Pancreatitis: acute vs. chronic

The pancreas is an important organ, instrumental in both digestion and in regulating blood sugar levels. When it becomes inflamed, the effects can be serious for the whole body. Renowned surgeon and professor of liver and pancreas surgery Professor Hemant Kocher explains the dangers of pancreatitis.

What is pancreatitis and what causes it?

Pancreatitis is inflammation of the pancreas. The pancreas is a deep-seated organ inside the tummy, close to the spine, and about level with the bottom of ribcage. It has two main functions: to digest the food in the bowel and to regulate the level of sugar in the bloodstream. It usually does not get inflamed.

However, some individuals are susceptible to inflammation of pancreas. Nearly 80 per cent of pancreatitis is caused by sensitivity to alcohol or the passage of gallstones near the pancreas. Uncommon causes of pancreatitis are high level of lipids or calcium in the bloodstream, injury to the pancreas, some specific medications and (rarely) a genetic or structural defect.

Pancreatitis can potentially be a severe illness and requires medical attention. Luckily, most cases of pancreatitis are self-limiting and recovery takes a few days to weeks after the initial episode.

Pancreatitis can sometimes become a chronic condition, where it requires life-long medical management and monitoring.

What’s the difference between acute and chronic pancreatitis?

Acute pancreatitis presents suddenly. Chronic pancreatitis, on the other hand, is something which an individual is usually aware of due to long-standing issues, although rarely it can be asymptomatic.

Acute pancreatitis is self-limiting, but in up to 20 per cent of instances it can be severe and life-threatening, requiring admission to an intensive care unit. It is difficult to tell within the first 48 hours if the acute pancreatitis will be mild or severe. For this reason, acute pancreatitis is always managed with hospital admission and close monitoring.

Chronic pancreatitis, on the other hand, is a long-standing issue, and therefore requires medical management and monitoring at regular intervals. This is usually done with regular outpatient visits, ideally with a pancreatic specialist, and assessment with blood tests and scans, as well as nutritional support and medications.

What symptoms should I look out for?

Acute pancreatitis is detected when a person gets severe upper tummy pain which may spread to the back and is usually accompanied by vomiting, but no diarrhoea.

There are other diseases which may cause similar symptoms, such as gastritis (inflammation in the stomach lining), a peptic ulcer (erosion of the lining of the stomach or bowel due to increased acid or bugs in stomach), gallstones, severe acid reflux, and occasionally problems with the spine. It is important to seek medical advice, starting with your GP to ensure that you are referred to a hospital for further assessments if necessary.

Chronic pancreatitis, on the other hand, may present with one or more of the following symptoms, which usually persist for a long period of time:

• Unrelenting upper abdominal pain radiating to the back
• Loss of appetite
• Weight loss
• Steatorrhoea – excess fat in the faeces, leading to foul-smelling, bulky stools, which are difficult to flush, usually associated with excessive flatulence.
• Diabetes
• Jaundice (yellow in the eyes)

Most people with chronic pancreatitis have been admitted to hospital with previous episodes of acute pancreatitis, but some may not have had any.

If you are experiencing symptoms of pancreatitis, book an appointment to get checked out by Professor Kocher by visiting his Top Doctors profile.