From the Guidelines
Pancreatitis typically presents with severe upper abdominal pain radiating to the back, nausea, vomiting, fever, and abdominal tenderness, and can be life-threatening, requiring prompt medical attention. The symptoms of pancreatitis can vary depending on whether it is acute or chronic. According to the 2019 WSES guidelines for the management of severe acute pancreatitis 1, acute pancreatitis is an inflammatory condition of the pancreas most commonly caused by bile stones or excessive use of alcohol. The most common symptom is severe upper abdominal pain that often radiates to the back and may worsen after eating, especially fatty foods. Nausea and vomiting frequently accompany this pain. Patients may develop fever, rapid pulse, and abdominal tenderness or swelling. In severe cases, the abdomen might become rigid and extremely sensitive to touch. Other symptoms include jaundice (yellowing of skin and eyes), clay-colored stools, and unexplained weight loss.
Some key points to consider when evaluating the symptoms of pancreatitis include:
- The severity of the symptoms, with severe cases being life-threatening
- The presence of organ failure, which can increase mortality rates 1
- The presence of infection, which can worsen organ dysfunction and increase mortality rates 1
- The need for prompt medical attention, especially in cases of severe abdominal pain and vomiting
Chronic pancreatitis, on the other hand, features persistent digestive problems like oily, foul-smelling stools (steatorrhea) due to malabsorption of fats, as well as diabetes symptoms as pancreatic damage progresses 1. The ESPEN guidelines on enteral nutrition: pancreas 1 recommend a reduced fat diet and pancreatic enzymes to manage symptoms. It is essential to seek immediate medical attention if symptoms persist or worsen over time, as pancreatitis can be life-threatening and requires prompt treatment.
From the Research
Signs and Symptoms of Pancreatitis
The signs and symptoms of pancreatitis can be understood by analyzing the effects of pancreatic exocrine insufficiency (EPI) on the body. Some key points to consider include:
- Abdominal pain: Studies have shown that pancreatic enzyme replacement therapy (PERT) can reduce abdominal pain in patients with chronic pancreatitis 2.
- Malnutrition: EPI can lead to malnutrition due to inadequate absorption of fat, proteins, and carbohydrates, causing steatorrhoea and creathorrhea, which results in abdominal discomfort, weight loss, and nutritional deficiencies 3.
- Steatorrhea: Steatorrhea is a common symptom of EPI, and patients may experience diarrhea and weight loss due to malabsorption of nutrients 4, 5.
- Nutritional deficiencies: Patients with EPI may experience nutritional deficiencies, including deficiencies in retinol-binding protein, prealbumin, and transferrin 4.
Diagnosis and Treatment
Diagnosing and treating EPI is crucial to preventing malnutrition-related morbidity and mortality. Some key points to consider include:
- Diagnosis: Determining if a patient is malabsorbing due to pancreatic exocrine insufficiency is the first step in determining if pancreatic enzyme therapy is appropriate 6.
- Treatment: PERT is indicated to correct EPI and malnutrition in chronic pancreatitis, and may be improved by higher doses, enteric coating, administration during food, and acid suppression 2.
- Dosage: Dosage guidelines for pancreatic enzymes vary, but recommendations include 25,000 to 40,000 units of lipase per meal using pH-sensitive pancreatin microspheres 5.