Where does pancreatitis hurt?

Written by Zhu Dan Hua
Gastroenterology
Updated on January 04, 2025
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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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Symptoms of Pancreatitis

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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How many days of fasting for acute pancreatitis?

The duration for which patients with acute pancreatitis must fast is determined by the severity of their condition. Some may only need to fast for a day or two, while others may require around three to four days, or even a week. In severe cases of acute pancreatitis, it might be difficult to say how long the fasting could last, potentially around two weeks. Once patients with pancreatitis start eating after a series of active treatments such as anti-infection measures, inhibiting pancreatic secretion, replenishing electrolytes, and balancing acid-base levels, and following treatments like using rhubarb to facilitate bowel movements, if their bowel movements and gas expulsion have mostly returned to normal and amylase levels have largely normalized, they can cautiously start consuming low-fat, high-vitamin, and high-calorie liquid foods.

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Can pancreatitis be contagious?

Pancreatitis is not contagious; it is a serious digestive system disease. The main causes of pancreatitis include gallstones, binge eating, alcohol abuse, and consumption of greasy foods among other factors. Once an attack of pancreatitis occurs, the patient must immediately refrain from eating and drinking, undergo gastrointestinal decompression, and have gastric juices, acids, and stomach contents suctioned out. Meanwhile, treatments for pancreatitis may involve the use of somatostatin or octreotide to inhibit the secretion of pancreatic juice, as well as the use of third-generation cephalosporins or quinolone antibiotics for anti-infection treatment. (Please use medications under the guidance of a physician.)

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How to take care of acute pancreatitis

Patients with pancreatitis should pay attention to their diet during the recovery period. The basic dietary principle for pancreatitis patients is to consume small amounts of easily digestible foods, with low protein and fat content, primarily carbohydrates. During acute episodes, it's crucial to strictly control the intake of fatty foods. Once the condition has improved, patients may gradually consume protein-rich, high-vitamin, high-carbohydrate foods, along with non-irritating, easily digestible foods. Patients should avoid consuming large amounts of meat and alcohol, and can eat rice soup, lotus root starch, noodles, etc.

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What can be eaten with severe pancreatitis?

Patients with severe pancreatitis should not eat orally. Historically, suppressing pancreatic enzyme secretion by resting the intestines has been considered an important means of controlling the progression of acute pancreatitis. Currently, the implementation of early enteral nutrition is proposed. Early enteral nutrition should be administered via a jejunal tube, which is safer. The nutritional formulation should be chosen based on the patient's condition and intestinal tolerance. Initially, only glucose water may be used to allow the intestines to adapt to the nutrition. Early nutrition should use low-fat preparations containing amino acids or short peptides, because whole proteins entering the intestine directly without being digested by stomach acid can cause indigestion. As the condition enters the recovery phase, the feeding amount and rate can be gradually increased, and preparations containing whole proteins may be given.