Symptoms of Pancreatitis

Written by Huang Ya Juan
Gastroenterology
Updated on September 16, 2024
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Pancreatitis is divided into acute pancreatitis and chronic pancreatitis. Acute pancreatitis is a condition caused by various reasons that lead to damage in the pancreatic tissue. This results in the premature activation of enzymes meant for digesting food, which instead begin to digest the pancreas itself. This “self-destructive” behavior leads to a series of consequences known as acute pancreatitis. The symptoms of acute pancreatitis primarily include abdominal pain, predominantly upper abdominal pain, which occurs suddenly and is persistent, severe, or knife-like, with intermittent exacerbation; fever, nausea, vomiting frequently, with vomitus consisting of food, bile, and even blood, and the abdominal pain does not ease after vomiting; some patients may also have jaundice, often caused by gallstones or common bile duct stones inducing pancreatitis, possibly accompanied by itching of the skin. Chronic pancreatitis, on the other hand, is not necessarily caused by repeated attacks of acute pancreatitis, but rather by various causes leading to persistent inflammatory changes in the pancreas, characterized mainly by chronic and persistent inflammation, damage, and fibrosis of the pancreatic parenchyma. This can lead to irreversible morphological changes such as dilation of the pancreatic ducts, pancreatic duct stones, or calcification. Symptoms include abdominal pain, primarily upper abdominal pain, which may radiate to the back, often triggered by alcohol consumption, overeating, a high-fat diet, or fatigue; gastrointestinal symptoms include reduced appetite, bloating, and indigestion; exocrine manifestations include diarrhea, specifically steatorrhea, where the stool contains oil droplets and often has a foul odor; there may also be weight loss, emaciation, and endocrine manifestations, such as what we commonly refer to as diabetes.

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Written by Wei Shi Liang
Intensive Care Unit
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Severe pancreatitis intestinal nutrition

In different stages of severe pancreatitis, the energy requirements vary. At the early onset of the disease, the principle of nutritional support is to provide the minimum metabolic substrates needed to maintain basic metabolic demands, correct metabolic disorders, and minimize protein loss to a reasonable level. Caloric provision should be between 20 to 25 kcal per kilogram per day. As the condition progresses, the focus of nutritional support gradually shifts towards increasing or balancing nutrient intake. Early intervention using jejunal tube feeding is considered safer. Formulas used should be tolerable by the intestines; initially, glucose water is used to help the intestines adapt to nutrition. Early use of low-fat formulas containing amino acids or short peptides is advisable. Additionally, whole proteins, after being digested by stomach acid and entering the intestines directly, may lead to poor absorption.

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Written by Li Qiang
Intensive Care Unit
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The difference between severe pancreatitis and mild pancreatitis

Generally speaking, mild pancreatitis is just a local inflammation of the pancreas, usually manifested as upper abdominal pain, nausea, vomiting, and bloating — symptoms of the gastrointestinal tract. Severe pancreatitis, however, is much more serious than mild pancreatitis. In severe pancreatitis, not only is the pain in the local pancreas area more intense and the abdominal bloating more pronounced, but there is also a lot of effusion accumulating in the abdomen. Severe pancreatitis can also affect many other organs, such as the lungs, which are most commonly affected. It can lead to patients developing acute respiratory distress syndrome, characterized by severe hypoxemia, with many patients requiring mechanical ventilation treatment. Another organ that is commonly affected is the kidney, with many patients with severe pancreatitis experiencing acute renal failure, reduced urine output, or even anuria. Severe pancreatitis can also affect the heart, brain, and other organs, leading to functional abnormalities in these organs. Therefore, besides affecting the local pancreas, severe pancreatitis can involve other important organs, resulting in multiple organ dysfunctions.

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Written by Wei Shi Liang
Intensive Care Unit
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Symptoms of severe pancreatitis

The main symptom of severe pancreatitis is abdominal pain. This type of abdominal pain manifests as intense pain in the upper-middle abdomen, which radiates to the back and both sides of the body. The pain is widespread and severe, with about 95% of patients experiencing abdominal pain. Onset often occurs following binge eating or excessive drinking, and the pain worsens after eating. Another symptom is abdominal distension, which is also a common symptom. It is caused by extensive effusion in the abdominal cavity and retroperitoneum, as well as intestinal paralysis. Fever in the early stage of the disease is also a common symptom, resulting from the absorption of a large amount of necrotic tissue. Fever occurring in the later stages is often caused by infections triggered within the abdominal cavity.

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Written by Wei Shi Liang
Intensive Care Unit
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Two major signs of severe pancreatitis

In patients with severe pancreatitis, physical examination may reveal abdominal distension with tympanic percussion sounds, prominent tenderness in the upper middle abdomen, and potentially widespread abdominal pain centered in the upper middle area. Some may exhibit rebound tenderness, moderate muscle tension is common, and a few cases may demonstrate shifting dullness. Occasionally, a mass in the upper middle abdomen can be palpated, possibly due to fluid in the lesser sac. Auscultation may reveal diminished or absent bowel sounds, accompanied by cessation of passing gas or stool, indicating features of paralytic ileus.

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Written by Yang Chun Guang
Gastroenterology
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How to check for pancreatitis?

Pancreatitis can cause acute abdominal pain, along with symptoms of nausea and vomiting, and severe cases can lead to hypotensive shock. In laboratory tests, the diagnosis is generally made by assessing serum or urine amylase levels. An amylase level that exceeds three times the normal value can diagnose pancreatitis. Additionally, ultrasound and CT scans can reveal an enlarged or exuding pancreas, and the presence of a small amount of fat necrosis around the pancreas can be diagnosed as pancreatitis. The onset time of serum amylase in pancreatitis varies; typically, serum amylase begins to increase between 6 and 12 hours and starts to decline after 48 hours, and can be detected within 3 to 5 days. Lipase levels typically start to rise between 24 to 72 hours and remain elevated longer, up to 7 to 10 days. Thus, lipase has diagnostic value for later stages of pancreatitis and tends to have higher specificity compared to amylase.