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Pancreatitis: Causes, Symptoms, and Risk Factors

Pancreatitis is inflammation of the pancreas. Acute pancreatitis is sudden and potentially life-threatening; chronic pancreatitis is progressive with permanent damage.

Major Causes (Acute)

  1. Gallstones (40–70%): Obstruct common bile duct → pancreatic duct backup → enzyme activation.
  2. Alcohol (25–35%): Chronic heavy use; direct toxic/metabolic effects.
  3. Hypertriglyceridemia (>1000 mg/dL): Lipotoxicity.
  4. Medications: Azathioprine, 6-MP, valproate, estrogens, thiazides, GLP-1 agonists (rare).
  5. ERCP: Post-procedure (5–10%).
  6. Trauma, infections (mumps, coxsackie), autoimmune, genetic (PRSS1, SPINK1, CFTR), hypercalcemia, scorpion venom.

Symptoms

  • Acute: Severe epigastric pain radiating to back, nausea/vomiting, fever, tachycardia, abdominal tenderness/distension.
  • Chronic: Recurrent pain, malabsorption (steatorrhea, weight loss), diabetes (endocrine insufficiency).

Diagnosis

  • Lipase/amylase >3× upper limit (lipase more specific).
  • CT abdomen (with contrast) for severity/necrosis (Balthazar score).
  • US for gallstones.

Treatment

  • Aggressive IV hydration (Lactated Ringer's).
  • Pain control (opioids).
  • Early enteral feeding (nasogastric/jejunal) — superior to NPO.
  • Antibiotics only for infected necrosis.
  • Cholecystectomy for gallstone pancreatitis (same admission if mild; delayed if severe).
  • Alcohol cessation, lipid-lowering, medication review.

Severity Scoring

Ranson's, APACHE II, BISAP, CT severity index guide ICU admission and prognosis.

Pancreatitis requires hospitalization. Early goal-directed fluid resuscitation improves outcomes.

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