Inflammation of the pancreas, also known as pancreatitis, is a serious condition that can present with sudden and severe symptoms, but may also persist as a long-term, chronic condition, significantly impairing quality of life. Many people are unaware that this organ may be the cause of abdominal pain, which is why early recognition of the symptoms is crucial. In this article, we explain in detail what signs to look out for and what diagnostic methods are available to accurately identify the condition. The Endomedix Gastroenterology Centre With our team of experts, we can help you navigate this complex topic.
The pancreas is an important digestive organ situated at the back of the abdominal cavity, behind the stomach. It has two main functions: on the one hand, it produces digestive enzymes which, once they reach the small intestine, aid in the breakdown of fats, proteins and carbohydrates; and secondly, it releases hormones, such as insulin, into the bloodstream, thereby regulating blood sugar levels. Inflammation occurs when, for some reason, the digestive enzymes are activated whilst still within the pancreas and begin to damage the organ’s own tissues.
There are two main forms of the disease: acute and chronic pancreatitis. The acute form develops suddenly and can be severe, even life-threatening, whilst the chronic form is a long-lasting, recurrent inflammatory process that can lead to permanent damage. Early diagnosis and appropriate medical treatment are vital in both cases.
Symptoms of acute pancreatitis
Acute pancreatitis usually presents with dramatic symptoms that require immediate medical attention. Patients often report extremely severe pain that begins suddenly and worsens continuously.
The most common symptoms are:
- Severe abdominal pain: This is the most common and most characteristic symptom. The pain typically begins in the upper abdomen or around the navel, and is deep, almost piercing in nature. It often radiates in a belt-like pattern to the back, particularly the lower back. Patients are restless and find it difficult to find a position that brings relief. The pain usually worsens when lying down, whilst bending forward or sitting may alleviate it somewhat. The intensity of the pain almost always increases after a meal.
- Nausea and vomiting: Abdominal pain is often accompanied by excruciating nausea and repeated vomiting, which, however, does not bring any relief.
- Fever: A slight rise in temperature is common, but a high fever and chills may indicate a complication, such as an infection.
- Rapid pulse and breathing: The body reacts to severe inflammation and pain with a rapid heartbeat (tachycardia) and rapid breathing (tachypnoea).
- Bloating and abdominal tenderness: The abdomen may feel extremely tender and tight to the touch. Bowel movements may slow down or stop altogether, leading to bloating.
- Skin discolouration (a rare but serious symptom): In severe, haemorrhagic cases, bluish-purple patches may appear around the navel (Cullen’s sign) or in the inguinal region (Grey-Turner’s sign). These signs indicate haemorrhage in the posterior part of the abdominal cavity and require immediate medical attention.
It is important to note that in approximately 5% of cases, acute pancreatitis can occur without abdominal pain, which makes diagnosis difficult.
Symptoms of chronic pancreatitis
Chronic pancreatitis is a more insidious, long-term condition in which the tissue of the pancreas is gradually and irreversibly damaged and scarred. The symptoms are less dramatic than in the acute form, but they significantly impair quality of life.
The most common clinical features:
- Recurrent or persistent abdominal pain: In 85% patients, this is the predominant symptom. The pain occurs in the abdomen and often radiates to the back. It may be constant and dull in nature, but can flare up from time to time, causing intense episodes similar to acute inflammation. Typically, eating – particularly the consumption of fatty foods – triggers the pain, which is why patients are often afraid to eat (this is known as sityophobia). In the early stages, this is the main cause of weight loss.
- Digestive disorders (malabsorption): As the pancreas’s ability to produce enzymes declines, digestion becomes inadequate. The first sign of this is an inability to digest fats, which steatorrhoea Symptoms: the stools are voluminous, loose, have an oily sheen, are foul-smelling and difficult to flush away. Later, protein malabsorption (azotorrhoea) also develops.
- Weight loss: Reduced food intake due to chronic pain, combined with digestive problems, leads to significant, unintentional weight loss.
- Diabetes (diabetes mellitus): As the disease progresses, the insulin-producing cells of the pancreas are also destroyed. As a result, around half of patients develop diabetes.
Diagnosis of pancreatitis
When someone presents to a doctor with the above symptoms, the gastroenterologist’s aim is to confirm the suspicion of pancreatitis, distinguish between the acute and chronic forms, assess the severity, and identify the underlying cause. The Endomedix Gastroenterology Centre It offers patients a range of modern diagnostic equipment.
The diagnostic process consists of several stages: taking a medical history, a physical examination, laboratory tests and imaging procedures. To diagnose acute pancreatitis, at least two of the following three criteria must be met:
- Typical, belt-like pain in the upper abdomen radiating to the back.
- An increase in the levels of pancreatic enzymes (amylase and/or lipase) in the blood to at least three times the upper limit of the normal range.
- Detection of signs of pancreatitis using imaging tests (e.g. ultrasound, CT).
Laboratory tests
- Serum amylase and lipase: These are enzymes produced by the pancreas, which are released into the bloodstream in large quantities in the event of inflammation. Lipase is more specific to the pancreas, so measuring it is more reliable. However, the extent of the increase does not necessarily reflect the severity of the inflammation.
- Inflammatory markers: Elevated levels of C-reactive protein (CRP) and white blood cell count indicate an inflammatory process taking place in the body.
- Liver function test results: In cases of pancreatitis caused by gallstones, levels of liver enzymes (e.g. GPT/ALT) may also rise due to obstruction of the bile ducts.
- Renal function and electrolytes: Severe acute pancreatitis is associated with fluid loss, which can affect kidney function; it is therefore essential to monitor these values.
Imaging studies
- Abdominal ultrasound (UH): This is usually the first imaging examination carried out. It is effective at detecting gallstones, dilation of the bile ducts and swelling of the pancreas, or any fluid accumulation (e.g. a pseudocyst) around the organ. A disadvantage is that intestinal gas or abdominal fat tissue may interfere with an accurate assessment of the pancreas.
- Computed tomography (CT): A CT scan provides a more detailed picture of the pancreas and the surrounding organs. It is particularly important for assessing the severity of inflammation, as it detects tissue death (necrosis). It is recommended in cases of diagnostic uncertainty or if symptoms do not improve.
- Magnetic resonance cholangiopancreatography (MRCP): This is a specialised MRI scan which, without the use of contrast medium, provides a detailed image of the bile ducts and the pancreatic duct. It can be used to detect small gallstones, narrowings of the duct or other developmental abnormalities. It is mainly used to investigate the cause of recurrent inflammation.
- Endoscopic ultrasound (EUS): During an EUS, a flexible instrument (endoscope) fitted with an ultrasound probe is guided through the mouth into the stomach and duodenum. As the ultrasound probe is positioned directly next to the pancreas, this provides an extremely detailed view of the organ’s structure and duct system. This is the most sensitive method for detecting early signs of chronic pancreatitis and small tumours. It also allows for the taking of a sample (EUS-FNA) if a tumour is suspected.
- Endoscopic retrograde cholangiopancreatography (ERCP): ERCP is a specialised endoscopic procedure used for both diagnostic and therapeutic purposes. During the procedure, a contrast agent is injected into the bile and pancreatic ducts, after which X-ray images are taken. This method can be used to remove stones from the bile ducts or to bypass narrowings by inserting a small tube (stent).
When to see a specialist
Pancreatitis is a serious condition, and its symptoms should never be ignored. If you experience sudden, severe, band-like abdominal pain accompanied by nausea and vomiting, seek emergency medical attention immediately.
If you experience recurring abdominal pain, digestive problems, fatty stools or unexplained weight loss, you should definitely consult a gastroenterologist. An early diagnosis and appropriate treatment are essential for preventing complications and improving your quality of life. The Endomedix Gastroenterology Centre Its experienced specialists and state-of-the-art diagnostic facilities ensure an accurate diagnosis and the development of a personalised treatment plan.
