Pancreatitis is inflammation of the pancreas. The exocrine pancreatic tissue is alway affected and this may impair the production, secretion and therefore action of the pancreatic enzymes responsible for digestion. In severe cases, the endocrine tissue may also be damaged thereby disrupting the metabolic function of the pancreas.
Pancreatitis often involves surrounding structures like the bile duct and duodenum. The extent of the inflammation and disruption of pancreatic functioning influences the clinical presentation of pancreatitis.
Signs and Symptoms of Pancreatitis
Acute Pancreatitis Symptoms
Constant upper abdominal pain is the most common symptom of acute pancreatitis. It may vary in intensity from mild to severe and radiates to the upper back and/or left shoulder. In severe cases the intensity of the pain causes a person to curl up and usually a patient will report some mild relief when leaning or stooping forward. The pain is worse upon standing up straight or lying flat.
Nausea and/or vomiting is usually present and the severity may be associated with the intensity of the pain. Most patients will report a lack of appetite and pain that exacerbates during and immediately after eating.
Abdominal examination will reveal diminished or absent bowel sounds and epigastric tenderness. In severe acute pancreatitis like hemorrhagic pancreatitis there may be discoloration of the skin noted on the flanks (Grey Turner’s sign) and around the umbilicus (Cullen’s sign).
Since gallstones are a common cause of pancreatitis, it is important to be familiar with the symptoms of gallstones. These features may be present simultaneously and contribute to the overall clinical presentation.
Other symptoms associated with acute pancreatitis includes :
Acute Pancreatitis Causes
Gallstones and alcohol misuse are two common causes of acute pancreatitis. The latter, alcohol misuse, is the reason that many acute pancreatitis cases are seen in the emergency room during the festive season where alcohol consumption is often excessive. It is also the reason for the prevalence of acute pancreatitis among alcoholics, which often progresses to chronic pancreatitis.
Another common cause seen these days is following an ERCP (endoscopic retrograde cholangiopancreatography), which is a widely used diagnostic procedure to investigate for gallbladder and bile duct diseases. Despite these known causative factors, many cases of acute pancreatitis arise for unknown reasons (idiopathic).
Other causes of acute pancreatitis includes :
- Post-operative injury
- Drugs like azathioprine, thiazide diuretics, sodium valproate
- Hereditary factors (mutations in PRSS1 and SPINK1 genes)
- Kidney failure
Chronic Pancreatitis Symptoms
Apart from these acute exacerbations marked by intense abdominal pain, patients with chronic pancreatitis may report persistent mild abdominal and back pain that gradually progresses in intensity over time. It is not uncommon, however, for chronic pancreatitis patients to report no pain.
Other signs and symptoms of chronic pancreatitis may include :
- Unintentional weight loss
- Steatorrhea (fatty stools)
- Signs of nutrient deficiencies due to malabsorption
- Symptoms of acute pancreatitis (discussed above)
Chronic Pancreatitis Causes
Chronic pancreatitis is characterized by repeated episodes of acute pancreatitis in most cases. Alcohol abuse is one of the common causes and eventually the damage to the pancreas is irreversible. Chronic pancreatitis is also associated with :
- Cigarette smoking
- Advancing age
- Hereditary factors (hereditary pancreatitis although not all cases will progress to chronic pancreatitis)
- Autoimmune causes (autoimmune pancreatitis or autoimmune diseases affecting multiple organs)
- Cystic fibrosis
- Congenital abnormalities discussed under pancreas problems
- Tropical pancreatitis (south Asia and west Africa)
- Persistent complications of acute pancreatitis like pseudocysts