Indications

Pancreatitis can be acute or chronic and, depending on which form it takes, the signs by which it manifests itself also differ. An acute pancreatitis (pancreatitis) is often first noticed by sudden, severe pain in the upper abdomen, which can radiate into the back in the form of a belt. This is often accompanied by nausea and vomiting.

In addition, there may be an intestinal obstruction (ileus) so that stool retention is present. The chronic form of pancreatitis usually proceeds without symptoms at first. Only at a later stage can symptoms appear, as in acute pancreatitis.

Although the pain in the upper abdomen is usually not as intense, it does occur repeatedly. As the disease progresses, the pain may increase or become permanent. If the pancreas is increasingly destroyed by the chronic inflammation, there is a progressive loss of function and the digestive enzymes are produced in insufficient quantities and released into the intestine.

This can lead to diarrhoea and fatty stools (steatorrhoea). In addition, flatulence and abdominal cramps can occur. The patient loses more and more weight over time. Since the pancreas is responsible for the production of insulin, diabetes mellitus can develop if there is chronic inflammation. If the inflammation is very advanced, the bile ducts can also become narrow and a yellowing of the skin (icterus) can occur.

Pain

A so-called leading symptom of pancreatitis is the pain, which usually makes the patient go to the doctor sooner or later. In about 90% of cases of pancreatitis, patients complain of moderate but increasing pain in the area of the central upper abdomen. It is described as permanent and can therefore be easily distinguished from the colic pain associated with biliary colic.

It can be felt for days to weeks and usually does not subside at any time of the day. However, there is a tendency for it to become worse. Patients perceive it as a deep pain that originates far from the surface of the abdomen.

For this reason, it can often only be triggered at the medical examination after deep palpation (an exception is very acute pancreatitis, which may also be accompanied by peritonitis. In this case a light touch of the middle upper abdomen area is often sufficient). The stated pain often occurs more strongly after eating, but unlike in the case of a gall bladder inflammation, for a longer time after eating.

Rather, it can be said that the basic pain in pancreatitis is present all day long, but is impressed by the ingestion of food in the form of a strong pain peak. Characteristically, the starting point of the pain is indicated in the middle upper abdomen. In many cases it spreads out on both sides towards the flank and in some cases it is also indicated as extending into the back.

Patients with upper abdominal pain that extends into the back should always make the examiner listen carefully and have further examinations performed. The term belt-shaped pain is often used here because it starts in the middle upper abdomen and then wraps itself around the body in a belt shape to converge at the back. This description of pain should make one think of pancreatitis, but the absence of it does not mean in any case that pancreatitis is not present. The character of the pain is described in the front part of the abdomen as dull to pulling to the side and in the back but often as burning or biting. However, numerous mixed forms of pain have also been described, and the location indicated as the type of pain should rather lead to the suspicion of pancreatitis.