Introduction

The pancreas is a large, flat gland, roughly the size of your hand, that sits behind the stomach and next to the small intestine. It aids in digestion and is responsible for producing digestive juices (enzymes) and hormones used to break down food and control blood sugar in the process. In the case of pancreatitis the pancreas is unable to or has a diminished ability to digest food.¹

What is pancreatitis?

Pancreatitis is a common gastrointestinal disorder that is characterised by inflammation caused by the activation of pancreatic enzymes while they are still inside the gland. A damaged or blocked pancreatic duct prevents the release of enzymes to the intestines, when left untreated lasting damage is caused to the pancreas. The damage can lead to cysts, scarring, tumours or even cancer.²

Types of pancreatitis 

Acute pancreatitis is a mild disease state that resolves itself without serious complications in the vast majority of patients. In many cases, the cause is clear however due to the disease complexity sometimes this cannot be pinpointed. This can cause diagnosis to be difficult and therefore identification of treatment or management could be impossible.³

Chronic pancreatitis is an umbrella term for a group of conditions that have caused permanent damage to the pancreas from extended periods of inflammation. Hereditary and autoimmune pancreatitis are specific types of this chronic disease whereby genetic mutation has interrupted function. The repetitive periods of inflammation cause scarring and loss of functionality which often result in chronic pain and enzymatic insufficiency.²

Causes of pancreatitis 

The causes of pancreatitis are easily established in a large proportion of patients, with the most common cause being gallstones and excess alcohol consumption. Gallstones are often causal of acute pancreatitis whereby once the stone has passed or has been removed then symptoms will settle and resolve themselves. It is however important in these instances to ensure referral to cholecystectomy services (surgical removal of the gallbladder) in order to seek to prevent recurrent problems. 

Pancreatitis resulting from alcohol consumption is however considered a spectronal manifestation where the extent or amount of consumption could be indicative of anywhere between an acute and chronic disease state. Genetic factors and smoking habits may also make an individual more sensitive to the effects of alcohol and therefore increasing risk of disease. This diagnosis is only considered in patients with a prolonged history of more than 5 years of heavy drinking (more than 50g per day).

Certain medications have also been evidenced to cause pancreatitis, particularly mercaptopurine (a drug used in cancer and autoimmune disease) and azathioprine (an immunosuppressant). The nature of these drugs can affect the functionality of the pancreas and it is important that if symptoms are experienced upon taking these medications then you should seek medical attention.

Underlying metabolic conditions such as hyperglycemia and hyperparathyroidism may also in rare cases influence pancreatic damage. The mechanism behind this however is not largely understood and therefore should not be presumed to be causal of disease manifestation.⁴

Roughly 10% of all pancreatitis cases are caused by infectious agents, predominantly viruses but in some occasions also bacteria or parasites. Human immunodeficiency viruses (HIV), mumps and hepatitis viruses are among the most common viral agents associated with pancreatitis, however this is not an exhaustive list. These cases are often sporadic and may be combined with flu-like symptoms.⁵

Symptoms

Symptoms may differ slightly between acute and chronic disease states, however both often exhibit a dull, constant pain in the upper left abdomen that spreads through to the back. This is often accompanied by sweating due to the intensity and continuity of the pain.⁶

Acute pancreatitis patients often present as looking extremely unwell and require medical intervention as soon as possible. The symptoms usually are characterised by:⁶

• Pain across a spectrum from mild to severe
• Pain may last several days (in occasions weeks)
• Accompanied features may include:
  • Fever
  • Nausea or vomiting
  • A faster heartbeat
  • A swollen abdomen
  • A tender abdomen

Patients with chronic pancreatitis may have:⁶

• Upper abdominal pain or in some cases none at all
  • The pain may:
    • Spread to the back
    • Increase in severity 
    • Become constant 
    • Worsen after eating
    • Disappear as an advanced stage
  • Pain can be accompanied by:
    • Nausea or vomiting
    • Diarrhea
    • Greasy or pale stools 
    • Weight loss

In some cases, pancreatitis may exhibit systemic symptoms such as:⁶

• Fever
• Excess sweating
• Rapid heartbeat
• Low blood pressure

And in latter stages of disease, dehydration may cause dry mouth and a decreased urine output that could have effects on the kidneys.

When to seek medical attention

With the pancreas’ function in digestion imperative to efficiency and success, prompt diagnosis to ensure this is not disrupted is paramount. Medical attention should therefore be sought after at the point of severe abdominal discomfort that does not diminish or that worsens with time or activity. If accompanied by nausea, vomiting, fever or chills this is also a sign of worsening and requires timely intervention.⁷

If left without treatment, there is an increased risk of further complications. These include:⁸

• Pseudocysts (cysts on the pancreas surface)
• Pancreatic necrosis (loss of blood supply and tissue death)
• Pancreatic infection (which can spread to the blood - sepsis)
• Chronic disease state (when acute condition reoccurs)

Diagnosis

Due to the complexity of pancreatitis, diagnosis can be difficult to achieve. A medical history and physical examination of a patient can however help to identify the cause. Blood tests, specifically those for blood glucose, digestive enzymes (amylase and lipase) and white blood cells. Elevated levels of any of these are indicative of a damaged pancreas. Imaging studies, such as ultrasounds or computed tomography (CT) scans, may also be required to identify gallstones or to show any inflammation. Using these techniques gives the specialist a visual of the affected area and may help in the diagnosis and choice of treatment regime once the target area is pinpointed. 

Summary

Sweating and abdominal pain are the two main hallmarks of pancreatitis, with sweating often resultant of the intense pain or associated fevers. Due to the complexity of pancreatitis and the risks of development, early recognition and intervention are essential. It is incredibly important for treatment to be administered at the earliest possible time in order to restore the functionality of the digestive system. Without the ability to properly digest foods, the body can shut down quickly and damage can continue to occur, inducing a chronic disease state. The risks associated mean that contacting a doctor to seek medical advice when symptoms first arise is paramount. You know your body best so if something feels different then get checked.