Pancreatitis is a complex and often painful condition that affects one of the most crucial organs in the digestive system—the pancreas. This inflammation of the pancreas can be sudden (acute) or long-standing (chronic) and may lead to serious health complications if not diagnosed and treated early. In this guide, we dive into everything you need to know about pancreatitis—from its causes and symptoms to treatment strategies and prevention tips.
What is Pancreatitis?
Pancreatitis is defined as inflammation of the pancreas, a gland located behind the stomach that helps digest food and regulate blood sugar. The inflammation disrupts the function of the pancreas, potentially leading to life-threatening complications.
There are two main types:
- Acute pancreatitis: Sudden onset that usually resolves with proper care.
- Chronic pancreatitis: Ongoing inflammation that leads to permanent damage.
Causes of Pancreatitis
1. Gallstones
Blockage of the common bile duct (CBD) by gallstones is the leading cause of acute pancreatitis. When the bile duct is obstructed, digestive enzymes become activated while still inside the pancreas, leading to tissue destruction.
2. Alcohol Abuse
Chronic alcohol consumption accounts for nearly 30–40% of pancreatitis cases. Alcohol irritates pancreatic cells and can trigger both acute and chronic inflammation.
3. Other Causes
- High triglyceride levels
- Hypercalcemia
- Certain medications (e.g., thiazide diuretics)
- Abdominal trauma
- Autoimmune conditions
- Genetic mutations
- Infections (mumps, HIV)
Types of Pancreatitis
Acute Pancreatitis
Acute pancreatitis is a sudden inflammation that may resolve completely or escalate to systemic complications. It’s often mild but can become severe or even fatal in certain cases.
Pathophysiology
- Enzymes like amylase, lipase, and trypsin become active inside the pancreas.
- This leads to tissue injury, necrosis, hemorrhage, and infection.
Chronic Pancreatitis
Chronic pancreatitis is a persistent inflammatory state that leads to scarring, calcification, and atrophy of the pancreatic tissue.
Key Features
- Endocrine dysfunction: insulin deficiency (diabetes)
- Exocrine dysfunction: enzyme deficiency (malabsorption, steatorrhea)
- Pain after meals due to ductal obstruction
- Weight loss and nutritional deficiency
Symptoms of Pancreatitis
Acute Pancreatitis
- Severe upper abdominal pain (radiating to the back)
- Nausea and vomiting
- Fever
- Abdominal tenderness
- Cullen’s sign (bruising around the umbilicus)
- Grey-Turner’s sign (flank bruising)
Chronic Pancreatitis
- Chronic abdominal pain
- Steatorrhea (fatty stools)
- Diabetes
- Unexplained weight loss
- Recurrent jaundice
Diagnosis of Pancreatitis
1. Blood Tests
- Serum amylase and lipase (elevated in acute)
- Glucose, urea, calcium levels
- White cell count
2. Imaging Tests
- Ultrasound: Identifies gallstones and fluid collections
- CT Scan: Evaluates necrosis and abscesses
- MRCP: Best for identifying biliary or pancreatic duct abnormalities
3. Imrie Criteria (Severity Index)
Used to predict the severity of acute pancreatitis. Scoring is based on:
- Age > 55 years
- WCC > 15,000/mm³
- Blood glucose > 7 mmol/L
- Blood urea > 7 mmol/L
- Albumin < 35 g/L
- Serum calcium < 2 mmol/L
- PaO₂ < 10 kPa
Severity Grading:
- Mild = 0
- Moderate = 1–2
- Severe = 3 or more (50% ICU admission rate, 90% mortality)
Complications of Pancreatitis
Acute Pancreatitis
- Pancreatic necrosis
- Abscess formation
- Acute respiratory distress syndrome (ARDS)
- Acute kidney injury (AKI)
- Disseminated intravascular coagulation (DIC)
- Myocardial depression
- Cerebral dysfunction
- Liver dysfunction
- Ileus and gastric stasis
- Inflammatory ascites
Chronic Pancreatitis
- Pancreatic pseudocysts
- Malabsorption syndromes
- Insulin-dependent diabetes
- Recurrent infections
- Gastric outlet obstruction
Treatment Options
Acute Pancreatitis Management
Hospital Admission: For IV fluids, electrolyte correction, pain managementSupportive Care: Oxygen therapy, nutritional support
Cause-specific Management:
- ERCP for gallstone removal
- Antibiotics if infection is confirmed
- Surgical drainage for abscess/pseudocyst
Chronic Pancreatitis Management
Lifestyle Changes: Alcohol abstinence, low-fat dietMedical Treatment:
- Analgesics
- Pancreatic enzyme replacement
- Insulin for diabetes
- Endoscopic or open drainage of pseudocyst
- Pancreatic resection in non-responsive cases
Lifestyle Changes and Prevention
- Avoid alcohol and smoking
- Maintain healthy triglyceride levels
- Early treatment of gallstones
- Regular follow-up if you have chronic GI symptoms
- Dietary management: Low-fat, high-protein, enzyme supplements
Prognosis and Recovery
Most patients with mild acute pancreatitis recover within a week. Chronic pancreatitis requires ongoing management, but with proper care, complications can be minimized.
Prognosis depends on:
- Severity (Imrie score)
- Age and comorbidities
- Timeliness of treatment
- Presence of organ failure
Frequently Asked Questions
1. What is the most common cause of pancreatitis?
Gallstones and alcohol are the top causes.
2. Can pancreatitis be cured completely?
Acute cases often resolve. Chronic cases require lifelong management.
3. What are the warning signs of pancreatitis?
Sudden upper abdominal pain, vomiting, fever, and jaundice.
4. What food should I avoid with pancreatitis?
Avoid fried foods, alcohol, and high-fat meals.
5. How is chronic pancreatitis different from acute?
Chronic is long-term and causes irreversible damage. Acute is sudden and potentially reversible.
