What Is Pancreatitis?

Pancreatitis is inflammation of the pancreas, a gland behind your stomach that produces digestive enzymes and hormones (like insulin) to regulate blood sugar. When these enzymes activate too early inside the pancreas, they begin to “digest” the pancreas itself, leading to pain, swelling and, in severe cases, life-threatening complications.

Pancreatitis occurs in two main forms:

• Acute pancreatitis
  Sudden inflammation that may be mild or life-threatening but usually resolves within days to weeks with proper treatment.
• Chronic pancreatitis
  Long-standing inflammation that leads to irreversible damage, fibrosis (scarring) and loss of function over time.

Both forms share similar causes and symptoms, but chronic pancreatitis can lead to ongoing digestive problems, diabetes and a higher risk of complications.

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Acute Pancreatitis

Pathophysiology & Classification

According to the revised Atlanta classification (Banks et al., 2013), acute pancreatitis is categorized by severity:

1. Mild
   No organ failure, no local or systemic complications.
2. Moderately Severe
   Transient organ failure (resolves within 48 hours) or local complications (e.g., fluid collections).
3. Severe
   Persistent organ failure (> 48 hours), which may involve the lungs, kidneys or cardiovascular system.

Common Causes

Most cases of acute pancreatitis are triggered by:

• Gallstones (block the pancreatic duct)
• Heavy alcohol use
• High blood triglycerides (hypertriglyceridemia)
• Certain medications (e.g., some diuretics, immunosuppressants)
• Trauma or surgical procedures near the pancreas
• Autoimmune disorders
• Genetic mutations (e.g., CFTR, PRSS1)
• Infections (rare)

Signs & Symptoms

Symptoms often develop suddenly and can range from mild discomfort to intense pain:

• Severe, constant upper abdominal pain, often radiating to the back
• Nausea and vomiting
• Abdominal tenderness and swelling
• Fever, rapid heart rate
• Jaundice (if a gallstone blocks the bile duct)

Diagnosis

Diagnosis combines clinical evaluation, blood tests and imaging:

• Blood tests: elevated pancreatic enzymes (amylase, lipase)
• Liver function tests (to check for gallstone obstruction)
• Abdominal ultrasound: first-line to detect gallstones and ductal dilation
• Contrast-enhanced CT scan: assesses severity, detects complications (necrosis, fluid collections)
• MRCP or endoscopic ultrasound: detailed images of ducts, stones

Treatment

There is no specific “cure” for acute pancreatitis; management is supportive:

• Hospital admission for close monitoring
• Aggressive IV fluids to maintain blood pressure and circulation
• Pain control (usually with opioid or non-opioid analgesics)
• Nutritional support
  • Mild cases: clear liquids advancing to a low-fat diet as tolerated
  • Severe cases: enteral feeding (tube) if oral intake is not possible
• Treat underlying cause
  • Gallstones: may require endoscopic retrograde cholangiopancreatography (ERCP) or surgery
  • High triglycerides: lipid-lowering therapy
  • Medications: adjust or discontinue potential triggers
• Monitor for complications
  • Infected necrosis (may need antibiotics or drainage)
  • Organ failure (intensive care support)

Most people with mild acute pancreatitis recover fully in 3–7 days. Moderately severe and severe cases may take weeks to months, especially if complications arise.

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Chronic Pancreatitis

How It Develops

Chronic pancreatitis is ongoing inflammation leading to permanent changes:

• Repeated acute attacks cause fibrosis (scar tissue)
• Loss of exocrine function (digestive enzymes)
• Loss of endocrine function (insulin production)

Over time, the gland becomes hard and shrunken, impairing digestion and blood sugar regulation.

Common Causes

• Long-term heavy alcohol use (most common)
• Genetic predisposition (e.g., hereditary pancreatitis)
• Autoimmune pancreatitis
• Obstruction of the pancreatic duct (e.g., strictures, stones)
• Idiopathic (unknown cause)

Signs & Symptoms

• Persistent or recurrent upper abdominal pain
• Weight loss (malabsorption of fats and proteins)
• Steatorrhea (fatty, foul-smelling stools)
• Diabetes mellitus (late complication)
• Fatigue, malnutrition

Diagnosis

• Imaging: CT, MRI/MRCP or endoscopic ultrasound show calcifications, ductal changes, atrophy
• Fecal elastase test: assesses exocrine insufficiency
• Blood glucose and HbA₁c: check for diabetes

Treatment

There is no cure—management focuses on symptom control and preventing progression:

• Pain management
  • Analgesics, nerve blocks, or endoscopic/surgical interventions
• Pancreatic enzyme replacement therapy (PERT)
  • Helps digest fats and proteins, improves weight gain
• Diet and lifestyle changes
  • Low-fat diet, small frequent meals
  • Complete abstinence from alcohol and smoking
• Blood sugar control
  • Insulin or oral medications for diabetes
• Endoscopic/surgical procedures for ductal stones or strictures

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Complications to Watch For

Both acute and chronic pancreatitis can lead to serious issues:

• Pseudocysts or fluid collections around the pancreas
• Pancreatic necrosis and infection
• Organ failure (lungs, kidneys, heart)
• Malnutrition, vitamin deficiencies
• Diabetes mellitus
• Increased risk of pancreatic cancer (chronic cases)

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When to Seek Help

Pancreatitis can be unpredictable. If you experience any of the following, get immediate medical attention:

• Sudden, severe abdominal pain
• Persistent vomiting and inability to keep fluids down
• Signs of shock (rapid heartbeat, low blood pressure, confusion)
• High fever with chills
• Yellowing of the skin or eyes (jaundice)

If you’re unsure about your symptoms, consider a free, online symptom check for pancreatitis to help decide if you need urgent care.

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Key Takeaways

• Pancreatitis is inflammation of the pancreas that can be acute (sudden) or chronic (long-term).
• Common triggers include gallstones, alcohol, high triglycerides and certain drugs.
• Diagnosis relies on symptoms, blood tests and imaging.
• Treatment is mainly supportive: fluids, pain relief, nutrition and addressing the root cause.
• Chronic pancreatitis leads to permanent damage, requiring enzyme replacement and diabetes management.
• Serious complications may arise; always seek prompt medical care for severe or worsening symptoms.

This overview is for educational purposes. Always speak to a doctor about any symptoms that could be life-threatening or serious.