Pancreatitis is the inflammation of the pancreas, which is a large gland located behind the stomach. The pancreas produces enzymes that aid in digestion as well as hormones like insulin that help regulate blood sugar. When the pancreas becomes inflamed, it can cause severe abdominal pain and other symptoms.
What are the Early Symptoms of Pancreatitis?
Some of the early symptoms that signal the start of an episode of acute pancreatitis include:
- Upper abdominal pain that radiates to the back
- Nausea and vomiting
- Abdominal bloating
- Fever
- Rapid pulse
The abdominal pain associated with pancreatitis is often described as dull, constant, and penetrating. The pain typically starts gradually, builds in intensity, and then persists. It can range from mild discomfort to severe pain.
The abdominal pain is usually centralized in the upper abdomen. From there it can radiate towards the back or below the left shoulder blade. The pain is thought to be caused by inflammation of the pancreas putting pressure on surrounding nerves and organs.
Nausea and vomiting commonly accompany the pain. The nausea can be mild to severe, which sometimes leads to dry heaving when the stomach is empty. Vomiting does not typically relieve the pain.
Some people report abdominal bloating or distention along with the pain. There may also be decreased bowel sounds.
Fever indicating inflammation is present may be low-grade or higher. The fever is caused by inflammatory cytokines in the body in response to the pancreatitis.
Tachycardia or a rapid heart rate over 100 beats per minute can happen. This is from a release of catecholamines induced by the inflammation.
What Causes the Symptoms of Acute Pancreatitis?
The symptoms of acute pancreatitis occur when digestive enzymes normally secreted by the pancreas become activated inside the pancreas. This causes them to start “digesting” the pancreatic tissue, resulting in inflammation and damage.
Two key causes of acute pancreatitis are:
- Gallstones – Gallstone obstruction of the ampulla of Vater can block pancreatic fluid outflow and trigger pancreatitis.
- Excessive alcohol use – Alcohol directly damages pancreatic acinar cells and results in release of digestive enzymes inside the pancreas.
Other potential causes include high blood triglycerides, certain medications, trauma, infections, medical procedures, and genetic conditions like cystic fibrosis.
How Quickly Do Symptoms Develop?
In most cases of acute pancreatitis, the symptoms tend to develop relatively rapidly over hours to days. The abdominal pain, nausea, and vomiting may start gradually but often increase in severity quickly.
In mild cases, symptoms may peak within the first 12-24 hours then gradually subside over a few days. With severe necrotizing pancreatitis, symptoms can worsen over the course of a week or more before plateauing and eventually improving.
Sudden onset of severe epigastric pain that radiates to the back is one of the hallmarks of acute pancreatitis. Oftentimes patients recall the exact moment the pain started because it becomes so pervasive.
How is Pancreatitis Pain Different from Other Abdominal Pains?
There are some unique features of the abdominal pain seen in acute pancreatitis compared to other causes of abdominal pain:
- The pain is usually very severe and constant
- Pain starts in upper middle of abdomen then radiates to back
- Pain is not relieved by bowel movements, passing gas, or eating
- Pain lasts for hours to days
- Pain is often accompanied by nausea and vomiting
This is contrasted with pain from gastric ulcers which may subside with food, or pain with gallstones which comes and goes. The pain with pancreatitis also tends to be more persistent and severe.
Can the Pain Fluctuate or Change Location?
The location and quality of the pain may evolve somewhat over the early course of a pancreatitis flare up. Some fluctuations may include:
- Pain spreading from upper abdomen to lower areas
- Transient pains in chest or below left shoulder
- Periodic intensification of pain severity
- Radiation of pain to the back may increase or decrease
However, the pain almost always starts and remains centered in the upper middle abdominal area. The fluctuations reflect progression of the inflammatory process involving the pancreas and surrounding tissues.
How is Pancreatitis Diagnosed?
If acute pancreatitis is suspected based on symptoms, doctors can use several tests to confirm the diagnosis:
- Blood tests – Levels of pancreatic enzymes like amylase and lipase are usually elevated in acute pancreatitis.
- Imaging – CT scan, MRI, or ultrasound of the abdomen can show inflammation of the pancreas.
- Stool tests – Can check for elevated levels of fat (steatorrhea) indicating malabsorption due to pancreatitis.
Doctors will also try to identify the underlying cause by checking gallstones, alcohol use, medications, medical history, and family history when diagnosing pancreatitis.
How is Acute Pancreatitis Treated?
The main priorities for treatment of an episode of acute pancreatitis include:
- Pain management with medication
- Intravenous fluids to prevent dehydration
- Resting the pancreas by not eating or drinking at first
- Treatment of any complications like infections
For mild cases, no special interventions may be needed beyond IV fluids and pain control. Severe cases may require hospitalization, oxygen, antibiotics, or surgery.
The goal is to keep the patient comfortable and avoid complications until the inflammation in the pancreas subsides. This usually takes several days but can last for weeks.
How Long Does it Take to Recover from Acute Pancreatitis?
The recovery time for acute pancreatitis often depends on severity:
- Mild cases – Recovery within 3-7 days
- Moderate cases – Recovery within 1-2 weeks
- Severe cases – Can take 4 weeks or longer
Factors impacting recovery include how much inflammation and damage occurred in the pancreas, whether complications like infections developed, and if there was any underlying damage to the pancreatic duct.
Even after initial recovery, some residual symptoms like fat intolerance or dull pain may persist for a while longer. Complete restoration of pancreatic function can take several months.
Tips for Recovering from Pancreatitis
Some tips to help promote recovery from pancreatitis include:
- Follow a low-fat diet to rest the pancreas
- Abstain from alcohol if it was related to the pancreatitis
- Drink plenty of clear fluids to prevent dehydration
- Take pancreatic enzyme supplements if needed for digestion
- See a doctor for any concerning or worsening symptoms
Can Pancreatitis Cause Permanent Damage or Problems?
In cases of severe acute pancreatitis, some complications can result in permanent damage and long-term effects:
- Pancreatic necrosis – Permanently damaged pancreatic tissue.
- Infection – Can spread to pancreatic tissue and elsewhere.
- Cysts or abscesses – Can develop in or near the pancreas.
- Pancreatic duct disruption – Leads to chronic pancreatitis.
- Diabetes – If insulin-producing cells are damaged.
Even a single severe case of acute pancreatitis can start a progression to chronic pancreatitis with recurring bouts of inflammation and loss of pancreatic function over time.
Can the Pain and Symptoms Return?
With acute pancreatitis, there is a chance of having another isolated flare up in the future. Recurrent acute pancreatitis or repeated episodes can increase the risk of developing chronic pancreatitis.
Factors associated with recurrent acute pancreatitis include:
- Gallstones
- Alcohol abuse
- High triglycerides
- Anatomical abnormalities
- Genetic mutations
- Metabolic conditions
Addressing any underlying condition, following appropriate dietary restrictions, and limiting alcohol intake can help reduce the likelihood of future occurrences of pancreatitis.
When to Seek Emergency Treatment for Pancreatitis
Urgent medical care should be sought if any of the following symptoms develop:
- Sudden severe upper abdominal pain radiating to the back
- Fever over 101°F (38.3°C)
- Rapid heart rate
- Confusion or disorientation
- Nausea/vomiting not relieved by medication
- Swelling or tightness of the abdomen
- Fatigue, weakness, or dizziness
- Yellowing skin or eyes (jaundice)
Severe or worsening symptoms can be a sign of complications arising from acute pancreatitis. Prompt medical treatment is needed to address the underlying inflammation and prevent secondary issues like infection, fluid loss, or low blood pressure.
Conclusion
The characteristic symptoms of pancreatitis beginning with severe upper abdominal pain, nausea, and vomiting should not be ignored. Seeking prompt medical attention can help diagnose the underlying cause of the inflammation and avoid potentially serious complications.
While frightening initially, most cases of acute pancreatitis resolve over days to weeks with conservative treatment. Paying attention to symptoms and following doctor’s orders can ensure the pancreas heals properly and reduce the chances of recurrence.
