage is reversible, a characteristic of the condition that distinguishes it from chronic pancreatitis. People with acute pancreatitis typically have elevated blood levels of amylase and lipase, two enzymes produced by the gland.
Chronic pancreatitis is characterized by progressive, irreversible destruction of pancreatic tissue that results in reduced production of pancreatic enzymes and hormones. Long-term alcohol abuse accounts for 70 percent of chronic pancreatitis cases. Medications, autoimmune diseases, physical trauma and cystic fibrosis are also risk factors. Recurrent episodes of acute pancreatitis may trigger ongoing inflammation resulting in chronic pancreatitis.
No single test is diagnostic for chronic pancreatitis. Your blood amylase or lipase may be elevated, although this is not a universal finding. Because people with chronic pancreatitis often develop abnormal calcium collections along their pancreatic ducts, your doctor may order an X-ray or CT scan check for pancreatic calcification. However, calcification may not be visible early in the course of chronic pancreatitis.
Endoscopic ultrasound -- an ultrasound performed through a scope inserted down your throat -- is useful for diagnosing early cases of chronic pancreatitis. ERCP, another technique that involves passing a scope down your throat, is also useful for diagnosing chronic pancreatitis. However, ERCP can trigger an episode of acute pancreatitis in approximately 5 percent of patients.
Pain control is a high priority in treating acute and chronic pancreatitis. Nutritional support, ensuring body fluid balance and monitoring for complications -- pancreatic destruction, infection and multiple organ failure -- are also priorities with acute pancreatitis. Surgery may be needed to deal with the causes or complications of acute pancreatitis, such as gallstones or a pancreatic abscesses.
Chronic pancreatitis is characterized by recurrent or persistent pain and progressive loss of pancreatic function. In addition to pain medications, people with chronic pancreatitis may benefit from digestive enzyme supplementation. Treatment for diabetes may also be necessary as production of the glucose-regulating hormone insulin wanes.
Sorting It Out
Overlapping signs and symptoms can cloud the line between acute and chronic pancreatitis. This is especially true if you have recurrent episodes of acute pancreatitis or develop acute pancreatitis on top of chronic pancreatitis. Laboratory tests and imaging studies help distinguish acute from chronic pancreatitis.