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Pancreatitis
The pancreas digests itself — severe abdominal pain belongs in hospital at once.
Also known as: pancreatitis · acute/chronic pancreatitis
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
In pancreatitis the pancreas becomes inflamed. There are two forms. Acute pancreatitis usually starts suddenly with severe upper-abdominal pain radiating like a belt to the back, often with nausea and vomiting — this needs prompt hospital care, because a severe course is possible. The most common triggers are gallstones and alcohol. Chronic pancreatitis develops over years, often from ongoing alcohol use; the tissue gradually scars, which can later cause two consequences: too few digestive enzymes (insufficiency with fatty stools) and diabetes, as insulin production also suffers. The good news: much can be well treated and supported, and the most important self-influenced protection — stopping alcohol and smoking — helps at every stage.
With severe sudden pain and vomiting, don’t wait — hospital provides fluids, pain relief and monitoring.
Gallstones are removed; if alcohol is the cause, stopping is decisive.
Enzyme replacement (pancreatin) for fatty stools, watch blood sugar, small lower-fat meals.
The most important self-influenced protection — it slows progression at any stage.
In warm countries a migrated roundworm is among the more common causes when neither stones nor alcohol fit. Ultrasound shows a fine strand in the duct.
In the acute attack there is no drug against the inflammation itself — treatment is fluids, painkillers and early food as soon as possible; the days of nil by mouth once usual are now considered outdated. Enzyme capsules replace, in the chronic form, what the gland no longer makes: they must be taken with the meal, not before or after, or they miss the food.
Lipase is at least three times above normal in an acute attack — and stays so for eight to fourteen days, while amylase falls faster. The height of the value says nothing about severity. The most common causes are gallstones and alcohol; together they account for about seven in ten cases. In a mild attack, food starts within twenty-four to forty-eight hours, because early feeding shortened the course in studies.
Sudden, radiating to the back, with nausea → get to hospital quickly.
These two are behind most acute attacks.
Signs of declining enzyme output (see pancreatic insufficiency).
Because the insulin-making cells suffer too.
Taken up right at the end of the small bowel and needing a helper from the stomach. If either place is affected a deficiency arises — often only after years, because the liver holds a store.
Taken up in the upper small bowel and needing stomach acid. Acid blockers, an inflamed lining and silent blood losses often come together here.
One of the fat-soluble vitamins, lost with the fat when fat digestion is disturbed. Fatty, floating stools over months are the pointer to it.
Needs vitamin D for uptake, and with disturbed fat digestion it additionally binds to fatty acids in the bowel. So bone density and bowel disease hang together more closely than assumed.
Lost in considerable amounts with lasting diarrhoea. Signs are cracked corners of the mouth, loss of taste, poor wound healing and thinning hair.
After repeated inflammations the enzyme output declines. Then they are not a supplement but a replacement — taken with the meal, and the amount follows the fat content of the food.
Without fat digestion the fat-soluble vitamins A, D, E and K do not arrive. They belong measured and often replaced at a higher amount, together with a fatty meal.
Medium-chain fats are absorbed without bile acids and largely without enzymes. That makes them an energy source when normal fat is not tolerated — worked up slowly, otherwise cramps and diarrhoea follow.
Clearly worthwhile and well supported when deficient — vegan, older adults, certain drugs. No energy boost without a deficiency.
Clearly effective with proven deficiency, useless without. Take only with a documented deficiency — excess is harmful.
The insulin-making cells lie in the middle of the inflamed organ. After repeated inflammations a diabetes therefore often arises — one in which the counter-hormone glucagon is missing too, which makes low sugars more dangerous.
That is exactly the difference from ordinary diabetes: if the counterpart is missing too, the body can no longer catch a low sugar itself. This is why the treatment is set more cautiously here.
Without fat digestion the fat-soluble vitamins do not arrive. A vitamin D deficiency is the rule rather than the exception with chronic pancreatitis — and bone density belongs with it.
Alcohol is the most common cause besides gallstones. After an attack the pancreas stays sensitive for months; each further attack can cost tissue permanently.
Start with light, carbohydrate-based food in small portions; fat increases over days to weeks. How fast follows the pain.
After an attack the diet is rebuilt over days to weeks. Alcohol and smoking are the two factors with the greatest influence on further attacks.
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