How is pancreatitis caused?

Written by Zhu Dan Hua
Gastroenterology
Updated on May 19, 2025
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Pancreatitis is also a common disease in clinical practice, especially acute pancreatitis. There are many causes of acute pancreatitis. From a definitional perspective, it refers to the inflammatory changes in the pancreas caused by various reasons. For Chinese people, some common causes include biliary tract stones, cholelithiasis, etc., as well as excessive eating and drinking, hyperlipidemia, and alcohol consumption. The symptoms of pancreatitis include upper abdominal pain or pain in the waist and back, accompanied by nausea, vomiting, fever, etc. The diagnostic criteria for acute pancreatitis include typical abdominal pain, abnormal serum and urinary amylase levels, and abnormalities found in abdominal ultrasound or abdominal CT scans. If the aforementioned three criteria are met, pancreatitis can be diagnosed. The treatment plan for pancreatitis varies depending on the cause. For example, lipid lowering treatment is recommended for hyperlipidemia-induced cases, and surgical intervention is suggested for biliary tract stones.

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Written by Zhu Dan Hua
Gastroenterology
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Where does pancreatitis hurt?

Pancreatitis generally presents as abdominal pain, specifically in the upper abdomen, the area above the navel, and near the xiphoid process. The pain is usually continuous and may intensify intermittently. Some patients also experience intolerable radiating pain in the lumbar and back areas, which can improve when they bend over. Patients commonly experience nausea and vomiting, which typically involve stomach contents without blood. Some patients may also have a fever, most commonly a low-grade fever between 37°C and 38.5°C. Patients usually seek medical attention for abdominal pain, and the pain in the upper abdomen and back area is a common complaint. To further clarify the diagnosis, patients typically need to undergo tests such as amylase evaluation, abdominal CT, and abdominal ultrasound. After these tests, a diagnosis of pancreatitis can usually be made. Treatment initially focuses on symptomatic management and medical treatment.

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Written by Wang Li Bing
Intensive Care Medicine Department
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Principles of Treatment for Severe Pancreatitis

The treatment principles for severe pancreatitis mainly include the following points: First, closely monitor the patient's heartbeat, respiration, blood pressure, blood oxygen, etc., and if possible, transfer them to the intensive care unit. Second, maintain electrolyte balance and blood volume, and actively rehydrate. Third, enhance nutritional support, which can include parenteral nutrition outside of gastrointestinal digestion. Fourth, routinely use antibiotics in severe pancreatitis to prevent infection from necrotizing pancreatitis. Fifth, reduce the secretion of pancreatic fluid, inhibit the synthesis of pancreatic enzymes, and suppress the activity of pancreatic enzymes. If the patient develops an infection associated with pancreatic necrosis, consider surgical treatment, etc.

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Written by Wei Shi Liang
Intensive Care Unit
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Severe Pancreatitis Criteria

Acute pancreatitis with persistent organ failure lasting more than 48 hours is considered severe pancreatitis. In the early stages of the disease, organ failure starts with a systemic inflammatory response produced by the activation of a cytokine cascade, involving the continuous failure of single or multiple organs. Such patients often have one or more local complications, with organ failure that can persist for several days after onset. The mortality rate can reach 36% to 50% once organ failure occurs. Infections in such patients can dramatically increase the mortality rate. CT imaging may show gas bubbles in peripancreatic necrotic tissue and fluid collections. Diagnosis is confirmed by positive results from either a smear of aspirate obtained via image-guided fine-needle aspiration or from bacterial cultures.

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Written by Chen Rong
Gastroenterology
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Is pancreatitis contagious?

Pancreatitis is a condition where pancreatic tissue damage is caused by self-digestion due to various etiologies. It can be seen in multiple causes and is not a contagious disease itself and does not spread. However, when pancreatitis is caused by infectious diseases such as acute epidemic mumps, influenza A infection, Chlamydophila pneumoniae infection, infectious mononucleosis, Coxsackie virus infection, etc., the pancreas can be affected as a target organ resulting in pancreatitis. In such cases, transmission of the primary disease may occur, but pancreatitis is more commonly associated with biliary diseases such as cholelithiasis, biliary infection, alcohol damage, pancreatic duct obstruction (like pancreatic duct stones, ascariasis, stricture, tumors), diseases of the descending part of the duodenum (such as post-bulbar perforation, ulcers, adjacent papillitis of the duodenum, surgical trauma), hyperlipidemia, autoimmune diseases, drug damage, etc., none of which are contagious.

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Written by Chen Rong
Gastroenterology
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How to check for pancreatitis?

The examination of pancreatitis requires laboratory tests and imaging examinations to assess the severity of the condition and to identify the cause. Elevated amylase and lipase levels more than three times the normal values, increased white blood cells, elevated C-reactive protein, increased blood sugar, elevated transaminases and bilirubin, decreased albumin, increased urea nitrogen and creatinine, decreased blood oxygen partial pressure, decreased blood calcium, elevated triglycerides, and abnormalities in blood sodium, potassium, and pH values all reflect the severity of pancreatitis. Abdominal ultrasound is a routine initial screening imaging examination for acute pancreatitis, and abdominal CT is helpful in confirming the presence of pancreatitis, peripancreatic inflammatory changes, and pleural effusion. Enhanced CT is beneficial in determining the extent of pancreatic necrosis and is generally performed about a week after the onset of the condition. However, when searching for the cause of pancreatitis, the sensitivity and accuracy of CT are not as good as MRI, therefore further MRI should be conducted to investigate causes related to the bile duct and to determine the cause of the pancreatitis.