What is pancreatitis?

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

Most cases of pancreatitis are mild. But 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 go to the Emergency Department.

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 the back and eased by leaning forward. It often feels worse after eating
• nausea and vomiting
• fevers and sweats
• rapid pulse
• being tender to the touch in the abdomen

If the pancreatitis is caused by alcohol, symptoms can come on 1 to 3 days after a drinking binge or after you stop drinking.

The 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 the abdomen. People with chronic pancreatitis might get repeated episodes of acute pancreatitis, where the pain gets worse. The pain may get worse with eating, drinking and drinking alcohol.

People with chronic pancreatitis can have trouble digesting food, particularly fats, because of the lack of digestive juices. This can lead to diarrhoea, weight loss, vitamin and mineral deficiencies and loose, greasy, foul-smelling stools that are difficult to flush. They may also develop jaundice.

In severe cases, the 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 drinking of alcohol. Around half of all people with acute pancreatitis have been heavy drinkers, which makes alcohol consumption one of the most common causes.

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

Other less common causes of pancreatitis include:

• a heavy blow to the abdomen, such as in a car accident
• surgery to the pancreas
• some medicines
• inherited disorders
• infections
• autoimmune disease, such as lupus
• cystic fibrosis or mutations of the cystic fibrosis gene
• high levels of calcium in the blood (hypercalcemia), which may be caused by an overactive parathyroid gland (hyperparathyroidism)
• high levels of triglyceride in the blood (hypertriglyceridemia)
• cancer in the pancreas

You are more likely to get pancreatitis if you smoke or if other people in your family have had it.

In some people, no cause is ever found.

How is pancreatitis diagnosed?

Diagnosing acute pancreatitis can be difficult because the signs and symptoms of pancreatitis are similar to other medical conditions. The doctor will talk to you, examine you and take some blood tests. You may also be asked to have other tests such as an x-ray, an ultrasound, MRI or a CT scan to get a picture of how the pancreas looks, and whether or not there is an obvious cause.

Some people also have an ERCP (endoscopic retrograde cholangiopancreatography), where a long tube is passed through the mouth into the gut. 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 because the symptoms can be more subtle, and can be so similar to other conditions. Also, some people have chronic pancreatitis with little or no pain.

Tests for chronic pancreatitis include those of 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

People with acute pancreatitis are usually admitted to hospital — even to intensive care if it’s severe. They are not allowed to eat and drink and are given fluids through a vein by a drip. They are given painkillers, and may be given antibiotics to prevent infection. In most people, the acute pancreatitis then starts to improve in about a week. If they still have trouble eating, they may need to be fed through a feeding tube.

Chronic pancreatitis

People with chronic pancreatitis are usually not admitted to hospital unless the pain is severe, or unless there are complications. Painkillers are prescribed.

They need to take care to avoid triggering more pain, which means having low-fat meals and cutting out alcohol. People with chronic pancreatitis may also need to take enzymes to help them digest food, and supplements to make up for the vitamins and minerals not being absorbed. Glucose levels will be monitored and you may need insulin if you have developed diabetes.

Other treatments

A range of other treatments may be recommended to fix the underlying cause of the pancreatitis. They include:

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

Can pancreatitis be prevented?

There are ways to prevent pancreatitis from occurring again.

You will probably be asked to cut down on 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 attack.

If the cause of the pancreatitis was alcohol, you will need to stop drinking completely. You should also quit smoking, as this is another cause of pancreatitis.