What is Pancreatitis?
Pancreatitis is inflammation of the pancreas, a large gland located behind the stomach. The pancreas produces digestive enzymes and hormones such as insulin. When the pancreas becomes inflamed, its own digestive enzymes begin to attack and damage the pancreatic tissue, causing pain and swelling.
Acute vs Chronic Pancreatitis
Acute Pancreatitis
Sudden inflammation that develops over hours to days. Can range from mild (most cases) to severe and life-threatening. With proper treatment, most patients recover completely. However, severe acute pancreatitis can lead to organ failure and requires intensive care.
Chronic Pancreatitis
Long-standing inflammation that leads to permanent structural damage to the pancreas. The pancreas gradually loses its ability to produce digestive enzymes and insulin. Can lead to chronic pain, malabsorption, and diabetes. Often caused by years of heavy alcohol use.
Common Causes
| Cause | Details |
|---|---|
| Gallstones | The most common cause of acute pancreatitis. A gallstone can block the common bile duct where it meets the pancreatic duct, causing pancreatic enzymes to back up and damage the pancreas. |
| Alcohol | The second most common cause and the leading cause of chronic pancreatitis. Heavy, long-term alcohol consumption directly damages pancreatic tissue. Even a single episode of binge drinking can trigger acute pancreatitis. |
| High Triglycerides | Very high blood triglyceride levels (usually above 1,000 mg/dL) can trigger acute pancreatitis. This is more common in people with uncontrolled diabetes or familial hypertriglyceridaemia. |
| Medications | Certain medications can rarely cause pancreatitis, including some antibiotics, anticonvulsants (valproic acid), immunosuppressants (azathioprine), and diuretics. |
| Other Causes | Autoimmune conditions, post-ERCP procedure, trauma to the abdomen, infections (mumps), pancreatic duct abnormalities, and in some cases, no cause is found (idiopathic). |
Symptoms
- Severe upper abdominal pain: Usually sudden onset, located in the upper middle or left upper abdomen. Often described as a deep, boring pain that radiates to the back.
- Pain worsens after eating: Especially after fatty meals.
- Nausea and vomiting: Often persistent and may not relieve the pain.
- Fever: Mild to moderate fever is common.
- Rapid pulse: Heart rate may increase due to pain and inflammation.
- Abdominal tenderness and bloating: The abdomen may be tender to touch and distended.
- Jaundice: Yellowing of the skin and eyes, especially if a gallstone is blocking the bile duct.
In chronic pancreatitis, patients may also experience:
- Persistent or recurrent upper abdominal pain
- Unintentional weight loss
- Oily, foul-smelling stools (steatorrhoea) due to fat malabsorption
- New-onset diabetes (as the pancreas loses its ability to produce insulin)
Diagnosis
| Test | Purpose |
|---|---|
| Serum Amylase | Elevated levels (usually more than 3 times normal) strongly suggest acute pancreatitis. Rises within hours of symptom onset. |
| Serum Lipase | More specific to the pancreas than amylase. Remains elevated longer and is the preferred diagnostic marker. |
| Ultrasound Abdomen | To detect gallstones, assess the bile ducts, and evaluate the pancreas. Usually the first imaging test performed. |
| CT Scan (Contrast-Enhanced) | The gold standard for assessing severity, detecting complications such as necrosis or pseudocyst, and guiding further management. Usually performed 48-72 hours after onset in severe cases. |
| Blood Tests | Full blood count, liver function tests (AST, ALT, bilirubin), calcium, triglycerides, and kidney function tests to assess overall status and identify the cause. |
Treatment
Hospital Treatment (Usually Required)
Most cases of acute pancreatitis require hospital admission. Treatment includes:
- NPO (Nothing by mouth): The patient is kept nil by mouth initially to rest the pancreas and reduce enzyme secretion. Clear fluids and a low-fat diet are gradually reintroduced as pain improves.
- Intravenous (IV) fluids: Aggressive fluid resuscitation is critical in the first 24-48 hours to prevent dehydration and maintain organ perfusion.
- Pain management: Strong analgesics (often IV paracetamol, tramadol, or opioids in severe cases) are used to control pain.
- Anti-nausea medication: To manage nausea and vomiting.
- Treat the underlying cause: If gallstones are the cause, surgical removal of the gallbladder (cholecystectomy) is usually recommended. If alcohol is the cause, strict abstinence is essential.
- Nutritional support: Early enteral feeding (via a nasogastric or nasojejunal tube) may be started in severe cases rather than waiting for complete pain resolution.
- ICU care: Severe cases with organ failure require intensive care monitoring and support.
Diet After Recovery
- Follow a low-fat diet: Limit fat to 30-50 grams per day. Avoid fried foods, rich curries with heavy coconut cream, fatty meats, and oily snacks.
- Eat small, frequent meals: 5-6 small meals per day instead of 3 large meals. This reduces the workload on the pancreas.
- Avoid alcohol completely: Even small amounts can trigger a relapse. This is one of the most important lifestyle changes.
- Choose lean proteins: Steamed or grilled fish, skinless chicken, egg whites, and dhal.
- Stay well hydrated: Drink plenty of water and clear fluids throughout the day.
- Avoid smoking: Smoking increases the risk of chronic pancreatitis and pancreatic cancer.
- Pancreatic enzyme supplements: In chronic pancreatitis, your doctor may prescribe enzyme capsules to take with meals to help digestion.
Complications
- Pancreatic pseudocyst: A collection of fluid and debris that can form weeks after acute pancreatitis. May require drainage if large or symptomatic.
- Pancreatic necrosis: Death of pancreatic tissue due to severe inflammation. Can become infected (infected necrosis), which is a serious, life-threatening complication requiring antibiotics and possibly surgery.
- Organ failure: Severe pancreatitis can cause respiratory failure, kidney failure, or cardiovascular collapse. This is the main cause of death in acute pancreatitis.
- Diabetes: Chronic pancreatitis can destroy enough of the pancreas to impair insulin production, leading to diabetes mellitus.
- Malabsorption: Chronic pancreatic damage reduces digestive enzyme production, leading to poor absorption of fats and nutrients.
Prevention
- Avoid excessive alcohol: Limit alcohol intake or abstain completely. Heavy drinking is the most preventable cause of pancreatitis.
- Treat gallstones promptly: If you have symptomatic gallstones, discuss surgical options with your doctor to prevent gallstone pancreatitis.
- Maintain a healthy diet: A balanced, low-fat diet helps reduce the risk. Control triglyceride levels through diet and medication if needed.
- Stop smoking: Smoking is an independent risk factor for pancreatitis and makes the disease worse.
- Manage diabetes and cholesterol: Proper control reduces the risk of recurrence.
When to Seek Immediate Medical Help
Go to a hospital or call us immediately if you experience:
- Severe, sudden upper abdominal pain that radiates to the back and does not improve with painkillers
- Persistent vomiting and inability to keep fluids down
- Fever with abdominal pain — may indicate infected necrosis
- Rapid heartbeat, dizziness, or feeling faint
- Jaundice (yellowing of skin and eyes) with abdominal pain
- Abdominal distension with increasing pain
- Recurrence of symptoms after a previous episode of pancreatitis
- Black or bloody stools
Important: This information is for educational purposes only. If you are unsure about your symptoms or they are severe, please consult a doctor. Our doctors are available for home visits and telemedicine consultations.