Virginia Mason gastroenterologists, surgeons, medical oncologists, interventional radiologists and others have achieved international acclaim for treating diseases and disorders of the pancreas. Acute pancreatitis is inflammation of the pancreas. It is marked by sudden intense pain in the upper abdomen caused by any number of factors: blocked bile and pancreatic ducts, leaking bile ducts, gallstones, a tumor or cyst, trauma to the abdomen, medications, the effects of drinking alcoholic beverages, or infection. Pancreatitis can be acute or chronic and both can cause serious, life-threatening complications. For more information or to schedule an appointment, call (206) 223-2319.
The most common symptom of acute pancreatitis is sudden pain in the upper abdomen. The pain is often worse when lying down but may feel less intense when sitting up or bending over.
Other symptoms include:
- Rapid pulse
- Pain radiating from abdomen to the back or chest
- Abdomen tender to the touch
- Distended (bloated) abdomen
The intense pain associated with pancreatitis occurs because enzymes that are normally released into the small intestine to digest food remain within the pancreas and attack the pancreas instead. Pancreatitis also affects the pancreas' ability to release insulin that is needed to regulate the body's glucose (sugar) levels.
Your gastroenterologist may suspect acute pancreatitis based on your medical history and your signs and symptoms. A number of excellent tests and procedures are available to guide him or her in the diagnosis:
- BLOOD TESTS
Your blood may be tested for abnormal levels of pancreatic enzymes that aid in digestion.
- ABDOMINAL ULTRASOUND
This non-invasive procedure uses sound waves rather than x-rays to produce images. The images can reveal the presence of gallstones and other blockages within the biliary tract. During this procedure, an ultrasound probe is passed over the abdomen and images are sent to a computer monitor. Abdominal ultrasound is commonly used in women who are pregnant.
- ABDOMINAL CT SCAN OR MRI A CT scan or MRI of the abdomen also can identify gallstones and other blockages within the biliary system. Both scans are noninvasive procedures, during which the bile duct images are shown on a computer monitor.
- ERCP WITH ENDOSCOPIC ULTRASOUND
Endoscopic retrograde cholangiopancreatography, or ERCP, is a specialized endoscopic technique used to study the gallbladder, pancreas and bile ducts, and has the added benefit of being a therapeutic tool. ERCP has been in use for more than 30 years, and is considered the standard modality for diagnosing and treating disorders of the biliary tract.
During ERCP, patients first receive an anesthetic to numb the throat along with a mild sedative. Your gastroenterologist will then pass a flexible endoscope with a miniature TV camera inside through your mouth and into the stomach and small intestine. When your gastroenterologist sees the bile and pancreatic ducts on a monitor, he or she will pass a thin ultrasound probe through the ERCP. Endoscopic ultrasound (EUS) uses ultrasound images in place of X-rays for better viewing of the bile and pancreatic ducts.
Special preparations are required for this endoscopic procedure.
Magnetic resonance cholangiopancreatography is newer technology being employed at Virginia Mason. This noninvasive diagnostic procedure is performed in Radiology using MRI technology (magnets and radio waves) to produce computer images of the gallbladder, pancreas and bile ducts. A contrast dye is injected first through the skin to enhance the images. Patients are not required to undergo endoscopy preparation and they do not undergo sedation. MRCP is being used primarily in patients who may have failed or who are not good candidates for ERCP, in those who do not want to undergo an endoscopic procedure, and in individuals considered to be at low risk of having a pancreatic duct or bile duct disorder. While ERCP allows for therapeutic options with cholangioscopy, MRCP is a diagnostic tool only.
Virginia Mason also is involved in national clinical trials to determine the accuracy of MRCP in diagnosing disorders of the biliary tract.
Most patients with acute pancreatitis are treated in the hospital over several days. However, in severe cases, some individuals may require a longer stay in the hospital. Patients normally receive antibiotics, intravenous fluids, pain relievers and other medications as needed. Patients do not eat solid meals or drink fluids over a period of time so that the pancreas has time to heal. For most patients, an acute attack of pancreatitis is treated successfully within a few days. If a cause is not determined additional tests will be scheduled.
In addition to its diagnostic role, endoscopic retrograde cholangiopancreatography (ERCP) is used therapeutically to treat disorders of the biliary tract. Once the bile and pancreatic ducts are visualized - usually with a contrast dye that produces X-ray images viewed on a monitor - miniaturized surgical instruments are passed through the ERCP.
Gallstones, for example, are removed using a small basket deployed from within the ERCP. When gallstones are present, the gallbladder, in most cases, also is removed during a minimally invasive surgical procedure called laparoscopic cholecystectomy or during open surgery. Cholecystectomy will depend on the severity of the pancreatitis before it is performed.
Other causes of pancreatitis - narrowing or blockage of the bile or pancreatic ducts, bile duct leaks and pseudocysts - all can be treated through the ERCP. These procedures include enlarging the duct, placing a stent (a hollow tube) to keep the duct open, performing a sphincterotomy and stent placement to treat a bile duct leak, and draining or removing a cyst.
Preventive measures also are advised for patients and include avoiding smoking and alcoholic beverages, and refraining from eating a high-fat diet.