What is Pancreatitis?

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Pancreatitis is inflammation of the pancreas. The pancreas is an organ located behind the stomach that has two major functions:

• It produces digestive enzymes that help break down food.

• It produces hormones, including insulin and glucagon, that help regulate blood sugar.

 

Normally, pancreatic digestive enzymes become active after they enter the small intestine. During pancreatitis, digestive enzymes can become activated prematurely and contribute to inflammation and injury within the pancreas.

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Types of Pancreatitis, Symptoms, & Their Complications

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Acute Pancreatitis

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Acute pancreatitis develops suddenly. The most characteristic symptom is upper abdominal pain that may:

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• Begin suddenly or gradually

• Become severe and persistent

• Occur in the upper middle abdomen

• Radiate through to the back

• Become worse after eating

• Last for hours to several days

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Other symptoms can include:

• Nausea

• Vomiting

• Abdominal tenderness

• Abdominal swelling

• Fever

• Rapid heart rate

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Severe cases can lead to:

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-Pancreatic necrosis, infection, pancreatic fluid collections

(Some collections resolve, while some may persist and cause pancreatic pseudocyst or walled-off necrosis), chronic pancreatitis (if many acute cases)

 

Chronic Pancreatitis

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As pancreatic function declines, patients may develop:

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• Chronic or recurrent abdominal pain

• Diarrhea

• Greasy or oily stools

• Foul-smelling stools

• Unintentional weight loss

• Nutritional deficiencies

• Diabetes

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Over time, inflammation can cause fibrosis and loss of normal pancreatic function leading to:

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-Malnutrition, exocrine pancreatic insufficiency, pancreatogenic or type 3c diabetes

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What Causes Pancreatitis?

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-Gallstones

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Gallstones are one of the most common causes of acute pancreatitis.

The pancreatic duct and common bile duct empty into the small intestine near one another. A gallstone that travels into the common bile duct can become lodged near this opening and interfere with pancreatic drainage.

This can trigger inflammation of the pancreas, known as gallstone pancreatitis.

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-Alcohol

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Heavy or prolonged alcohol use can cause both acute and chronic pancreatitis.

Not everyone who drinks heavily develops pancreatitis, suggesting that individual susceptibility and other factors also influence risk. Continued alcohol use after pancreatitis can increase the likelihood of recurrent attacks and chronic pancreatic damage.

 

-High Triglycerides

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Very high levels of triglycerides, a type of fat in the blood, can cause acute pancreatitis.

The risk becomes particularly important with severe hypertriglyceridemia, especially when triglyceride levels are around 1,000 mg/dL or higher, although pancreatitis can occur at lower levels in some circumstances.

 

-High Calcium Levels

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Significantly elevated blood calcium (hypercalcemia) can cause pancreatitis.

One important cause of persistent hypercalcemia is primary hyperparathyroidism.

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-Additional causes can include:

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• Genetic disorders affecting the pancreas

• Autoimmune pancreatitis

• Abdominal trauma

• Certain infections

• Pancreatic or bile duct abnormalities

• Pancreatic tumors

• Pancreas divisum

• ERCP, an endoscopic procedure involving the bile and pancreatic ducts

 

-Sometimes no cause can be identified. This is called idiopathic pancreatitis.

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How Is Acute Pancreatitis Diagnosed?

 

-Diagnosis is based on the patient's symptoms, physical examination, laboratory testing, and sometimes imaging.

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-Acute pancreatitis is generally diagnosed when at least two of the following three features are present:

1. Typical abdominal pain consistent with acute pancreatitis

2. Lipase or amylase at least three times the upper limit of normal

3. Imaging findings characteristic of acute pancreatitis

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-Additional Blood Tests May Include:

• Complete blood count (CBC)

• Comprehensive metabolic panel

• Liver enzymes

• Bilirubin

• Triglycerides

• Calcium

• Blood glucose

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-Ultrasound - especially when gallstones are suspected

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-CT Scan

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-Magnetic resonance cholangiopancreatography (MRCP) is a specialized MRI that can provide detailed images of the pancreatic and bile ducts.

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How is Chronic Pancreatitis Diagnosed?

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-Patient history and symptoms

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-CT or MRI/MRCP to look for structural changes. Abdominal US not very sensitive. 

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-signs/symptoms of exocrine pancreatic insufficiency often associated with chronic cases = ffecal elastase-1 stool test, steatorrhea (greasy/oily stools), weight loss, bloating, nutritional deficiencies

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-Amylase and Lipase are usually normal

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How Is Acute Pancreatitis Treated?

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-Treatment primarily involves supporting the body while the pancreatic inflammation resolves and treating the underlying cause.

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-Acute pancreatitis frequently requires hospital evaluation and treatment including fluids and pain medicine. 

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-Large, infected, bleeding, or symptomatic collections may require drainage or other treatment.

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How Is Chronic Pancreatitis Treated?

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-Damage from established chronic pancreatitis is generally permanent, so treatment focuses on controlling symptoms, replacing lost pancreatic function, addressing the underlying cause, and preventing additional damage.

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-Pancreatic Enzyme, Fat-Soluble Vitamins, and Nutrition Replacement to treat exocrine pancreatic insufficiency.

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-Type-3c Diabetes management

 

-Pain Management

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