What causes pancreatitis?

Pancreatitis is inflammation of the pancreas, a gland behind your stomach that produces digestive enzymes and hormones like insulin. When the pancreas becomes irritated or injured, these enzymes can activate too early, causing damage to pancreatic tissue and leading to a range of symptoms from mild discomfort to life-threatening complications.

Types of Pancreatitis

• Acute pancreatitis
  • Sudden onset, often severe pain
  • Usually resolves in days or weeks with treatment
• Chronic pancreatitis
  • Long-term inflammation causing permanent damage
  • Leads to scarring, reduced enzyme production, possibly diabetes

Common Causes of Pancreatitis

1. Gallstones

   • Account for up to 40% of acute cases (Yadav & Hawes, 2007).
   • Small stones can block the bile or pancreatic duct, triggering enzyme build-up and inflammation.

2. Alcohol Consumption

   • Responsible for roughly 30% of acute cases and most chronic cases.
   • Heavy, prolonged drinking alters pancreatic cells and ductal flow, leading to repeated injury.

3. High Triglycerides (Hypertriglyceridemia)

   • Levels above 1,000 mg/dL can precipitate acute attacks.
   • Fat breakdown products may damage pancreatic cells.

4. Medications

   • Certain drugs have been implicated, including:
     • Some diuretics (e.g., furosemide)
     • Azathioprine and other immunosuppressants
     • Didanosine (an HIV medication)
   • Always review side effects if you develop abdominal pain on new medications.

5. Autoimmune Pancreatitis

   • The body’s immune system attacks the pancreas.
   • Often associated with other autoimmune conditions (e.g., primary sclerosing cholangitis).
   • May respond well to steroids.

6. Genetic Mutations

   • Hereditary pancreatitis linked to mutations in PRSS1, SPINK1 or CFTR genes.
   • Family history increases risk, especially if onset is in childhood.

7. Structural Abnormalities

   • Anatomic issues like pancreas divisum (two separate duct systems) can impair enzyme drainage.
   • Congenital anomalies may require endoscopic or surgical correction.

8. Infections and Trauma

   • Viral (mumps, coxsackievirus), bacterial, or parasitic infections can inflame the pancreas.
   • Abdominal injury (e.g., from sports or accidents) may directly damage pancreatic tissue.

9. Other Metabolic Causes

   • High calcium (hypercalcemia) due to hyperparathyroidism.
   • Rarely, toxins or venoms from scorpion stings.

Risk Factors That Increase Susceptibility
• Age and Sex: Gallstone-related pancreatitis is more common in women over 60; alcohol-related more common in men 35–45.
• Obesity: Raises risk of gallstones and hypertriglyceridemia.
• Smoking: Independently increases risk for both acute and chronic pancreatitis.
• Family History: Genetic forms often present earlier and recur more frequently.

How Pancreatitis Develops

1. Premature Enzyme Activation
   • Normally, digestive enzymes are stored inactive in pancreatic cells.
   • Injury or blockage causes activation within the gland, leading to “self-digestion.”
2. Inflammatory Cascade
   • Cell injury triggers the release of inflammatory mediators (cytokines).
   • This attracts immune cells, amplifying tissue damage.
3. Systemic Effects
   • Severe cases can lead to fluid shifts, organ failure, and systemic inflammatory response syndrome (SIRS).

Symptoms to Watch For

• Sudden, severe pain in the upper abdomen, often radiating to the back
• Nausea, vomiting, loss of appetite
• Fever, rapid pulse (in acute cases)
• Weight loss, oily or fatty stools (in chronic cases)

If you’re experiencing these symptoms, you might consider doing a free, online symptom check for abdominal pain and related issues. However, only a healthcare professional can diagnose pancreatitis.

Diagnosis and Evaluation
• Blood Tests: Elevated amylase and lipase enzymes are key markers.
• Imaging:
– Ultrasound to detect gallstones
– CT scan or MRI to assess inflammation and complications
• Endoscopic Ultrasound (EUS): Detailed view of ducts and tissue
• Genetic Testing: When hereditary pancreatitis is suspected

Treatment Approaches

• Acute Pancreatitis
  • Hospitalization for IV fluids, pain control, and nutritional support
  • Fasting or minimal oral intake to rest the pancreas
  • ERCP (endoscopic retrograde cholangiopancreatography) if gallstones block the duct
• Chronic Pancreatitis
  • Pancreatic enzyme replacement to aid digestion
  • Pain management, potentially including nerve blocks
  • Lifestyle changes: Alcohol cessation, low-fat diet, smoking cessation
  • Surgery in refractory cases (e.g., ductal decompression, partial pancreatectomy)

Prevention Strategies

• Manage Gallstones: If you have known gallstones, discuss elective removal with your doctor.
• Limit Alcohol: Abstinence or moderation significantly reduces risk.
• Control Lipids: Diet, exercise, and medications to keep triglycerides below 500 mg/dL.
• Quit Smoking: Seek support through counseling or nicotine replacement.

When to Seek Immediate Help
• Intense, persistent abdominal pain
• Vomiting that won’t stop
• Signs of shock (rapid heartbeat, low blood pressure)
• High fever, confusion, difficulty breathing

These symptoms could indicate severe pancreatitis or complications like infection, necrosis, or organ failure. Always err on the side of caution—speak to a doctor promptly if you suspect pancreatitis.

Key Takeaways on Pancreatitis Causes

• Gallstones and alcohol are the top triggers of acute and chronic pancreatitis.
• Less common causes include high triglycerides, certain medications, autoimmune disease, genetic mutations, and trauma.
• Early recognition and management can prevent serious complications.
• Lifestyle changes and medical interventions reduce recurrence.

Pancreatitis can range from a mild, self-limited condition to a life-threatening emergency. If you have concerning symptoms or known risk factors, consult your healthcare provider. Only a doctor can confirm the diagnosis, rule out complications, and guide treatment. If you suspect anything serious, don’t wait—speak to a doctor right away.