Causes
- Gallstones: The most common cause of acute pancreatitis — a stone passing out of the gallbladder can block the pancreatic duct where it joins the bile duct.
- Alcohol: Heavy drinking is the other leading cause of acute attacks and the most common cause of chronic pancreatitis; risk rises with the amount and duration of drinking.
- High triglycerides: Severely elevated levels, as seen in poorly controlled hypertriglyceridemia, can trigger acute pancreatitis.
- Medications and procedures: Certain drugs and ERCP (a bile-duct procedure) occasionally cause pancreatitis.
- Other causes: High calcium levels, genetic mutations, autoimmune pancreatitis, and smoking; in a minority of cases no cause is found.
Symptoms
Acute pancreatitis typically causes:- Severe upper abdominal pain: Steady, boring pain in the upper abdomen that often radiates straight through to the back and may ease slightly when leaning forward.
- Nausea and vomiting: Usually persistent, with inability to keep food down.
- Fever and a rapid pulse: The abdomen is often tender and distended.
Diagnosis
Acute pancreatitis is diagnosed from the combination of typical pain, a blood lipase level several times above normal, and imaging when needed — usually an abdominal ultrasound to look for gallstones, with CT reserved for severe or unclear cases. Triglyceride and calcium levels help identify the cause. For chronic pancreatitis, CT or MRCP shows calcifications and duct changes, and a stool elastase test measures how well the pancreas is producing enzymes. Repeated attacks without an obvious cause may prompt additional testing, including genetic evaluation in younger patients.Treatment
- Acute pancreatitis: Treated in the hospital with generous intravenous fluids, pain and nausea control, and early resumption of eating as tolerated. Most mild cases settle within days, while severe cases with organ involvement are managed in intensive care.
- Treating the cause: When gallstones are responsible, gallbladder removal — often during the same admission — prevents repeat attacks; a stone stuck in the bile duct may need endoscopic removal. Triglyceride-induced pancreatitis is managed by aggressively lowering triglycerides with diet and medication.
- Chronic pancreatitis: Complete abstinence from alcohol and smoking is essential to slow damage. Pancreatic enzyme replacement capsules taken with meals improve digestion and reduce oily stools, smaller low-fat meals help symptoms, and pain is managed in a stepwise fashion. Because the insulin-producing cells can fail over time, blood sugar is monitored and diabetes is treated when it develops.