Pancreatitis
- Fysiobasen
- Sep 9
- 4 min read
Pancreatitis is an inflammation of the pancreas, which can be either acute (sudden and severe) or chronic (long-lasting and recurrent). The pancreas is a gland that produces both digestive enzymes and important hormones such as insulin. Alcohol abuse is one of the most common causes of chronic pancreatitis, followed by gallstones. Pancreatitis can be severe and carries the risk of the gland being broken down by its own enzymes (autodigestion), which may damage both the organ itself and surrounding tissues.
Acute Pancreatitis
Acute pancreatitis is a sudden inflammatory reaction triggered by the activation and leakage of the pancreas’ own enzymes. This causes swelling and pain and may affect nearby organs, and in some cases lead to a systemic reaction with fever and circulatory failure.
Most cases are mild (80%) and resolve with treatment without lasting damage, but about 20% develop severe pancreatitis with tissue necrosis, increased risk of complications, and higher mortality²⁴.
Chronic Pancreatitis
Chronic pancreatitis develops after prolonged, recurrent inflammation that causes irreversible damage to the pancreas, scar tissue formation, and narrowing of the gland’s ducts. This leads to gradual loss of both endocrine (insulin) and exocrine (digestive enzymes) function. Symptoms persist or occur in waves, and the disease is not reversible.
Causes (Etiology)
Alcohol: About half of acute pancreatitis cases and most chronic pancreatitis cases are due to long-term, heavy alcohol consumption.
Gallstones: The second most common cause of acute pancreatitis.
Rare causes:
Trauma/surgery involving the pancreas
Hereditary pancreatic or metabolic disorders
Viral infection (especially mumps)
Medications (including certain diuretics)
Epidemiology
Acute pancreatitis causes about 275,000 hospital admissions annually (USA).
80% of patients have mild courses; the mortality rate for acute pancreatitis is about 2%.
Risk of recurrence varies depending on cause, highest with alcohol use.
Chronic pancreatitis: 5–12 new cases per 100,000 persons per year. Prevalence 50 per 100,000.
Most common in the 30–40 age group, more frequent in men³.
Symptoms:
Acute pancreatitis:
Severe abdominal pain, often radiating to the back
Bloating
Fever and sweating
Nausea, vomiting
Collapse/circulatory failure in severe cases
Chronic pancreatitis:
Persistent or recurrent abdominal pain
Weight loss and malnutrition (due to impaired digestion and nutrient absorption)
Steatorrhea (fatty, foul-smelling stools)
Reduced insulin production leading to diabetes in 20–30% over time
Increased risk of developing pancreatic cancer
Comorbidity and Complications
Acute pancreatitis: Alcoholism, progression to chronic disease, infection/abscess, circulatory failure, kidney failure, respiratory failure, diabetes.
Chronic pancreatitis: Alcoholism, cystic fibrosis, diabetes, chronic pain, increased cancer risk, malnutrition, functional impairment, and reduced quality of life.
Diagnostics
Diagnosis is based on symptoms, clinical examination, and imaging:
Blood tests: Elevated amylase/lipase levels
Ultrasound: Detects gallstones or edema
CT or MRI: Shows degree of inflammation, tissue damage, and complications (MRCP can display the duct system)
Other: X-ray, endoscopy if needed
Treatment
Acute pancreatitis:
Always hospital admission
Intravenous fluids and electrolytes
Pain management (often intravenous)
Fasting until inflammation subsides (to rest the pancreas)
Endoscopy to remove gallstones if needed
Surgery only in cases of complications (e.g., necrosis or abscess)
Abstinence from alcohol
Chronic pancreatitis:
Abstinence from alcohol
Low-fat diet
Digestive enzyme supplements with meals
Insulin therapy if blood sugar regulation fails
Pain management
Surgery may be considered to remove damaged tissue or gallstones
Physiotherapy in Pancreatitis
Acute Pancreatitis
Patients with acute pancreatitis may seek physiotherapy due to back pain, often localized to the thoracolumbar junction. Inflammation and scarring of the pancreas can reduce the ability to extend the spine, and decreased mobility may persist even after the inflammation has subsided. This is because deep scar tissue is often difficult to influence with standard manual therapy techniques, leaving patients with long-term reduced mobility.
Pain relief can be achieved through the use of heat to reduce muscle tension, relaxation techniques, and specific positions such as leaning forward, sitting upright, or lying on the left side in a fetal position. The physiotherapist must be thorough in history-taking and assessment, since patients often do not associate back pain with gastrointestinal symptoms such as diarrhea, postprandial pain, loss of appetite, or weight loss. Such links may indicate underlying pancreatitis.
Many patients with diabetes have an increased risk of pancreatitis. Physiotherapists working with this population must be aware of warning signs and symptoms of pancreatitis to ensure timely medical referral if needed.
If the patient develops complications such as acute respiratory distress syndrome (ARDS), physiotherapy can support respiratory care and pulmonary physiotherapy. During acute management, the physiotherapist must always follow medical restrictions: even small amounts of fluid (e.g., ice chips) can stimulate enzyme production and worsen pain, so it is important to confirm with nursing/medical staff what the patient is allowed before starting any intervention.
During hospitalization, the physiotherapist must also monitor for signs of internal bleeding (e.g., bruising).
Chronic Pancreatitis
Patients with chronic pancreatitis may experience persistent pain in the upper thoracic spine or thoracolumbar junction. Especially those with alcohol-induced disease may also present with symptoms of peripheral neuropathy. The physiotherapist should always take a complete history and consider visceral causes of musculoskeletal complaints, particularly when standard treatments are ineffective.
In patients with known pancreatitis or after pancreatic surgery, the physiotherapist must evaluate complications and adapt follow-up, including monitoring pulse and blood glucose when relevant.
Patients should be informed about malabsorption and the risk of osteoporosis due to impaired nutrient absorption.
Differential Diagnoses
Acute pancreatitis:
Several conditions may present with similar symptoms, including perforated peptic ulcer, intestinal or mesenteric infarction, strangulation or obstruction of the intestine, gallstones, appendicitis, diverticulitis, myocardial infarction (inferior wall), infection, kidney failure, hematoma, pregnancy, diabetic ketoacidosis, and other visceral or vascular conditions.
Chronic pancreatitis:
In patients without classic risk factors (e.g., alcohol abuse, repeated acute attacks), pancreatic cancer must always be excluded. Chronic pancreatitis may also be mistaken for gallstones, tumors, or inflammatory masses, and in early stages it may be difficult to distinguish from acute pancreatitis.
References
Better Health. Pancreatitis. Available from: https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/pancreatitis
Goodman CC, Fuller KS. Pathology: Implications for the Physical Therapist. 3rd ed. Saint Louis, MO: Saunders; 2009.
Mohy-ud-din N, Morrissey S. Pancreatitis. 2019. Available from: https://www.statpearls.com/articlelibrary/viewarticle/26577/
Beers MH, et al., eds. The Merck Manual of Diagnosis and Therapy. 18th ed. Whitehouse Station, NJ: Merck Research Laboratories; 2006.
American Diabetes Association. Available from: http://www.diabetes.org/
Cleveland Clinic: Center for Continuing Education. Chronic Pancreatitis. Available from: http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/gastroenterology/chronic-pancreatitis/
Carroll J, Herrick B, Gipson T. Acute Pancreatitis: Diagnosis, Prognosis, and Treatment. Am Fam Physician. 2008;77(5):594. Available from: http://www.aafp.org/afp/2007/0515/p1513.html
The Department of Anaesthesia and Intensive Care. Acute Pancreatitis. Available from: http://www.aic.cuhk.edu.hk/web8/acute_pancreatitis.htm
