Pancreatitis: when to see a doctor?

Pancreatitis is a serious, often sudden condition that can cause intense pain and serious complications. Many patients are afraid of interventions and unsure of the symptoms, so it is important to be aware of the signs to look out for and when medical help is essential. In this post, we detail the causes and symptoms of pancreatitis, how it is diagnosed, and treatment and prevention options. Our aim is to provide clear and reliable information to help allay fears about the disease.

The pancreas is an important organ located in the upper part of the abdomen, behind the stomach. It has two basic functions: firstly, it produces digestive enzymes that help break down food (proteins, fats, carbohydrates) in the small intestine and secondly, it produces hormones such as insulin and glucagon, which play a key role in regulating blood sugar levels.

Pancreatitis develops when digestive enzymes are for some reason already activated within the pancreas and start to damage the organ's own tissues. This triggers a self-destructive process leading to inflammation, swelling and severe pain. There are two main forms of the disease: acute (sudden onset) and chronic (prolonged, recurrent) pancreatitis. Early detection and appropriate treatment are essential for recovery and to avoid dangerous complications.

From Endomedix Gastroenterology Centre experts are committed to accurate diagnosis and effective therapy to help patients regain their health as soon as possible.

Main causes of pancreatitis

Two main factors are responsible for about 75% of cases of pancreatitis: gallstones and excessive alcohol consumption. However, it is important to note that many other factors can also contribute to the development of the disease.

• Bile ducts: Stones that form in the gallbladder can block the common bile duct and pancreatic duct, preventing digestive fluids from flowing into the small intestine. Enzymes build up in the pancreas, activate prematurely and cause inflammation.
• Alcohol consumption: Regular, heavy alcohol intake is the most common cause of chronic pancreatitis, but it can also trigger acute inflammation. Alcohol directly damages the cells of the pancreas and alters the composition of the digestive fluids.
• High blood fat levels (hypertriglyceridaemia): Extremely high levels of triglycerides circulating in the blood can also provoke inflammation.
• Medicines: Pancreatitis can also develop as a side effect of certain medicines, such as certain diuretics, antibiotics or immunosuppressants.
• Genetic predisposition: A family history of pancreatitis may increase the risk of the disease.
• Autoimmune diseases: The immune system can mistakenly attack the pancreas' own cells, causing inflammation.
• Injuries and operations: Trauma to the abdomen or certain medical procedures (e.g. ERCP - endoscopic retrograde cholangiopancreatography) can also trigger inflammation.
• Anatomical anomalies: Rarely, congenital malformations such as pancreas divisum can also cause problems.

When should you see a doctor immediately? Symptoms of pancreatitis

The symptoms of pancreatitis can be sudden and extremely intense. It is important to take these signs seriously, as immediate medical attention can be life-saving.

Symptoms of acute pancreatitis

The most characteristic symptom of the acute form is sudden onset, severe, continuous abdominal pain, typically in the abdomen or around the navel.

• Pain: The pain is deep, „drilling” and often radiates into the back. The patient is typically restless and has difficulty finding a comfortable position. The pain may be relieved by bending forward or sitting, but increases when lying supine.
• Nausea and vomiting: The pain is almost always accompanied by severe nausea and vomiting, which does not bring relief.
• Fever and malaise: Fever or fever is common, as is general weakness and malaise.
• Bloating and abdominal tenderness: The abdomen can be tight, swollen and very sensitive to the touch. Bowel sounds may be reduced or completely absent (ileus).
• Severe symptoms: In severe cases, a rapid heart rate (tachycardia), low blood pressure (hypotension) and sweating may occur due to fluid loss and shock to the body. Rarely, a bluish discolouration around the navel (Cullen's sign) or in the groin (Grey-Turner's sign) may appear, indicating internal bleeding.

If you experience any of the symptoms mentioned above, especially sudden onset of severe abdominal pain, call an ambulance or visit the nearest emergency department immediately.

Symptoms of chronic pancreatitis

The symptoms of the chronic form are less dramatic but can be long-lasting and recurrent.

• Recurrent abdominal pain: The pain can be constant or intermittent. It typically worsens after eating, causing the patient to become afraid of eating (sitophobia).
• Indigestion and weight loss: A pancreas with inadequate enzyme production leads to fat indigestion. This is indicated by large amounts of loose, fatty, stinky stools (steatorrhoea). This leads to malabsorption and significant unintentional weight loss.
• Diabetes: As the disease progresses, insulin-producing cells can also be damaged, which can lead to the development of secondary diabetes.

Diagnosis of pancreatitis

In general, at least two of the three criteria must be met for an accurate diagnosis. From Endomedix Gastroenterology Centre has a modern diagnostic toolkit for fast and accurate examinations.

• Typical clinical signs: The presence of typical abdominal pain as described above.
• Laboratory tests: A blood sample shows a significant increase in pancreatic enzymes (amylase and lipase), at least three times the upper limit of normal. In addition, inflammatory parameters (e.g. CRP) are also elevated.
• Imaging studies:

- Abdominal ultrasound (UH): The primary test, which may detect swelling of the pancreas, surrounding effusion or gallstones.

- Contrast-enhanced computed tomography (CT): It gives a more detailed picture of the pancreas and surrounding organs. It helps to assess the severity of inflammation, possible necrosis and complications.

- Magnetic resonance cholangiopancreatography (MRCP): It is a non-invasive procedure that can accurately visualise the bile ducts and pancreatic duct.

- Endoscopic ultrasound (EUS): The most sensitive test is for diseases of the pancreas and bile ducts. Using a special endoscope, an ultrasound scan of the stomach or duodenum is performed, giving a very detailed picture.

Treatment options and prevention

Treatment of acute pancreatitis always requires hospitalisation. The aim of therapy is to relieve symptoms, support the body and prevent complications.

Treatment of acute pancreatitis

• Pain relief: Strong, often narcotic painkillers are used to relieve severe pain.
• Fluid replacement: To prevent dehydration and shock, large amounts of fluids (infusion) are given intravenously.
• Fasting and feeding: Initially, oral feeding is suspended to relieve the pancreas. In severe cases, it is important to start artificial feeding (enteral feeding) early, within 24-48 hours, which delivers nutrients directly to the intestinal tract through a thin tube (feeding tube). This reduces the risk of infectious complications.
• Oki therapy: If gallstones are the cause of the inflammation, ERCP may be needed to remove the stone. After the acute inflammation has resolved, surgical removal of the gallbladder (cholecystectomy) is usually recommended.

Treatment of chronic pancreatitis

Treatment of the chronic form is complex, aiming to reduce pain, improve digestion and manage complications.

• Lifestyle changes: The most important is a total ban on alcohol. Smoking cessation and a low-fat diet are also key.
• Enchymosis: The missing digestive enzymes are replaced by taking capsules before each meal.
• Pain management: In addition to painkillers, endoscopic or surgical interventions may be considered.

Prevention strategies

• Moderate alcohol consumption: The most important preventive step is to avoid excessive alcohol consumption.
• Healthy eating: A balanced, low-fat diet can help prevent gallstones and high blood fat levels.
• Treatment of gallstones: If gallstones are diagnosed and are causing symptoms, it may be worth considering removing the gallbladder to reduce the risk of pancreatitis.

When expert help is essential

Pancreatitis is a disease that should not be delayed if it is suspected. Timely treatment significantly improves the chances of recovery and reduces the risk of serious and even life-threatening complications (e.g. infected necrosis, abscess, pseudocyst).

From Endomedix Gastroenterology Centre experienced specialists and a modern diagnostic background ensure that you receive the highest level of care, from examination to treatment and long-term care. If you have digestive complaints, don't hesitate to seek help. Contact us with confidence so that together we can find the best solution to restore your health.