Pancreatitis: Understanding Causes, Symptoms, and Treatment

Pancreatitis is inflammation of the pancreas—a gland behind the stomach that produces digestive enzymes and hormones (insulin, glucagon) regulating blood sugar. It ranges from mild, self-limiting illness to a life-threatening emergency with multi-organ failure.

Types and Severity

• Acute pancreatitis: Sudden onset; most resolve within days with supportive care. ~20% develop severe disease with necrosis, infection, or organ failure.
• Chronic pancreatitis: Persistent inflammation causing irreversible fibrosis, loss of function (exocrine/endocrine), and chronic pain.

Symptoms

Acute Pancreatitis

• Severe epigastric pain radiating to the back—often sudden, persistent, worse after eating
• Nausea, vomiting
• Fever, tachycardia
• Abdominal tenderness, distension

Chronic Pancreatitis

• Recurrent or constant abdominal pain
• Weight loss, steatorrhea (fatty, foul-smelling stools) from malabsorption
• Diabetes symptoms (thirst, polyuria) from insulin deficiency

Major Causes

• Gallstones: #1 cause of acute pancreatitis (obstruct pancreatic duct).
• Alcohol: Leading cause of chronic pancreatitis; also triggers acute episodes.
• Metabolic: Severe hypertriglyceridemia (>1000 mg/dL), hypercalcemia.
• Medications: Azathioprine, 6-MP, valproate, estrogens, certain diuretics, GLP-1 agonists (rare).
• Structural: Pancreas divisum, sphincter of Oddi dysfunction, tumors.
• Genetic: PRSS1, SPINK1, CFTR, CTRC mutations (hereditary pancreatitis).
• Infections, trauma, autoimmune, post-ERCP.

Diagnosis

Requires ≥2 of 3 criteria: (1) characteristic abdominal pain, (2) serum lipase/amylase ≥3× upper limit of normal, (3) imaging findings (CT, MRI, ultrasound). Lipase is preferred—more specific and stays elevated longer.

Treatment

Acute Pancreatitis

• Aggressive IV hydration: Lactated Ringer's preferred; goal 2.5–3 L in first 24h.
• Pain control: IV opioids (hydromorphone, fentanyl); avoid morphine if sphincter of Oddi concern.
• Nutrition: Early oral feeding (low-fat, soft) as tolerated—improves outcomes vs. NPO. Enteral (NJ) if unable to eat; TPN only if enteral fails.
• Address cause: Cholecystectomy for gallstone pancreatitis (same admission if mild; delayed if severe). Alcohol cessation counseling.
• Severe disease: ICU monitoring, antibiotics for infected necrosis, endoscopic/percutaneous drainage, surgery for necrosectomy.

Chronic Pancreatitis

• Pain management (multimodal, avoid chronic opioids when possible)
• Pancreatic enzyme replacement therapy (PERT) for exocrine insufficiency
• Diabetes management (often insulin-requiring)
• Endoscopic therapy (stenting, lithotripsy for ductal stones) or surgery (drainage, resection) for refractory pain
• Absolute alcohol abstinence, smoking cessation

Prevention

Limit alcohol, maintain healthy weight, treat hypertriglyceridemia, avoid unnecessary medications, and if you have gallstones, discuss prophylactic cholecystectomy with your doctor.

Early recognition and appropriate management dramatically improve outcomes. If you suspect pancreatitis, seek medical attention immediately.