What Is Pancreatitis? Symptoms, Causes, Diagnosis, Treatment, and Prevention

胰腺炎是pancreas，坐落在胃后面和小肠DuodeNum的第一部分的腺体。

胰腺在体内具有两个主要的基本功能：

• It secretes digestive enzymes to help the intestines digest food.
• 它通过产生激素胰岛素和胰高血糖素。

当胰腺的酶开始消化胰腺组织时，就会发生胰腺炎。这会导致胰腺肿胀，流血和损害。Gallstones,酗酒，某些类型的药物会导致胰腺炎。

There are two main types of pancreatitis: acute and chronic. "Pancreatitis" is often used synonymously with "acute pancreatitis," because this form of the disease — which appears suddenly and is short lived — is the most common. (In this series, the term pancreatitis will refer to acute pancreatitis.)

在胰腺内，称为腺泡细胞的细胞会产生催化剂，这些细胞是通过代谢过程转化为酶的无活性物质。

这些原酶通过胰管传播到小肠，在那里它们转化为活动形式。一旦活跃，这些酶就可以消化碳水化合物，proteins，脂肪和其他食物。

But if the acinar cells become damaged or the pancreatic duct is injured or blocked, the proenzymes may accumulate within the pancreas and activate prematurely.

发生这种情况时，胰腺中的酶消化细胞膜，从而引发免疫系统的炎症反应。

急性和慢性胰腺炎的症状不同。

急性胰腺炎症状

• A sharp, sudden pain in the abdomen that you may also feel in your back, which is a defining symptom of acute pancreatitis
• 发烧
• 呕吐
• 心率升高
• 腹部肿胀

患有急性胰腺炎的人通常看上去不好。国家糖尿病与消化和肾脏疾病（NIDDK）指出，立即寻求医疗很重要。（（1)

急性胰腺炎突然突然出现，通常在一周内通过治疗消退，尽管严重病例可以持续更长的时间。它通常是由胆结石或过度饮酒引起的，但是某些药物或甘油三酸酯升高（血液中发现的一种脂肪）可能引起攻击。

Chronic Pancreatitis Symptoms

慢性胰腺炎最常见的结果f alcoholism. Individuals with chronic pancreatitis often have had several bouts of acute pancreatitis. The pain in the abdomen that accompanies acute pancreatitis — which radiates in your back and may worsen after eating — can still be present, but not as strong. Sometimes, though, there's no pain at all.

其他symptoms of chronic pancreatitis可能包括油腻的，浅色的凳子和减肥。（1）

了解有关胰腺炎症状的更多信息

急性胰腺炎的最常见原因是胆结石和酒精。

胆结石是形成卵石状沉积物gallbladderas a result of the hardening of two substances: cholesterol and bilirubin. Bilirubin is a byproduct of the breaking down of red blood cells that is found in bile. (This substance also contributes to黄疸）

研究表明，胆结石会导致40％至70％的急性胰腺炎病例。（（2）小胆结石（通常小于5毫米），增加了过去的研究，增加了胰腺炎的风险。（（3)

It's thought that gallstones cause pancreatitis by creating an obstruction in the pancreatic duct. This forces digestive enzymes back into the pancreas, which leads to inflammation.

急性胰腺炎的另一个常见原因（在约30％的病例中）是过量的饮酒。Merck Manual。（（4)

It's unclear just how alcohol causes the condition, but it's thought that the way the pancreas processes alcohol may generate compounds that are toxic to the organ's acinar cells.

酒精还可以使腺泡细胞对胆囊化蛋白的作用敏感，胆囊成蛋白是由十二指肠分泌的激素，可刺激消化酶的释放。

It's hard to pin down just how many drinks will lead to acute pancreatitis. One study, which followed Swedish men and women for several years and was published in theBritish Journal of Surgery，发现急性胰腺炎的风险增加了52％，一次消耗五种饮料的每一次增量。（（5)

值得记住的是，美国国家酒精滥用和酒精中毒研究所在大约两个小时内将暴饮暴食定义为四种饮料，男性大约两个小时的饮料。（（6）药物滥用和精神卫生服务管理局将大量饮酒定义为一个月内五天或更多天的暴饮暴食。（（7，PDF）

What Are Other Causes of Pancreatitis?

Medical students use the mnemonic "I GET SMASHED" to remember the following additional causes of pancreatitis:

• 我为特发性（未知原因）
• G for gallstones
• E乙醇（酒精）
• t因创伤
• S类固醇
• M for mumps — as well as other infections, such as ascaris lumbricoides parasites, Coxsackie B virus,病毒性肝炎，钩端螺旋体病，以及艾滋病病毒— and malignancy (tumors)
• Autoimmune pancreatitis, which develops from an excess of IgG4 antibodies
• S蝎子s
• H用于高脂血症和高甘油三酯血症（血液中脂肪水平升高）和高钙血症（血液钙水平升高，可能导致钙沉积在胰管中或介导胰腺酶)
• e for ercp或endoscopic retrograde cholangiopancreatography，一种侵入性的诊断技术
• D用于药物

哪些药物会引起胰腺炎？

Drugs cause pancreatitis in various ways. They may, for example, be toxic to the pancreas, constrict the pancreatic duct, cause vascular problems, or affect the pancreatic processing systems.

Drug-induced pancreatitis is rare. It's estimated that medication is only responsible for 1.4 to 2 percent of cases, per an article published in 2015 in theOschner Journal。（（8）但是有许多不同的药物会引起它。

根据一项n article published in the journal贝勒大学医学中心会议记录,there are published case reports of drug-induced pancreatitis for more than 40 of the top 200 most prescribed drugs. (9)

该报告指出，与胰腺炎有关的六种最常见的药物或药物类别：

• 他汀类药物， 哪个下胆固醇并包括Zocor (imvastatin)和Lipitor（Atorvastatin）
• ACE inhibitors， 其中包括Vasotec (enalapril)和Zestril（Lisinopril）, forhypertension和congestive heart failure
• Estrogens inoral contraception和激素替代疗法
• 利尿剂， 包含lasix（速尿）和微氮化物（氢氯噻嗪）
• Highly active antiretroviral therapy (HAART), includingepivir（拉米夫丁）和Viracept (nelfinavir)for HIV
• 丙戊酸（Depakote，Depacon，Stavzor）癫痫发作

您将进行体格检查，您的医生将订购blood tests和成像测试以确认您是否患有急性胰腺炎或严重的胰腺炎。在体格检查期间，您的医生可能会感觉到您的胃，看看您的肌肉是刚性还是胃部嫩。

血液检查只能指向胰腺炎（不能确定诊断），可以测量胰腺中两种消化酶的量。

With the onset of acute pancreatitis, the levels of those enzymes are higher than usual — typically more than 3 times the normal level, per Stat Pearls. (10) Other blood tests may measure kidney function and white blood cell count.

Your doctor may also order the following imaging tests to check for the presence of gallstones, inflammation, and other changes:

• X-rays
• 超声波
• 计算机断层扫描（CT）扫描
• Endoscopic ultrasounds (EUS)
• Magnetic resonance cholangiopancreatography (MRCP)

The EUS test involves inserting a lighted tube into your mouth and down into your intestine to check for blockage or damage.

The MRCP is a form ofMRI在其中注射了一种染料，该染料照亮了胰腺和周围区域。

慢性胰腺炎的诊断方式相同。医生可能会订购不同的血液检查，因为在慢性胰腺炎中，消化酶水平可能看起来正常。粪便测试也很常见，因为慢性胰腺炎损害了器官消化和吸收营养素的能力，这会导致粪便的变化，每Medline Plus。（（11)

For some people, acute pancreatitis may require an extended (a week or more) hospital stay after causing issues such asdehydration,低血压，可能是器官衰竭。这些症状通常在几天之内消退。

Chronic pancreatitis does improve or go away, but only worsens over time, leading to permanent damage, notes Medline Plus. (12)

Acute pancreatitis that is mild can be treated with rest and pain medication taken at home. You may have to follow a low-fat, no-alcohol pancreatitis diet, as high-fat foods and alcohol can irritate the pancreas and cause pain. Other recommended lifestyle changes could includequitting smoking和减肥。

Depending on how severe the case is, it may require a hospital stay, where you’ll receive intravenous (IV) fluids, and possibly insulin if your blood sugar ortriglyceride levels高。如果发现了继发感染，您将被处方抗生素。如果确定胆结石是原因，则可能必须将胆囊删除。

在急性和慢性胰腺炎中，如果有死亡或感染的胰腺组织，则可能需要手术。在慢性胰腺炎中，由于营养吸收受损，您可能还需要服用药物和维生素。

Learn More About Treating Pancreatitis

Prevention of Pancreatitis

进行某些生活方式可以帮助您降低胰腺炎的风险。这包括：

限制饮酒这甚至可能意味着完全切割出来。急性胰腺炎的最常见原因是饮酒过量，慢性胰腺炎最常见的是酗酒。

吃低脂饮食避免脂肪和油炸食品可以降低胆结石的风险，这是急性胰腺炎的主要原因。高水平的甘油三酸酯也会增加您患急性胰腺炎的风险。限制较高的简单糖（糖果，含糖苏打）的食物会有所帮助。

Exercising Regularly超重会增加胆结石的风险，这会使您面临更大的胰腺炎风险。但是，避免碰撞剂，这会导致您的肝脏增加胆固醇的产生，从而增加胆结石的风险。

不吸烟根据2019年9月发表的《杂志》的研究评论，吸烟的成年人患急性或慢性胰腺炎的可能性是非吸烟者的1.5倍。Pancreatology。（（13)

Roughly 15 percent of acute pancreatitis cases are severe, notes the National Pancreas Foundation. (14)In严重的胰腺炎，酶在器官上吞噬会导致胰腺坏死或胰腺组织死亡。但是胰腺坏死本身并不是致命的。

Severe pancreatitis can also cause organ failure,胃肠道bleeding, and possibly death.

由于胰腺遭受的长期损害，慢性胰腺炎可能导致胰岛素分泌受损而导致的糖尿病, as well as difficulty digesting and absorbing the nutrients needed to keep your body running as it should.

People who have both chronic pancreatitis and diabetes are at a higher risk for胰腺癌，指出niddk。（（15)

慢性胰腺炎也可能导致exocrine pancreatic insufficiency，其中胰腺受损，以至于缺乏消化酶，无法正确消化脂肪，蛋白质和碳水化合物；这可能导致营养不良和体重减轻。

这也可能导致osteoporosis患有慢性胰腺炎患者的（骨质流失）。研究于2016年6月发表PLOS ONE还建议患有急性胰腺炎的人（尤其是50岁以上的女性）患骨质疏松症的风险更大。（（16)

胰腺炎is the cause of more than 500,000 hospitalizations each year in the United States, according to the NIDDK. (17）

An article published in November 15 in the journalPancreasnoted that each year there are an estimated 5 to 73 cases of acute pancreatitis per every 100,000 people worldwide. (18)

胰腺炎is rare in children, though the number of children with acute pancreatitis has increased. (15)

Acute pancreatitis affects men and women equally, but men are more at risk for developing chronic pancreatitis.

Chronic pancreatitis results in about 86,000 hospital stays per year. (15)

黑人和胰腺炎

杂志上的一项研究指出Gastroenterology。（（19）原因尚不清楚，研究人员说迫切需要更多的研究。

一项于2016年10月发表的研究美国胃肠病学杂志found that when compared with white patients, Black patients were almost twice as likely to be diagnosed with chronic pancreatitis due to alcohol or smoking. (20) They were also more likely to have "constant or severe" pain and have more disease-related disability.

RELATED:Diabetes in Black Americans: How to Lower Your Risk

Indigenous People and Pancreatitis

A review of studies and meta-analysis published in January 2019 inDigestive Diseases and Sciences指出，与白人研究对象相比，土著人口（新西兰毛利人）的急性胰腺炎发生率高4.8倍。（（21）胰腺后的发生率糖尿病was up to 3 times higher in indigenous populations.

胰腺炎可能很难导航，但是那里有很多资源可以提供有关疾病的更多信息以及寻找支持的地方。单击下面获取综合资源指南。

了解有关胰腺炎资源的更多信息

Additional reporting byCarlene Bauer。