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Pancreatitis – Causes, Symptoms & Treatment

Pancreatitis is an inflammation of the pancreas that can occur as an acute or chronic condition. It causes severe abdominal pain and requires prompt medical attention.

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Things worth knowing about "Pancreatitis"

Pancreatitis is an inflammation of the pancreas that can occur as an acute or chronic condition. It causes severe abdominal pain and requires prompt medical attention.

What is Pancreatitis?

Pancreatitis is an inflammation of the pancreas, an important glandular organ located in the upper abdomen. The pancreas produces digestive enzymes as well as hormones such as insulin and glucagon, which regulate blood sugar levels. In pancreatitis, digestive enzymes are prematurely activated within the organ, causing damage to the pancreatic tissue itself. The condition can occur suddenly as acute pancreatitis or progress to chronic pancreatitis, which leads to lasting organ damage.

Causes

The most common causes of pancreatitis include:

Gallstones: Gallstones can block the pancreatic duct and trigger inflammation. This is the most common cause of acute pancreatitis.
Alcohol: Regular or excessive alcohol consumption is the leading cause of chronic pancreatitis.
Medications: Certain drugs such as corticosteroids or diuretics can induce pancreatitis.
Metabolic disorders: Elevated blood triglyceride levels (hypertriglyceridemia) or elevated calcium levels (hypercalcemia) can damage the pancreas.
Trauma: Abdominal injuries or surgical procedures in the abdominal area can trigger inflammation.
Infections: Viral infections, such as mumps, can affect the pancreas.
Idiopathic: In some cases, no identifiable cause is found.

Symptoms

Typical symptoms of pancreatitis include:

Severe, often band-like upper abdominal pain that may radiate to the back
Nausea and vomiting
Fever and general feeling of illness
Bloating and digestive problems
Tenderness in the abdominal area
In severe cases: jaundice, circulatory shock, and organ failure

Chronic pancreatitis additionally presents with fatty stools (steatorrhea), weight loss, and over time may lead to diabetes mellitus due to damage to the insulin-producing cells.

Diagnosis

Pancreatitis is diagnosed through a combination of tests:

Blood tests: Elevated levels of the enzymes lipase and amylase in the blood are typical markers of acute pancreatitis.
Imaging: Ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI) can assess the pancreas and detect complications such as necrosis or pseudocysts.
Stool analysis: In chronic pancreatitis, reduced fecal elastase levels indicate impaired exocrine pancreatic function.
ERCP: Endoscopic retrograde cholangiopancreatography is used to visualize the bile ducts and pancreatic duct, especially when gallstones are suspected.

Treatment

Acute Pancreatitis

Acute pancreatitis is typically treated in a hospital setting. Key measures include:

Fasting and intravenous fluids: The pancreas is given rest by temporarily withholding food, while fluids and nutrients are delivered intravenously.
Pain management: Effective pain relief medications are administered to control the often severe pain.
Treatment of the underlying cause: If gallstones are responsible, they may be removed endoscopically or surgically. Alcohol must be completely avoided.
Antibiotics: Used when bacterial complications or infected necrosis are present.
Surgery: In severe cases involving necrosis or abscesses, surgical intervention may be necessary.

Chronic Pancreatitis

The main treatment options for chronic pancreatitis include:

Abstinence from alcohol and smoking: The most important step to slow disease progression.
Dietary adjustments: A low-fat diet with regular small meals; supplemented with pancreatic enzyme replacement therapy to support digestion.
Pain management: Medication-based pain control; in severe cases, interventional procedures may be needed.
Diabetes treatment: If insulin-producing cells are affected, appropriate diabetes therapy is required.
Endoscopic or surgical procedures: For ductal obstructions or persistent pain.

Complications

Without adequate treatment, pancreatitis can lead to serious complications:

Pancreatic pseudocysts: Fluid collections in or around the pancreas
Pancreatic abscess: Purulent infection within the pancreas
Pancreatic insufficiency: Loss of digestive enzyme and hormone production
Increased risk of pancreatic cancer: Long-standing chronic pancreatitis raises the risk of pancreatic carcinoma
Multi-organ failure: In very severe acute cases

Prevention

The following measures help reduce the risk of developing pancreatitis:

Moderate or no alcohol consumption
A healthy, balanced diet to prevent gallstones and elevated blood fat levels
Not smoking
Regular medical check-ups for individuals with known risk factors

References

Leppkes, M. et al. (2020): S3 Guideline Pancreatitis. German Society of Gastroenterology, Digestive and Metabolic Diseases (DGVS). AWMF Registry No. 021-003.
Tenner, S. et al. (2013): American College of Gastroenterology Guideline: Management of Acute Pancreatitis. American Journal of Gastroenterology, 108(9), 1400-1416.
Mayerle, J. et al. (2019): Chronic Pancreatitis. In: Harrison's Principles of Internal Medicine, 20th Edition. McGraw-Hill.

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