Pancreatitis can occur for various reasons. The two most common known causes are excessive alcohol use and gallstones. In some cases the cause is unknown.
Heavy alcohol use over many years is a leading cause of chronic pancreatitis. Excessive alcohol may also cause an acute attack. Why some people get the disease while most don't is uncertain. It's also unclear how alcohol damages the pancreas. One theory is that excessive alcohol leads to protein plugs — precursors to small stones — that form in the pancreas and block parts of the pancreatic duct. Another theory is that alcohol directly injures pancreatic tissues.
A leading cause of acute pancreatitis is gallstones. Sometimes these stones migrate out of the gallbladder through the common bile duct, which merges with the pancreatic duct near the entrance to the duodenum. At this junction, gallstones can lodge in or near the pancreatic duct and block the flow of pancreatic juices into the duodenum. Digestive enzymes become active in the pancreas instead of in the digestive tract, causing acute pancreatitis.
Less common causes
Other conditions that may lead to acute pancreatitis include:
Occasionally, a complication of acute pancreatitis, such as narrowing of the pancreatic duct, can lead to chronic pancreatitis. Sometimes, young adults with cystic fibrosis and associated gene abnormalities develop episodes of chronic pancreatitis. Some people are born with a hereditary form of the disease that can cause attacks in childhood or adolescence.
When to seek medical advice
If you have intense, persistent abdominal pain, see your doctor to determine whether pancreatitis or some other medical condition is the cause. It's important to diagnose pancreatitis early before severe and irreversible damage to your pancreas occurs.
Screening and diagnosis
If your doctor suspects that you have acute pancreatitis, he or she will check your abdomen for pain and tenderness. A sample of your blood also may be analyzed for abnormalities signaling acute inflammation:
Your doctor may request an ultrasound or computerized tomography scan of your abdomen to examine your pancreas and look for gallstones, a duct problem or destruction of the gland. You may also have X-rays of your abdomen and chest to rule out other causes of your pain.
To confirm a diagnosis of chronic pancreatitis, your doctor will likely take samples of your blood and your stool. Blood tests can identify abnormalities associated with chronic pancreatitis and help rule out acute inflammation. The stool test measures the fat content in your feces. Chronic pancreatitis often causes excess fat in your stool because the fat isn't digested and absorbed normally by your small intestine.
Your doctor may have you undergo X-ray, ultrasound or endoscopic procedures to look for evidence of a blockage in the pancreatic duct or common bile duct. In standard (external) ultrasound, a wand-like device (transducer) is placed on your body. It emits inaudible sound waves that are reflected to the transducer, like sonar. Those reflected sound waves are translated into a moving image by a computer. Endoscopic ultrasound may provide images of your pancreas and bile and pancreatic ducts that are superior to those produced by standard ultrasound. In endoscopic ultrasound, your doctor uses a small flexible tube with a light (endoscope) to thread a small ultrasound device through your stomach to generate a close-up image on a computer screen.
In a procedure called endoscopic retrograde cholangiopancreatography, your doctor places an endoscope into your mouth, down your throat and through your stomach to where the bile and the pancreatic ducts drain. A dye passed through a thin, flexible tube (catheter) inside the endoscope and into the bile and pancreatic ducts allows for X-ray images of the ducts.
If you've lost weight or your doctor suspects a malabsorption problem, you may receive a pancreatic function test. A solution is injected into your bloodstream to stimulate the pancreas. The gland's ability to discharge secretions into the duodenum is then measured.
You may also need additional tests if your doctor is concerned about the possibility of other diseases, such as pancreatic cancer. Chronic pancreatitis puts you at a slightly higher risk of pancreatic cancer.
Severe cases of acute pancreatitis may lead to a number of complications: