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Pancreatitis

Pancreatitis refers to inflammation (swelling) of the pancreas. It is often caused by gallstones or heavy alcohol abuse. Both acute and chronic pancreatitis symptoms are similar.
Overview

Overview

  • Pancreatitis refers to inflammation (swelling) of the pancreas that is most often caused by gallstones or heavy alcohol abuse.
    • There are other causes that your gastroenterologist will look for, as well.
  • Pancreatitis often starts as a sudden attack of upper belly pain.
  • Treatment for pancreatitis usually focuses on easing pain and meeting the fluid and nutritional needs of the patient.
  • There are two types of pancreatitis, acute and chronic.
  • Both have similar symptoms that can be recurrent and either mild or severe.

Acute pancreatitis

Chronic pancreatitis

Can occur suddenly and goes away within a few days. Takes many years to develop and does not go away, since the pancreas is  permanently injured or scarred.
Most often caused by gallstones or heavy alcohol use, but there are other causes. Sometimes, no cause can be found. Chronic pancreatitis can be associated  with frequent flare-ups or persistent symptoms such as pain, diabetes or issues digesting fat.
Most cases are mild. Many patients with chronic pancreatitis will have calcifications of the pancreas that show on a computerized tomography (CT) scan.
Mostly involves a short hospital stay to heal the pancreas. Most people with chronic pancreatitis have a good outlook if they follow their management plan.

Chronic and acute pancreatitis have similar symptoms, but a few vary. Patients may have a few or all of these symptoms:
  • A slow or sudden severe pain in the middle part of the upper belly going through to your back. This pain may get worse when you eat and builds to a pain that does not go away.
  • Nausea and throwing up.
  • Weight loss.
  • Greasy or oily stools.
  • Diarrhea (loose stool).
  • Diabetes.
  • Jaundice (when your skin and/or the whites of your eyes turn yellow). This is rare.
If you have unexplained weight loss that lasts more than a few weeks, call your doctor.
Getting Tested

Getting Tested

In talking with your doctor about your symptoms, he or she may order certain tests to find out if you have pancreatitis and to see if it is acute or chronic. You can expect your doctor to:

Take your medical history and do an exam of your belly

  • Be sure to give your doctor a list of all medications you take, including prescription and over-the-counter medicines, vitamins and supplements.
  • Be sure to tell your doctor how much alcohol you drink and cigarettes you smoke (if any).

Take blood

  • Your blood can show the doctor your pancreatic enzyme levels.
  • High levels may be a sign you havea acute pancreatitis, while low levels can be seen in chronic pancreatitis.

X-ray or other imaging test

  • This will show how hurt or scarred your pancreas may be.
  • Most likely, you will be awake for the test, but it will not hurt.
  • Examples of imaging tests are:
    • Computerized tomography (CT) scan.
    • Magnetic resonance imaging/cholangiopancreatography (MRI/MRCP).
      • MRI is a medical imaging scan used to view detailed images of the organs and tissues within the body. MRCP is a medical imaging test that looks at your bile and pancreas ducts.
    • Endoscopic ultrasound (EUS).
Treatment

Treatment

Treating either acute or chronic pancreatitis calls for similar plans. Most cases of acute pancreatitis can go away within a week, while chronic pancreatitis can often be managed if the treatment plan is followed properly.
  • You may need to stay at the hospital for a few days (with acute pancreatitis).
  • You will be given antibiotics if there is evidence of a bacterial infection.
  • If needed, you can ask for medicine to help ease any pain.
  • You will initially be given IV fluids through a vein, then you will be able to gradually eat.
  • You might have an endoscopic retrograde cholangiopancreatography (ERCP).
    • This is used to treat your pancreas if something is blocking it or a bile duct is enlarged.
    • Learn more about ERCP.
  • If the cause of your acute pancreatitis is gallstones, you might be told to have your gallbladder removed to put off further attacks.
  • Your doctor may give you a special, temporary diet to follow as part of your plan to cut the amount of fats you eat, since your body has trouble digesting fat.
  • You may need to take pancreatic enzyme supplements with each meal. These supplements will help your body absorb food and help you get back some of the lost weight.
  • If you drink alcohol, you need to stop drinking.
  • If you smoke cigarettes, you need to stop smoking.
Complications

Complications

Pancreatitis can cause other issues, so caring for it the right way is very important to stop other problems from occurring. Talk to your doctor about ways to stop future attacks or future health issues.

Acute pancreatitis

  • Gallstones.
    • Gallstones can be the reason for acute pancreatitis.
    • You may need surgery to remove the stones or the gallbladder.
    • To learn more about gallstones, click here.
  • Infection.
    • Endoscopic procedures, percutaneous drains, or surgery may be needed to drain infected areas.
  • Pancreatic fluid collections (buildup of fluid and/or tissue).
    • These often resolve on their own.
    • These can be drained with endoscopy.
    • If they do not go away, these collections can get in the way of normal digestion.
  • In severe cases, pancreatitis can cause breathing problems or kidney failure.

Chronic pancreatitis

  • Can cause severe stomach and/or back pain.
  • Pseudocysts (buildup of fluid).
    • These often resolve on their own.
    • If not treated, pseudocysts could cause symptoms.
    • These can be drained with endoscopy, such as endoscopic ultrasound (EUS).
  • Calcification of the pancreas (the tissue becomes hard).
    • Pancreatic stones may block the main pancreatic duct and need an ERCP to be removed.
    • Surgery may be needed to remove or drain part of the pancreas.
  • In many cases, chronic pancreatitis can cause diabetes and reduce bone strength.
  • Pancreatic cancer develops more frequently in patients with chronic pancreatitis.

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