Pancreatitis: when to worry

Pancreatitis: When to Worry

Pancreatitis is inflammation of the pancreas, an organ behind your stomach that helps with digestion and blood sugar control. Mild cases often improve with rest and fluids, but severe pancreatitis can cause life-threatening complications. Knowing when to seek urgent medical care can make a critical difference in outcomes.

---

What Is Pancreatitis?

• Acute pancreatitis comes on suddenly and may last days.
• Chronic pancreatitis develops over months to years, often after repeated acute episodes.
• Common causes include gallstones, heavy alcohol use, certain medications, high triglycerides, and infections.

---

Typical Symptoms

People with pancreatitis often experience:

• Intense upper-abdominal pain that may radiate to the back
• Nausea and persistent vomiting
• Fever, rapid pulse, or low blood pressure
• Swollen or tender abdomen
• Jaundice (yellowing of skin/eyes) if bile ducts are blocked

Symptoms can range from mild discomfort to excruciating pain. Any sudden, severe pain that doesn’t improve with rest or over-the-counter pain relievers warrants medical attention.

---

Severity Classification (Revised Atlanta Criteria)

According to the 2012 revision of the Atlanta Classification (Banks et al., Gut, 2013), acute pancreatitis falls into three categories:

1. Mild Acute Pancreatitis
   – No organ failure
   – No local or systemic complications

2. Moderately Severe Acute Pancreatitis
   – Transient organ failure (resolves within 48 hours)
   – Local complications (pancreatic necrosis, fluid collections)

3. Severe Acute Pancreatitis
   – Persistent organ failure (lasting > 48 hours), affecting lungs, kidneys or heart

Severe cases carry the highest risk of complications and in-hospital mortality.

---

Risk Scoring: BISAP

The BISAP score (Wu et al., Clin Gastroenterol Hepatol, 2008) is a simple tool to predict in-hospital mortality. One point is assigned for each:

• BUN > 25 mg/dL
• Impaired mental status (Glasgow Coma Scale < 15)
• SIRS (Systemic Inflammatory Response Syndrome)
• Age > 60 years
• Pleural effusion on chest X-ray

A score of 3–5 indicates increased risk of severe disease and complications. Your care team may use this score early in your hospitalization to guide monitoring and treatment intensity.

---

When to Seek Immediate Care

Even if you’ve had mild pancreatitis before, new or worsening signs can signal a more serious problem. Seek emergency care if you experience any of the following:

• Unrelenting abdominal pain that doesn’t improve with home measures
• Persistent vomiting, unable to keep fluids down
• High fever (over 101°F or 38.3°C) or chills
• Rapid heartbeat (over 100 beats per minute) or dizziness
• Shortness of breath or chest pain
• Yellowing of skin or eyes (jaundice)
• Swelling or hardening of the abdomen
• Cold, clammy skin or confusion (signs of shock)

These symptoms suggest complications such as infection, pancreatic necrosis, organ failure, or internal bleeding.

---

Warning Signs of Organ Failure

Pancreatitis can trigger systemic inflammation that affects other organs. Be particularly vigilant for:

• Breathing difficulties: May indicate acute respiratory distress syndrome (ARDS).
• Decreased urine output: Sign of kidney involvement.
• Low blood pressure: Could signal septic shock or internal bleeding.
• Altered mental state: Confusion, lethargy, or agitation can point to severe inflammation or low blood pressure.

Any combination of these signs requires prompt hospitalization and close monitoring in an intensive care setting.

---

What to Do at Home

If you’ve been diagnosed with mild pancreatitis and your doctor agrees it’s safe to manage at home:

• Stay hydrated with clear fluids (water, broth, electrolyte solutions)
• Avoid solid foods until nausea and pain subside
• Take prescribed pain medications as directed
• Follow any instructions on stopping alcohol or certain medications

However, if home care fails to control pain or you develop any worrying signs (see above), return to the emergency department immediately.

---

Consider a Free, Online Symptom Check

If you’re unsure whether your symptoms need urgent attention, you might consider doing a free, online symptom check for pancreatitis to better understand your risks. Online tools can guide you on whether to seek prompt medical evaluation.

---

Long-Term Concerns

Chronic pancreatitis can lead to:

• Ongoing abdominal pain
• Malabsorption and weight loss
• Diabetes due to loss of insulin-producing cells
• Increased risk of pancreatic cancer

If you have repeated episodes of pancreatitis, regular follow-up with a gastroenterologist is crucial to monitor for long-term complications.

---

When to Follow Up with Your Doctor

Even after successful treatment for an acute episode, schedule follow-up within a few weeks to:

• Identify and address the underlying cause (gallstones, alcohol use, high triglycerides)
• Review imaging studies (ultrasound, CT, MRI) for residual complications
• Discuss strategies to prevent recurrence

Ongoing management may include dietary changes, enzyme supplements, or procedures to remove gallstones or drain fluid collections.

---

Key Takeaways

• Pancreatitis ranges from mild to life-threatening.
• Watch for severe, unrelenting pain; persistent vomiting; fever; rapid heart rate; and jaundice.
• Risk scores like BISAP help doctors predict who will need intensive care.
• Seek emergency care immediately if you develop signs of organ failure or shock.
• Consider a free, online symptom check for pancreatitis if you’re unsure.
• Speak to a doctor about any serious or life-threatening symptoms.

---

Always err on the side of caution. Speak to a doctor about anything that could be life-threatening or serious. Your health and safety come first.