Pancreatitis

What is pancreatitis?

Pancreatitis is the inflammation of your pancreas. The pancreas is an organ that sits near your stomach and liver. Your pancreas produces digestive juices and certain hormones, including insulin, which is responsible for regulating your blood sugar.

Most cases of pancreatitis are mild. In severe cases, pancreatitis can be life-threatening. If you have severe abdominal (tummy) pain that lasts for more than 20 minutes, call your doctor or visit the emergency department of your local hospital.

Pancreatitis can be either acute (sudden onset) or chronic (ongoing and longer-term).

What are the symptoms of pancreatitis?

Acute pancreatitis

Typical symptoms of acute pancreatitis include:

• sudden, severe upper abdominal pain, often spreading through to your back and eased by leaning forward, it often feels worse after eating
• nausea and vomiting
• fevers and sweating
• rapid pulse
• a tender abdomen (pain when your abdomen is touched)

If your pancreatitis is caused by alcohol, you might notice symptom 1 to 3 days after a drinking binge or after you stop drinking.

Symptoms of acute pancreatitis can be similar to symptoms of other medical emergencies such as a heart attack. If you or someone in your care has these symptoms, seek immediate medical attention.

In some people, there is no pain at all.

Chronic pancreatitis

The most common symptom of chronic pancreatitis is long-standing pain in the middle of your abdomen. If you have chronic pancreatitis, you might get repeated episodes of acute pancreatitis, where your pain gets worse. Your pain may get worse with eating, drinking and drinking alcohol. You may also develop jaundice.

If you have chronic pancreatitis, you can have trouble digesting food, particularly fats, because of your lack of digestive juices. This can lead to vitamin and mineral deficiencies, and other symptoms including:

• diarrhoea
• weight loss
• loose, greasy, foul-smelling stools

In severe cases, your pancreas may not produce enough insulin, leading to diabetes. Chronic pancreatitis is a risk factor for pancreatic cancer.

What causes pancreatitis?

The 2 most common causes of pancreatitis are gallstones and heavy alcohol consumption. Around 1 in every 2 people with acute pancreatitis have been heavy drinkers.

Gallstones cause most of the remaining cases. Gallstones are like little pebbles in your gall bladder, an organ that is next to your pancreas. Your gallbladder and pancreas both help to digest your food and share a common entry tube (duct) to your gut. The stones can block this duct from your pancreas, so the juices can’t escape. This causes inflammation.

Other less common causes of pancreatitis include external factors such as:

• a heavy blow to your abdomen, such as in a car accident
• surgery to your pancreas
• some medicines

Other causes are of pancreatitis are medical conditions or diseases such as:

• infections
• autoimmune disease, such as lupus
• inherited disorders including cystic fibrosis
• high levels of calcium in your blood (hypercalcemia), which may be caused if you have an overactive parathyroid gland (hyperparathyroidism)
• high levels of triglycerides in your blood (hypertriglyceridemia)
• cancer in your pancreas

You are more likely to get pancreatitis if you smoke or if you have a family history of pancreatitis.

In some people, no cause is ever found.

When should I see my doctor?

You should see a doctor if you develop sudden, severe abdominal pain, nausea and vomiting, or if you’ve been suffering from longstanding abdominal pain.

If you were once a heavy alcohol drinker or have had gallstones, let your doctor know. This information might help them decide which tests to refer you for, and they will most likely check you for pancreatitis.

How is pancreatitis diagnosed?

Diagnosing acute pancreatitis can be difficult, because the signs and symptoms of pancreatitis are similar to other medical conditions.

To diagnose you, your doctor will talk to you, examine you and refer you for blood tests. You may also have other tests such as an x-ray, an ultrasound, MRI or a CT scan to get a picture of how your pancreas looks, and whether or not there is an obvious cause of your symptoms.

You may also have an ERCP (endoscopic retrograde cholangiopancreatography). This is a procedure where a long tube is passed through your mouth into your gut. ERCP It can help diagnose pancreatitis and, if the cause is a gallstone, can remove the stone.

It can be more difficult to diagnose chronic pancreatitis. This is because your symptoms may be subtle and may mimic other conditions. Also, you may have chronic pancreatitis with little or no pain.

Tests for chronic pancreatitis include those for acute pancreatitis, along with:

• stool (poo) tests — to detect abnormal levels of fat (which would mean you’re not absorbing nutrients properly)
• blood tests or scans to rule out pancreatic cancer

How is pancreatitis treated?

Acute pancreatitis

If you have acute pancreatitis, you’ll usually be admitted to hospital — if your case is severe you might need go to an intensive care unit. You will not be able to eat and drink and you’ll be given fluids through an intravenous (IV) drip, pain-relieving medicines and sometimes antibiotics. Acute pancreatitis usually starts to improve in about a week. If you still have trouble eating, you may need to feed through a tube while you recover.

Chronic pancreatitis

If you have chronic pancreatitis you usually won’t need to go to hospital unless your pain is severe, or if you have complications. Your doctor might recommend that you take pain-relieving medicines.

You need to take care to avoid triggering more pain, which means eating low-fat meals and avoiding alcohol. You may also need to take enzymes to help you digest food, and supplements to make up for the vitamins and minerals you aren’t absorbing. Your glucose levels will be monitored, and you may need insulin if you have developed diabetes.

Other treatments

Your health team might recommend other treatments to fix the underlying cause of your pancreatitis, including:

• surgery to find and remove any cause of blockage to tubes from your pancreas, such as gallstones
• surgery to remove your gallbladder or damaged areas of your pancreas
• supplements to improve your digestion of food

Can pancreatitis be prevented?

Depending on the cause of your pancreatitis, there may be ways to you can prevent pancreatitis from recurring.

You may need to reduce your intake of fatty foods and to eat a healthy diet. This is especially important if the cause was gallstones and your gallbladder has not been removed. Drinking plenty of clear fluid, like water, will also help prevent another episode.

If the cause of your pancreatitis was alcohol, you will need to stop drinking completely to avoid recurrence.