Nov 20, 2017
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Pancreatitis

The pancreas is a large gland behind the stomach and close to the duodenum, and has two different jobs.  One is that it contains the islets of Langerhans that secrete insulin and glucagon.  The other primary role of the pancreas is the creation of digestive enzymes that it secretes into the small intestine.  Pancreatitis is inflammation of the pancreas, and this can be either acute (short-term) or chronic (long-term) issue.  It happens when digestive enzymes start digesting the pancreas itself. (1, 2)

The most common cause of acute pancreatitis is gallstones (1,2). Gallstones pass through the common bile duct to enter the small intestine. At the entry of the small intestine, the main pancreatic duct lies near to the common bile duct. It is believed that stones that get stuck in the common bile duct impinge on the main pancreatic duct, causing an obstruction of the normal flow of pancreatic fluid and leading to pancreatic injury (1,2). Another way that a stone can cause pancreatitis is by causing a backflow of bile into the pancreatic duct, resulting in pancreatic injury. (2)

There are several other causes of acute pancreatitis including:  high triglyceride levels (possibly familial chylomicronemia syndrome), certain medications, high triglyceride levels, high serum calcium levels in the blood, heavy alcohol consumption (2).  Acute pancreatitis occurs suddenly and usually goes away in a few days with treatment.  Common symptoms are severe pain in the upper abdomen, nausea, and vomiting (1,2,3). Treatment is usually a few days in the hospital for intravenous (IV) fluids, antibiotics, and medicines to relieve pain.

The most common cause of chronic pancreatitis is many years of heavy alcohol use (1,2,3). The chronic form of pancreatitis can be triggered by one acute attack that damages the pancreatic duct (1,2). The damaged duct causes the pancreas to become inflamed. Scar tissue develops and the pancreas is slowly destroyed.  (1,2)

Other causes of chronic pancreatitis include: cystic fibrosis and other inherited disorders, high levels of calcium or fats in the blood, some medicines, and autoimmune conditions (1,2).  Hereditary pancreatitis can present in a person younger than age 30, but it might not be diagnosed for several years (2,3).  Symptoms include nausea, vomiting, weight loss, and oily stools (2).  Treatment for chronic pancreatitis may require hospitalization for pain management, IV hydration, and nutritional support (2).  Nasojejunal feedings may be necessary for several weeks if the person continues to lose weight.  Jejunal enteral nutrition clinical outcomes have been shown to be equal to or better in the group receiving enteral nutrition compared to those receiving parental nutrition (3).   Complications of pancreatitis, i.e. pseudocysts, abscess, or ascites, are not a contraindication to enteral nutrition (3).

People with chronic pancreatitis often lose weight, even when their appetite and eating habits are normal. The weight loss occurs because the body does not secrete enough pancreatic enzymes to digest food, so nutrients are not absorbed normally (2, 3). Poor digestion leads to malnutrition due to excretion of fat in the stool, and as such, fat-soluble vitamins (2).

When a normal diet is resumed, the doctor may prescribe synthetic pancreatic enzymes if the pancreas does not secrete enough of its own. The enzymes should be taken with every meal to help the person digest food and regain some weight (2,3). The next step is to plan a nutritious diet that is low in fat and includes small, frequent meals (2,3).  A dietitian can assist in developing a meal plan.

Chronic pancreatitis also can lead to calcification of the pancreas, which means the pancreatic tissue hardens from deposits of insoluble calcium salts (2). Surgery may be necessary to remove part of the pancreas.  When pancreatic tissue is destroyed in chronic pancreatitis and the insulin-producing cells of the pancreas, called beta cells, have been damaged, diabetes may develop (1,2,3).  Your medical team, of doctor, diabetes educator, dietitian, can help you adjust your medicine and meal plan for these changes and get back to your life.

References:

  1. National Institutes of Health- National Institute of Diabetes and Digestive and Kidney Disease: https://www.niddk.nih.gov/health-information/digestive-diseases/pancreatitis. Accessed 10/10/17
  2. The National Pancreatic Foundation: https://pancreasfoundation.org/patient-information/acute-pancreatitis.  Accessed 10/10/17
  3. S.P.E.N. Adult Nutrition Support Core Curriculum, 2nd Edition. 2012.

 

 

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