Asked by VaLenda McKee, Oklahoma City, Oklahoma
I recently landed in the hospital for five days because of pancreatitis. I am the atypical patient for this condition. I have type 1 diabetes. I do not drink, and my gallbladder was removed in 2003. CT scans showed a seriously inflamed pancreas, but doctors could not find a reason why. Any ideas? I have never hurt so bad in all my life, and they say since they can't find a reason for it, it can happen again with no warning just like this last one. Please help.
Dr. Otis Brawley
Chief Medical Officer,
American Cancer Society
The pancreas is an organ in the mid-abdomen that secretes digestive fluids through the pancreatic duct into the small bowel. These fluids contain enzymes that break down food as part of the digestive process. Pancreatitis is an inflammation of the organ as these fluids start damaging the organ itself.
I cannot overemphasize how incredibly painful this condition can be. Acute pancreatitis begins as a sudden onset of sharp pain in the mid- and upper abdomen. Some relief can often be obtained by bending forward. Most people have nausea and vomiting with it. It requires hospitalization with nothing to eat or drink, hydration and narcotics to control pain. An episode of pancreatitis often goes away after a few days, but some patients have recurrence.
The most common cause of pancreatitis is gallstone obstruction of the duct leading from the pancreas to the small bowel, causing the fluids to back up into the pancreas. The second most common cause is alcohol damage to the pancreas, often after binge drinking. A third of pancreatitis episodes are due to other causes, which in most cases will never be identified.
Certain drugs such as steroids, some anti-hypertensives such as angiotensin converting enzymes, and even antibiotics and anti-virals can cause pancreatitis. Trauma to the abdomen can also cause pancreatitis. Some folks with cystic fibrosis, high serum triglycerides and other familial syndromes are at increased risk of acute pancreatitis.
The most serious cause that I have seen is dysplasia of the pancreatic duct. In very rare cases, this ductal dysplasia can progress to pancreatic cancer. A second episode of pancreatitis should lead to a consultation with a gastroenterologist and consideration of procedures to assess the duct. These are quite invasive, and I would not recommend them after only one unexplained episode.
Your type I or juvenile-onset diabetes is due to the islet cells located in your pancreas no longer producing insulin. Usually, this is the result of an immune reaction that destroys the islet cells. Some people do have an immune reaction causing chronic (long-term) pancreatitis, which is very different from painful acute pancreatitis. Chronic pancreatitis can also be caused by alcohol and various familial diseases. Chronic pancreatitis can sometimes lead to type 1 diabetes. It is more likely that you have two separate and unrelated diseases involving the same organ.
I hope you can find some reassurance in the fact that studies show that less than 5 percent of patients with one episode of acute pancreatitis ever has a second. That means 19 out of 20 people who have acute pancreatitis for unknown reasons will never have it again.
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