Pancreatitis: Symptoms, Causes, and Treatment

Pancreatitis = pancreatic inflammation from premature trypsinogen activation → autodigestion.

Acute vs. Chronic

Feature	Acute	Chronic
Onset	Sudden	Insidious
Duration	Days	Months/years
Pathology	Edema, necrosis	Fibrosis, calcification, atrophy
Pain	Severe, constant, radiates to back	Recurrent, may burn out

Etiology

• Acute: gallstones (40%), alcohol (30%), HTG (>1000 mg/dL), ERCP, drugs, trauma, infections, Scorpion sting.
• Chronic: alcohol (60–70%), smoking, genetic (PRSS1, SPINK1, CFTR), obstructive, idiopathic.

Diagnosis

• Lipase >3× ULN (specificity >95%).
• CT abdomen (necrosis, fluid, pseudocyst) — delay 48–72h unless diagnostic uncertainty.
• Revised Atlanta Classification (mild/moderate/severe).

Treatment

• Acute: aggressive IV fluids (RL), early enteral nutrition, analgesia, antibiotics only for infected necrosis, ERCP if cholangitis.
• Chronic: pancreatic enzyme replacement, pain management (stepwise), antioxidants, diabetes screening, endoscopic/surgical decompression for ductal obstruction.

Prevention

• Cholecystectomy after gallstone pancreatitis.
• Alcohol cessation, smoking cessation.
• HTG control (fibrates, omega-3, insulin).