Pancreatitis is the inflammation of the pancreas, an organ located behind the stomach that plays a vital role in digestion and blood sugar regulation.

There are two main types:

1. Acute pancreatitis – sudden onset inflammation, often severe but usually reversible with treatment.
2. Chronic pancreatitis – long-standing inflammation that leads to permanent damage, scarring, and loss of pancreatic function.

The causes of pancreatitis:

1. Most Common Causes

1. Gallstones – Blockage of the pancreatic duct by gallstones can trigger inflammation.
2. Alcohol consumption – Chronic heavy drinking is a major cause, especially in adults.

2. Metabolic Causes

• Hypertriglyceridemia – Very high triglyceride levels (>1000 mg/dL)
• Hypercalcemia – Often due to hyperparathyroidism

3. Drug-induced Causes

• Certain medications can trigger pancreatitis, such as:
  • Azathioprine
  • Valproic acid
  • Certain diuretics (e.g., furosemide)
  • Some antibiotics (e.g., tetracyclines)

4. Infectious Causes

• Viruses: mumps, coxsackievirus, hepatitis
• Bacterial or parasitic infections (less common)

5. Traumatic or Procedural Causes

• Abdominal trauma
• Post-ERCP (Endoscopic Retrograde Cholangiopancreatography)

6. Genetic and Structural Causes

• Hereditary pancreatitis (mutations in PRSS1, SPINK1 genes)
• Congenital anomalies of the pancreatic ducts

7. Idiopathic

• Sometimes no identifiable cause is found; these are called idiopathic pancreatitis.

The Pancreatitis symptoms:

1. Acute Pancreatitis

• Severe upper abdominal pain – often sudden, may radiate to the back
• Nausea and vomiting
• Abdominal tenderness
• Fever
• Rapid heartbeat (tachycardia)
• Swollen or distended abdomen in severe cases
• Sometimes jaundice if bile duct is involved

2. Chronic Pancreatitis

• Persistent abdominal pain – may be intermittent or constant
• Weight loss – due to malabsorption
• Steatorrhea – oily, foul-smelling stools (fat malabsorption)
• Diabetes mellitus – due to loss of insulin-producing cells
• Nausea and vomiting may also occur

Other signs in severe cases of acute pancreatitis:

• Low blood pressure
• Confusion or lethargy
• Signs of shock (if complicated by necrosis or infection)

The Treatment of pancreatitis

1. Acute Pancreatitis

Main goals: Supportive care, relieve pain, treat underlying cause, prevent complications.

a) Hospital care and supportive measures:

• Fasting (NPO) – allow the pancreas to rest
• IV fluids – to prevent dehydration and maintain blood pressure
• Pain control – usually with opioids
• Nutritional support – enteral feeding if prolonged fasting is needed

b) Treat underlying cause:

• Gallstones – may require ERCP or surgery
• High triglycerides – lipid-lowering therapy
• Medication-induced – stop the offending drug

c) Complication management:

1. Infections – antibiotics if infected necrosis occurs
2. Surgery – for pancreatic necrosis or abscess

2. Chronic Pancreatitis

Main goals: Manage pain, prevent further damage, replace lost pancreatic function.

a) Lifestyle modifications:

• Avoid alcohol completely
• Low-fat diet

b) Medications:

• Pancreatic enzyme replacement therapy (PERT) – to help digestion
• Insulin – if diabetes develops
• Pain management – analgesics, sometimes nerve blocks

c) Procedures or surgery:

• Drainage of pseudocysts
• Surgery to remove damaged tissue or relieve duct obstruction