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Pancreatitis

Pancreatitis is inflammation of the pancreas, most often from gallstones, alcohol, or high triglycerides; acute attacks cause severe upper abdominal pain and usually need hospital care.

Gastrointestinal
Pancreatitis is inflammation of the pancreas, the gland behind the stomach that produces digestive enzymes and the hormones insulin and glucagon. It occurs in two forms: acute pancreatitis, a sudden attack that ranges from mild to life-threatening, and chronic pancreatitis, in which repeated or ongoing inflammation gradually scars the gland and impairs its function. Acute pancreatitis is one of the most common digestive reasons for hospital admission in the United States, and both forms deserve careful medical attention. 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.
Chronic pancreatitis causes recurring or constant upper abdominal pain, and as the gland loses function, oily floating stools (from fat malabsorption), unintended weight loss, and eventually diabetes. Because fat absorption is impaired, deficiencies of vitamins A, D, E, and K can also develop over time. 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.
When to Seek Immediate Care: Severe, persistent upper abdominal pain — especially with vomiting, fever, or a racing heartbeat — warrants emergency evaluation. Untreated severe pancreatitis can affect breathing, kidneys, and circulation, and early hospital care makes a real difference. After recovery, the priority is preventing the next attack: treating gallstones, controlling triglycerides, and eliminating alcohol. The internal-medicine team at Zimmer Medical Group can identify your risk factors and build a prevention plan.

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