The pancreas is a large gland behind the stomach and close to the first part of the small intestine. It secretes digestive juices into the small intestine through a tube called the pancreatic duct. The pancreas also releases the hormones insulin and glucagon into the bloodstream.
Pancreatitis is inflammation in the pancreas. The pancreas is a long, flat gland that sits tucked behind the stomach in the upper abdomen. The pancreas produces enzymes that help digestion and hormones that help regulate the way your body processes sugar (glucose).
Pancreatitis is inflammation of the pancreas. It happens when digestive enzymes start digesting the pancreas itself. Pancreatitis can be acute or chronic. Either form is serious and can lead to complications.
Acute pancreatitis occurs suddenly and usually goes away in a few days with treatment. It is often caused by gallstones. Common symptoms are severe pain in the upper abdomen, nausea, and vomiting. Treatment is usually a few days in the hospital for intravenous (IV) fluids, antibiotics, and medicines to relieve pain.
Recognizing patients with severe acute pancreatitis as soon as possible is critical for achieving optimal outcomes. Management depends largely on severity. Medical treatment of mild acute pancreatitis is relatively straightforward. Treatment of severe acute pancreatitis involves intensive care. Surgical intervention (open or minimally invasive) is indicated in selected cases.
What Is Pancreatitis?
Pancreatitis is a disease in which your pancreas becomes inflamed.
The pancreas is a large gland behind your stomach and next to your small intestine. Your pancreas does two main things:
It releases powerful digestive enzymes into your small intestine to help you digest food.
It releases insulin and glucagon into your bloodstream. These hormones help your body control how it uses food for energy.
Your pancreas can be damaged when digestive enzymes begin working before your pancreas releases them.
Types of Pancreatitis
Acute pancreatitis usually starts with pain that
- begins slowly or suddenly in your upper abdomen
- sometimes spreads to your back
- can be mild or severe
- may last for several days
Other symptoms may include
- nausea and vomiting
- fast heartbeat
- swollen or tender abdomen
People with acute pancreatitis usually look and feel seriously ill and need to see a doctor right away.
Most people with chronic pancreatitis
feel pain in the upper abdomen, although some people have no pain at all.
The pain may
- spread to your back
- become constant and severe
- become worse after eating
- go away as your condition gets worse
People with chronic pancreatitis may not have symptoms until they have complications.
Other symptoms may include
- greasy, foul-smelling stools
- weight loss
What Are the Signs and Symptoms of Pancreatitis?
Pancreatitis causes upper abdominal pain which can range from mild to severe.
The pain may come on suddenly or it may develop gradually. Often, the pain will start or worsen after eating, which can also occur with gallbladder or ulcer pain. Abdominal pain tends to be the hallmark of acute pancreatitis. People with acute pancreatitis usually feel very ill.
Acute pancreatitis signs and symptoms may include:
- Abdominal pain that may radiate to the back
- Nausea and vomiting
- Worsening pain after eating
- Tenderness to touch of the abdomen
- Fever and chills
- Weakness and lethargy
In chronic pancreatitis, abdominal pain also can be present, but it is often not as severe, and some people may not have any pain at all.
Chronic pancreatitis signs and symptoms may include:
- Abdominal pain
- Unintentional weight loss
- Foul smelling, oily stool
Pancreatitis Causes and Risk Factors
Pancreatitis occurs when digestive enzymes become activated while still in the pancreas, irritating the cells of your pancreas and causing inflammation.
With repeated bouts of acute pancreatitis, damage to the pancreas can occur and lead to chronic pancreatitis. Scar tissue may form in the pancreas, causing loss of function. A poorly functioning pancreas can cause digestion problems and diabetes.
Acute pancreatitis causes include:
- Autoimmune diseases
- Drinking lots of alcohol
- Metabolic disorders
In up to 15% of people with acute pancreatitis, the cause is unknown.
Chronic pancreatitis causes include:
- Cystic fibrosis
- Family history of pancreas disorders
- High triglycerides
- Longtime alcohol use
In about 20% to 30% of cases, the cause of chronic pancreatitis is unknown. People with chronic pancreatitis are usually men between ages 30 and 40.
How Is Pancreatitis Diagnosed?
Your provider may suspect pancreatitis based on your symptoms or risk factors, such as heavy alcohol use or gallstone disease. To confirm diagnosis, you may go through additional tests.
Diagnosing acute pancreatitis
For acute pancreatitis, your provider may order a blood test that measures the levels of two digestive enzymes (amylase and lipase) produced by the pancreas. High levels of these enzymes indicate acute pancreatitis. An ultrasound or computed tomography (CT scan) provides images of your pancreas, gall bladder and bile duct that can show abnormalities.
Diagnosing chronic pancreatitis
Diagnosing chronic pancreatitis is more involved. You may also need:
- Secretin pancreatic function test: This test checks for your pancreas’s response to a hormone (secretin) released by the small intestine. Secretin usually triggers the pancreas to release a digestive juice. A medical professional passes a tube from your throat, through your stomach, into the upper part of the small intestine to insert secretin and measure the response.
- Oral glucose tolerance test: You may need this test if your provider suspects that pancreatitis has damaged your insulin-producing pancreas cells. It measures how your body handles sugar with a blood test before and after you drink a sugary liquid.
- Stool test: Your provider may order a stool test using a sample of your stool to see if your body is having difficulty breaking down fat.
- Endoscopic ultrasound (endosonography): An internal (endoscopic) ultrasound takes clearer pictures of your pancreas and connecting ducts (tubes). A healthcare professional inserts a thin tube with a tiny ultrasound attachment into your throat, through your stomach and into your small intestine. The endoscopic ultrasound takes detailed pictures of your internal organs including pancreas, part of liver, gall bladder and bile duct.
- ERCP (endoscopic retrograde cholangiopancreatography): A tube with a tiny camera is passed from your throat to your stomach and into your small intestine up to the area called the ampulla, where the pancreas and bile duct opens. Dye is injected into the pancreas duct and /or bile duct. The test lets your provider see inside the pancreas and bile duct. Anything blocking the pancreas or bile duct, such as a gallstone or pancreas stone, may be removed.
Treatment for acute pancreatitis
You’ll probably need to stay in the hospital, where your treatment may include:
- Antibiotics if your pancreas is infected
- Intravenous (IV) fluids, given through a needle
- Low-fat diet or fasting. You might need to stop eating so your pancreas can recover. In this case, you’ll get nutrition through a feeding tube.
- Pain medicine
If your case is more severe, your treatment might include:
- ERCP to take out gallstones if they’re blocking your bile or pancreatic ducts
- Gallbladder surgery if gallstones caused your pancreatitis
- Pancreas surgery to clean out fluid or dead or diseased tissue
Treatment for chronic pancreatitis
If you have chronic pancreatitis, you might need more treatments, including:
- Insulin to treat diabetes
- Pain medicine
- Pancreatic enzymes to help your body get enough nutrients from your food
- Surgery or procedures to relieve pain, help with drainage, or treat blockages
- Lowering fat intake
- Supplementing digestion by taking pancreatic enzyme tablets with food
- Cutting out alcohol
Because many cases of pancreatitis are caused by alcohol abuse, prevention often focuses on limiting how much you drink or not drinking at all. If your drinking is a concern, talk to your doctor or health care professional about an alcohol treatment center. A support group such as Alcoholics Anonymous could also help.
Stop smoking, follow your doctor’s and dietitian’s advice about your diet, and take your medications so you’ll have fewer and milder attacks of pancreatitis.
Eating high-fiber foods and avoiding sugar may help you prevent gallstones, which are the main cause of acute pancreatitis.
These healthy lifestyle choices will also help you avoid gallstones, which cause 40% of acute pancreatitis cases. Your provider may recommend removing your gallbladder if you have painful gallstones multiple times.
How long does pancreatitis last?
Typically, acute pancreatitis lasts only a few days. But if you have a more severe case, it may take several weeks to months to recover. Chronic pancreatitis requires lifelong management.
Will pancreatitis go away?
With treatment, most people with acute pancreatitis completely recover.
Chronic pancreatitis is a long-lasting condition. Once it’s severely damaged, your pancreas doesn’t function properly. You need ongoing support to digest food and manage blood sugar.
Can pancreatitis return?
With chronic pancreatitis, painful episodes can come and go or persist (last a long time).
You can also have another attack of acute pancreatitis, especially if you haven’t resolved the underlying problem. For example, if you have another gallstone that blocks the opening to the pancreas, you can get acute pancreatitis again.
Is pancreatitis fatal?
Most people with a mild case of acute pancreatitis fully recover. However, those with severe pancreatitis are more likely to have life-threatening complications such as:
- Infection of the pancreas.
- Bleeding in the pseudocyst or damaged pancreas.
- Heart, lung or kidney failure from spreading infection or if the pancreas leaks toxins into the blood.