Pancreatitis: what it is, symptoms, acute and reactive forms

Your pancreas makes enzymes that digest food and hormones that control blood sugar. Pancreatitis is inflammation of the pancreas. Normally, the enzymes only switch on in the bowel. In pancreatitis, they activate inside the gland and start damaging its own tissue.

Pancreatitis can be acute or chronic, and these are two different stories. An acute attack is an emergency that belongs in hospital, not something to treat at home. Below we cover the symptoms and treatment of the acute form, what doctors in our region mean by "reactive" pancreatitis, which tests you need and how to eat after an attack.

What causes it most often? The MSD Manual names two main triggers: gallstones and alcohol. Together they explain most cases of acute inflammation. Other causes are less common, but your doctor will check for them too.

A gallstone is dangerous because it can block the shared opening of the bile and pancreatic ducts. Alcohol does the most harm with regular heavy drinking. Rarer causes include very high blood triglycerides, certain medicines, abdominal injury and endoscopic procedures on the ducts. Infections, autoimmune conditions and inherited gene changes can also trigger it. In some people no cause is found at all.

Gallstone pancreatitis

This is inflammation caused by a stone from the gallbladder. The stone slips into the bile duct and gets stuck where it joins the pancreatic duct. Pancreatic juice can't get out, pressure in the ducts rises and the enzymes activate inside the gland. It's important to recognize this type, because after the attack the stones need to be dealt with. Otherwise the inflammation will come back. Usually that means planning gallbladder removal.

The main sign is severe belly pain. As the NHS describes it, the pain starts suddenly and doesn't go away. It can be sharp or knife-like, it affects the upper belly and spreads to your sides and back. It gets worse after eating, when you move or lie flat, and eases a little when you sit leaning forward or lie with your knees pulled up to your chest.

• severe upper belly pain, often band-like, spreading to the back
• nausea and repeated vomiting that brings no relief
• fever, a fast pulse
• a bloated belly that's tender to the touch
• in severe cases weakness, low blood pressure, bluish patches on the sides or around the belly button

When to call an ambulance

Severe upper belly pain that won't ease, especially after a meal with alcohol or fatty food, with vomiting and fever, means calling an ambulance, not waiting until morning. Acute pancreatitis is treated only in hospital. Most attacks are mild, but some turn severe and affect other organs, and then every hour counts. Until help arrives, skip food, alcohol and any painkillers you'd pick yourself.

The typical area is just below the breastbone and under the left ribs, with pain often wrapping around to the back. But other conditions cause the same pain. The NHS warns that acute pancreatitis can feel like appendicitis or a stomach ulcer, so you can't tell them apart on your own.

Symptoms in women

The signs are the same as in men. Mostly, the causes differ. Women form gallstones more often, so stone-related pancreatitis is more common in them, while alcohol-related pancreatitis is more common in men. Pancreatitis in pregnancy is rare but dangerous. Any severe upper belly pain during pregnancy means a same-day checkup.

The term is common in post-Soviet medicine, but it isn't used in international classifications. It usually describes a mild acute attack that develops alongside another problem: gallstones, a flare of gastritis or an ulcer, food poisoning, or a heavy meal with alcohol. The pancreas seems to "react" to its neighbors.

The symptoms are the same as in acute pancreatitis, only milder. Pain below the breastbone or around the waist, nausea, bloating, sometimes vomiting. The trap is that "reactive" sounds harmless. In reality, it may be the start of true acute pancreatitis. So you need the same tests, blood work and an ultrasound, not a "pill for the pancreas".

Testing also shows what exactly the pancreas reacted to. If it's gallstones, episodes will keep coming back until they're treated. If it's gastritis or an ulcer, those get treated. If it was a party, the conclusion is obvious.

A word on the chronic form. Chronic pancreatitis develops over years, most often due to alcohol and repeated attacks. Scar tissue gradually replaces the gland, and it makes fewer enzymes and less insulin. We cover whether it can be cured and how to live with it in a separate article.

Acute pancreatitis is diagnosed by three signs: typical pain, raised enzymes in the blood and changes on scans. Two out of three are enough. The MSD Manual says the same: diagnosis rests on symptoms, blood amylase and lipase levels and imaging.

Besides lipase and amylase, blood tests include a complete blood count, liver tests, bilirubin, glucose, calcium and triglycerides. An abdominal ultrasound shows the state of the gland and any fluid, and above all gallstones. CT of the liver, spleen and pancreas with contrast is usually done a few days after onset. It shows severity, dead tissue and fluid collections. If a stone in the duct is suspected, MR cholangiography is added.

Doctors judge severity by how other organs are doing: the kidneys, lungs and heart. Under the classification MSD uses, pancreatitis is mild, moderately severe or severe. That decides where you're treated: a regular ward or intensive care.

Complications to know about

Fluid can collect around the inflamed gland. Part of the tissue sometimes dies (necrosis), and dead tissue can become infected. After a few weeks, a pseudocyst, a fluid-filled pocket, may form in place of the fluid. Doctors either watch it or drain it. These complications are what make severe pancreatitis dangerous, so don't skip follow-up tests after an attack.

Treatment is decided in hospital. There are no specific "pancreatitis pills" that stop the inflammation. Treatment supports your body while the gland heals: IV fluids, pain relief, close monitoring and early feeding as soon as possible. Most mild attacks settle within a few days.

Medicines and why you shouldn't self-treat

In hospital, the core of treatment is IV fluids, which restore fluid levels and blood flow to the gland. Pain relief is a must. The doctors choose its type and dose. Anti-nausea medicines are added if needed. Antibiotics are used only if there are signs of infection, not "just in case". During recovery, enzymes and acid-reducing drugs may be prescribed if needed.

Treating yourself with pills from the medicine cabinet is risky. Painkillers at home blur the picture, and you may miss a severe attack. Enzyme pills don't stop acute inflammation. If a stone caused the attack, a gastroenterologist or surgeon decides when and how to remove it, sometimes with an endoscopic procedure on the ducts.

If a complication requires surgery on the pancreas, Oberig clinic has a Center for Liver, Pancreas and Transplant Surgery led by Professor Oleg Kotenko, MD, PhD. The center operates on pancreatic tumors, bile duct problems and complex liver conditions.

Honestly, no. An acute attack isn't treated at home. Ice on the belly, fasting or enzyme pills won't replace IV fluids and a doctor's care. Severe pain, vomiting or fever means going to hospital.

Home is where you recover after discharge. Follow the diet your doctor recommended. Give up alcohol completely. Don't skip follow-up tests and ultrasounds. And get your gallstones treated if they were the cause. That's how you lower the risk of another attack.

For the first hours in hospital, you usually don't eat. But long fasting is no longer recommended. As soon as the pain eases and the vomiting stops, eating resumes step by step, starting with liquid and light food.

Your doctor will tell you what's fine after discharge, but the general rules are:

• small meals 5-6 times a day, no overeating
• lean meat and fish, grains, cooked vegetables, low-fat dairy
• boiled, stewed or steamed dishes, no fried crust
• very little fatty, smoked or spicy food and fast food
• no alcohol at all, not even "a little for a celebration"

Eating after an attack isn't a one-week diet. Alcohol and heavy fatty meals after the first episode are the most common causes of a second one.

Keep an eye on your weight and triglycerides if they were high. A healthy weight, regular activity and blood sugar control ease the load on the pancreas. Quitting smoking helps too: smoking raises the risk of repeat attacks and of the disease turning chronic.

Children get pancreatitis less often than adults, and for different reasons. These include belly injuries, viral infections, inborn duct abnormalities, some medicines, gallstones and inherited diseases. Alcohol is almost never the cause. A child complains of belly pain, vomits and refuses food. Testing is the same: blood work and an ultrasound. A child with severe belly pain and vomiting should see a doctor the same day.

Can pancreatitis be cured?

Acute pancreatitis usually clears completely. After a mild attack, the gland recovers. Remove the cause (gallstones, alcohol), and the attack may never return. Chronic pancreatitis can be controlled, but tissue that has already changed won't recover.

Does pancreatitis always come back?

No. If the cause is found and removed, many people never have another attack. Repeat attacks are most common in people who keep drinking or leave gallstones untreated. Each new episode raises the risk of chronic damage, so prevention really pays off.

How long will I stay in hospital?

A few days for a mild case. Severe forms with complications take weeks.

Can I drink alcohol after pancreatitis?

No. Even if gallstones caused the attack, alcohol further damages the gland and raises the risk of it happening again.

Should I take enzymes "to prevent" attacks?

No. Enzyme pills are prescribed when tests confirm the pancreas really makes too few enzymes. Without that, they don't protect you from an attack.

Which doctor should I see?

With acute pain, go to the emergency department. After discharge or if symptoms return, see a gastroenterologist. If gallstones are the cause, you'll also need a surgeon.

Is surgery needed for pancreatitis?

Usually not. Surgery is needed for complications, or to remove a gallbladder with stones after a stone-related attack.

Come in for a checkup if you get pain below the breastbone or in your back after eating, you've already had pancreatitis, or an ultrasound found gallstones. At Oberig clinic, we perform abdominal ultrasound on an expert-class ACUSON Sequoia (Siemens) scanner, run blood tests in our own lab and do a CT scan if needed. A gastroenterologist from our Gastro Center will put together a plan to prevent repeat attacks.

For acute belly pain, call an ambulance. To book a routine consultation, call +38 044 521 30 03 or book online.