Home Conditions Pancreatitis
Condition · Liver, gallbladder and pancreas
Pancreatitis
Pancreatitis means the pancreas is inflamed. An acute attack comes on suddenly, with severe pain in the upper abdomen, and needs hospital care. Chronic pancreatitis is long-standing damage that causes repeated pain and, in time, trouble digesting food. In both, the first job is to find the cause, most often gallstones or alcohol, and deal with it.
At a glance
What it is
Inflammation of the pancreas, the gland behind the stomach that makes digestive enzymes and insulin.
Common signs
Severe upper abdominal pain that goes through to the back, with vomiting. In chronic disease: repeated pain, greasy stools and weight loss.
How it is confirmed
Typical pain, a blood lipase level more than three times normal, and a scan. Two of the three are enough.
How it is treated
Hospital care with fluids, pain relief and early feeding; then treating the cause, such as removing the gallbladder.
What are the signs of pancreatitis?
An acute attack
- Severe, steady pain in the upper abdomen, often going straight through to the back
- Pain that is worse lying flat and a little easier sitting forward
- Nausea and repeated vomiting
- A swollen, tender abdomen
- Fever or a fast pulse
Chronic pancreatitis
- Attacks of upper abdominal pain that keep returning, or a constant dull pain
- Pale, greasy, foul-smelling stools that are hard to flush
- Weight loss without trying
- Diabetes that appears in adult life
Go to an emergency department now if you have
- Severe upper abdominal pain that does not ease within an hour or two
- Pain with repeated vomiting, fever or yellow eyes
- Pain with breathlessness, confusion or very little urine
Acute pancreatitis cannot be treated at home. Do not wait for an appointment.
What it is
What is happening inside?
The pancreas makes enzymes that digest food. They are meant to switch on only after they reach the intestine. In pancreatitis they switch on inside the gland and begin to digest the pancreas itself. The gland swells and the tissue around it becomes inflamed.
In about four out of five people the attack is mild and settles within a week. In the rest, the inflammation affects other organs such as the lungs and kidneys, or part of the pancreas loses its blood supply and dies. Doctors grade an attack as mild, moderately severe or severe. An attack is called severe when another organ fails for more than 48 hours.
Chronic pancreatitis is different. Repeated or long-standing inflammation leaves scar tissue. Over the years the gland makes fewer enzymes and less insulin.
Why it happens
What causes pancreatitis? The causes I look for
Gallstones
A small stone slips out of the gallbladder and blocks the shared opening of the bile duct and the pancreatic duct. This is one of the two commonest causes. See gallstones.
Alcohol
Regular heavy drinking over years is the other common cause, and the main cause of chronic pancreatitis.
High blood fats or calcium
A very high triglyceride level, or a high calcium level, can set off an attack. Both are found on a simple blood test.
Smoking
Tobacco raises the risk of chronic pancreatitis on its own, and adds to the harm from alcohol.
Medicines and procedures
A few medicines can cause it, and an attack can follow an endoscopic procedure on the bile duct.
Less common causes
Inherited gene changes, an autoimmune form, and a growth that blocks the duct. In a person over 40 with a first attack and no clear cause, I look carefully for a growth.
How I find out
Which test answers which question?
Blood lipase
It tells us: Whether the pancreas is inflamed. A level more than three times the upper limit of normal, with typical pain, confirms the diagnosis.
When I use it: At once, in anyone with sudden severe upper abdominal pain.
Ultrasound of the abdomen
It tells us: Whether there are gallstones.
When I use it: In every first attack, because finding stones changes the plan.
CT or MRI scan
It tells us: How much of the gland is affected, and whether there is fluid, dead tissue or a blocked duct.
When I use it: When the diagnosis is unclear, or when a person is not improving after two to three days. It is not needed on day one in a typical attack.
Triglycerides, calcium and liver tests
It tells us: Whether blood fats, calcium or a stone in the bile duct is the cause.
When I use it: In every attack.
Stool elastase
It tells us: Whether the pancreas is making enough digestive enzymes.
When I use it: In chronic pancreatitis, or when stools turn greasy and weight falls after an attack.
Treatment
How is pancreatitis treated?
In hospital, during an attack
- Fluids through a drip, adjusted to how the body responds
- Pain relief, given regularly
- Food by mouth as soon as you can manage it, usually within a day or two in a mild attack. Long periods of “resting the gut” are no longer advised
- Antibiotics only if an infection is found. They do not prevent complications when given routinely
- Monitoring of breathing, urine output and blood tests, in intensive care if the attack is severe
Treat the cause
- Gallstones: the gallbladder is removed by keyhole surgery, in the same hospital stay after a mild attack. Waiting invites a second attack
- A stone stuck in the bile duct with infection: removed by an endoscopic procedure, which I arrange with a colleague
- Alcohol: stopping completely, with support. This matters more than any medicine
- High triglycerides or calcium: treated so that the attack does not repeat
Complications
Collections of fluid often settle on their own. If dead tissue becomes infected, treatment is stepped up in stages: antibiotics first, then drainage through a tube or by endoscopy, and an operation only if those are not enough. Where possible, these procedures are delayed for about four weeks, when they are less risky.
Chronic pancreatitis
- No alcohol and no tobacco
- Enzyme capsules with meals and snacks when stools are greasy or weight is falling
- A plan for pain, which may include medicines for nerve pain
- Checks for diabetes, vitamin D and bone strength
- For a blocked duct or stones in the duct, drainage by endoscopy or by an operation
When surgery is the right answer
After gallstone pancreatitis, removing the gallbladder prevents the next attack. In severe attacks, surgery or drainage deals with infected dead tissue that has not responded to simpler steps. In chronic pancreatitis with a blocked duct and pain that has not settled, an operation to drain or remove the affected part gives lasting relief for selected patients.
Root-cause care
The integrative view: what else I look at
Getting through the attack and removing the cause come first. For recovery, and for chronic pancreatitis, I also look at:
- Eating enough: small, frequent meals with adequate protein. Most people with chronic pancreatitis do not need a very low-fat diet. If fat causes symptoms, enzyme capsules are adjusted before food is restricted.
- Vitamins and bones: poor fat digestion lowers vitamins A, D, E and K. I check levels and bone strength, and correct what is low.
- Blood sugar: a damaged pancreas makes less insulin. A yearly check finds diabetes early.
- Alcohol and tobacco: stopping both is the single most useful step. A counsellor and a health coach in my practice help with this.
- Pain, sleep and mood: long-standing pain affects all three, and each makes the others worse. They are treated together.
This work runs alongside the treatment above. It does not replace it.
Recovery
What should I expect?
| When | What happens |
|---|---|
| First 48 hours | Admission, fluids, pain relief, blood tests and an ultrasound. The severity of the attack becomes clear. |
| Days 3 to 7 | In a mild attack, pain settles and you are eating. The gallbladder is removed before discharge if stones were the cause. |
| Weeks to months | A severe attack needs a longer stay and follow-up scans. Fluid collections are watched and drained only if they cause trouble. |
| Long term | No alcohol or tobacco. Stool, weight, blood sugar and vitamin D are reviewed, more closely in chronic pancreatitis. |
Questions patients ask me about pancreatitis
Is pancreatitis always caused by alcohol?
No. Gallstones are just as common a cause, and they affect people who have never had a drink. High triglycerides, some medicines and inherited causes account for others. In some people no cause is found even after a full set of tests.
Will it come back?
It can, if the cause remains. After gallstone pancreatitis, removing the gallbladder brings the risk down sharply. After alcohol-related pancreatitis, the risk depends almost entirely on whether drinking stops.
What should I eat after an attack?
Start with ordinary soft food as soon as you can eat, in small portions, and build up. There is no need for a long period on liquids. Avoid alcohol completely. If stools become greasy or you lose weight, tell me, because that suggests the pancreas needs enzyme support.
Do I need my gallbladder removed if the pain has gone?
If gallstones caused the attack, yes. The stones are still there, and another one can block the duct. Surgery during the same admission is advised after a mild attack. See gallbladder stone surgery.
Does chronic pancreatitis lead to diabetes or cancer?
Diabetes is common in long-standing chronic pancreatitis, which is why I check blood sugar every year. The risk of pancreatic cancer is higher than in other people, though still small for any one person. New weight loss, yellow eyes or a change in the pattern of pain should be reported promptly.
Are enzyme capsules needed for life?
After a mild acute attack, usually not at all. In chronic pancreatitis with greasy stools or weight loss they are generally long-term, taken with every meal and snack. The dose is set by how you respond.
Sources
This page is written for patients and is based on the guidelines and studies below. It is for education and does not replace a consultation.
- American College of Gastroenterology guideline on acute pancreatitis. Tenner S et al. Am J Gastroenterol. 2024. PubMed 38857482
- Revised Atlanta classification of acute pancreatitis. Banks PA et al. Gut. 2013. doi:10.1136/gutjnl-2012-302779
- American College of Gastroenterology guideline on chronic pancreatitis. Gardner TB et al. Am J Gastroenterol. 2020. doi:10.14309/ajg.0000000000000535
- American Gastroenterological Association review of pancreatic enzyme insufficiency. Whitcomb DC et al. Gastroenterology. 2023. doi:10.1053/j.gastro.2023.07.007
- European Association for the Study of the Liver guideline on gallstones. EASL. J Hepatol. 2016. PubMed 27085810