Just heard of an acquaintance who went into hospital with pancreatitis and died.
Is it normally fatal? I thought it was just extremely painful and draining.
I’m so sorry.
Pancreatitis is one of those that can be mildly annoying or a very big deal indeed. The mortality rate for those who are hospitalized with pancreatitis is between 5-10%. If they have another infection or necrosis somewhere on their body, that goes up to 30%. 
Sorry about your acquaintance. The pancreas secretes enzymes that digest food, and the body is, as far as those enzymes can tell, made up of the same stuff. So when the enzymes get where they are not supposed to be, they start digesting and breaking down the tissues they come in contact with. This sets off a systemic inflammatory response that affects the body as a whole, resulting, in the most severe cases, in multi organ system failure. It’s that systemic inflammatory response that can cause death, not the pancreatitis per se (of course chicken-egg).
Pancreatitis as you’ve just been made so tragically aware, can be a lethal condition. I see a lot of it in my practice and have learned to respect it.
In terms of mechanisms of death (and major ‘morbidity’), there are a number of them (often mutually reinforcing):
- Sepsis (severe infection) - in and around the area of the pancreatic inflammation, there is, essentially, dead tissue and various products of inflammation (cellular debris, partially digested fat, old blood, etc.). It provides a nice medium for bacteria to grow and, by definition, is a ‘deep infection’ at the outset (i.e. not readily drainable).
But in addition to infection around the pancreas, other infections are also promoted, with pneumonia, in particular, always a risk (see below)
- Lung Complications - the ‘stress’ of the pancreatitis itself, infection (around the pancreas or elsewhere), and the presence of fat digesting enzymes in the bloodstream (having been released from the destroyed pancreas), can singly or in concert cause what is called ‘acute respiratory distress syndrome’ or ARDS. The syndrome is characterized by the presence of fluid in the spaces where there should be air. In other words, it’s almost a form of drowning. The mortality rate for ARDS is high, somewhere between 25 and 50 percent.
In addition to ARDS affecting the lungs, people with pancreatitis also tend to get collapse of their lungs (or parts thereof) since a) they tend not to take deep breathes since doing so causes pain in the area of the pancreatitis, and failure to take deep breathes predictably leads to collapse of parts of the lungs and b) the presence of inflammation around the pancreas almost always leads to fluid leakage and accumulation around the lungs (not in the airspaces) called pleural effusions. The effusions further compress the lungs thereby further promoting the latter’s collapse.
Collapsed lung is, by itself, not a good thing. In addition, because collapsed lung tissue is ‘just sitting there’ not being aerated and cleared, the chance of developing pneumonia is high.
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As mentioned by WhyNot, the inflammation in the pancreas can also eat through the blood vessels there, and that can lead to major, life-threatening hemorrhage.
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Pancreatitis (for a number of reasons that I can elaborate if you wish), tends to cause kidney failure. And, once kidney failure occurs (even if only partial), everything else becomes more precarious. The risk of infection is also increased in the setting of kidney failure.
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Metabolic derangements - blood sugar elevation and calcium problems are typical in severe pancreatitis. Details on request.
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Protein calorie malnutriton - severe pancreatitis victims need lots of calories ‘to heal’ yet few are able to take them by mouth. Often, nutrition must be given by the IV route. That requires a large, so-called central line and is not infrequently a portal of entry for bacteria into the bloodstream. Even with nutritional support, people with pancreatitis can experience all the complications of depleted protein such as massive swelling and muscle breakdown. Both can lead to infection and other problems.
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Blood clots - any severe, acute illness tends to activate the coagulation system. The tendency to clot formation is compounded by the immobility of pancreatitis patients, i.e. blood stagnates, and can clot, if you’re not moving about. Blood clots can be fatal and are still grossly under-appreciated.
The above are just the shorter term complications. There is another set of long term complications, unfortunately.
I missed the edit window but had wanted to add:
As with any acute condition, the patient’s baseline health status is important. A major cause of pancreatitis is alcohol use (not necessarily abuse). But, if there is prior alcohol-induced liver disease, for example, the person is not only that much more likely not to tolerate the pancreatitis, but can also develop a whole slew of other major problems each of which can be a threat to his/her survival (e.g. other forms of bleeding and kidney failure, a severe form of delirium called encephalopathy, . . .).
Wow, I had no idea it could be so serious. Thanks all for your comments.
The only previous time I’d heard of it was when our former Prime Minister, Brian Mulroney, had it a few years ago. He was under care for a month or two, but no suggestion it was life-threatening in his case.
Frightening. I had pancreatitis as a teen-ager (so over 60 years ago). I couldn’t eat anything containing fat for a couple weeks and then I was fine. No complications and no long term effects. But Karl Gauss’s post is real scary.
My pancreatitis was a prelude to my entire pancreas shriveling up and dying.
My spouse wound up diabetic as a result of pancreatitis, as it destroyed a sufficient amount of his pancreas that it had trouble producing sufficient insulin. There are also some sort of indications that he suffered a heart attack during it, but he doesn’t remember crushing chest pain, or rather, if he did, he couldn’t distinguish it from the rest of the pain he was feeling at the time.
Karl pretty much covered what I was going to say, but in much better detail than I could have given.
I want to point out that I lost my summer this year because of a gall bladder attack. By the time it came out, it was more than doubled in size, necrotic, and embedded in the underside of my liver. Another day or so would have it rupturing with a significant chance of fatality from peritonitis and blood loss.
Since they are adjacent, I’m surprised the gall bladder didn’t take out my pancreas also. It did cause liver damage that I’m trying to deal with now.
My father was an M.D. who developed pancreatitis in his early 40s. He was not a drinker; the disease may have been related to a blocked duct after his gall bladder was removed. Anyway, he was in the hospital for months, and nearly died. He was on total parenteral nutrition (TPN) for months as well. He recovered, but the disease damaged his pancreas, kidneys, and other organs, including his digestive system, which led to malnutrition and muscle loss, and he ultimately died of these complications 20 years later. 
Even though he was debilitated, he was still seeing patients up until a week before he died. I miss him…
I have a very close friend who suffered from pancreatitis repeatedly (and was made well aware that it’s a dangerous, and potentially lethal, condition). Thank you for your detailled post, I’m going to bookmark it.
Could you elaborate about this?
FTR, the cause of my friend’s pancreatitis is unknown. Some doctors have attributed it to an allergic issue, but “allergic pancreatitis” seems to be an Unidentified Medical Object (I found one medical article refering to it, though), so others dismiss this as not being a possibility.
IIRC, my mother-in-law (years ago) had a gallstone problem. The stones got into the ducts and blocked the duct hat also lead to the pancreas, thus producing blockage and inflammation of the gall bladder and pancreas as they filled up with fluid (bile?). Make all that stuff back up and increase in pressure, the organs become infected, the pressure threatens to burst them and spill bacteria into the tissues between the organs, thus causing even more infection, etc. (Same idea as a burst appendix, I assume).
At a certain point your body cannot handle the mess, and burst pieces of organs are not really likely to be getting the blood flow to help them fight infection. Plus if the other organs pick up that infection, they could shut down, causing a cascade of failures and eventual body failure.
It’s never a good idea to have deep infections.
Most people do well after an episode of pancreatitis. In some cases, if an underlying cause was discovered, it will have been corrected thus lessening the chance of subsequent episodes.
By the way, by far the most common causes of pancreatitis are alcohol use and gall bladder disease (e.g. gallstones). Something like 90 percent of cases are attributable to one of those two risk factors. I should note, that with respect to the gall bladder, pancreatitis can still occur even if someone’s had their gall bladder removed.
Other causes/risks of pancreatitis include:
- in association with ERCP (endoscopic retrograde cholangiopancreatography) which is a procedure where the bile ducts and pancreatic duct are
- VERY high levels of triglyceride (like 50 or 100 times normal, i.e. levels in the thousands (mg/dL) = levels of 20 to 100 (mmol/L))
- high levels of blood calcium
- certain drugs (e.g. ‘gliptins’ for diabetes, various anti-HIV agents, thiazide diuretics, and many more)
- previous episodes of pancreatitis
- trauma, especially to the abdomen (including surgery)
- infections (e.g. mumps, hepatitis)
- and more . . .
Now, in terms of the late, or longer term, complications of pancreatitis, I’d break it down into two major categories:
- Local/mechanical
- Impaired pancreas function
Late local or mechanical complications include:
- recurrent pancreatitis (sometimes one episode, a first episode, sets in motion a sequence of chronic and/or relapsing pancreatitis)
- cyst formation (more accurately termed pseudocyst formation) when a collection of ‘junk’ accumulates at the site of the pancreatitis. Pseudocysts contain dead tissue, white cells, digested fat, ‘debris’) and can cause severe pain, can bleed, can rupture, get infected, or compress nearby vital structures. Bleeding, rupture, and infection can be catastrophic, and compression of say, the bile duct (that should be draining the liver) is also a serious problem.
Impaired pancreatic function is in some sense predictable, since the pancreas is essential for both the production of digestive enzymes (for fat) and for the production of insulin. Especially after recurrent episodes of pancreatitis, the pancreas can become so damaged (and atrophied) that it can no longer make adequate fat digestive enzymes and/or insulin. The result is ‘fat malabsorption’ and diabetes, respectively. Often, this situation is referred to as pancreatic insufficiency, with the term exocrine pancreatic insufficiency used to denote loss of the fat digesting enzymes and endocrine pancreatic insufficiency to refer to the lack of insulin and the diabetes that results.
Fat malabsorption causes severe diarrhea and weight loss. When this occurs, and is left untreated, people can lose huge amounts of weight. Further, it’s not just fat calories that won’t be absorbed - fat soluble vitamins will also be poorly absorbed leading to a drop in their levels, and that leads to its own problems.
If the pancreatic insufficiency extends to cause inadequate insulin production, and thus diabetes, sugar levels tend to be erratic with periods of high sugar interrupted by periods of very low sugar. Part of the reason this happens is that a) people may be eating but not absorbing their calories as a result of fat digestive enzyme deficiency and b) in addition to making insulin, the pancreas also produces ‘glucagon’ which, in a way, is like an anti-insulin. It tends to do the opposite of insulin. Although people can inject insulin, the same is not true for glucagon (except in emergency situations). In the absence of glucagon, the blood sugar can fall to dangerously low levels and stay there. Living with diabetes that has arisen as a complication of pancreatic insufficiency can be extremely challenging to put it mildly.
There, an overview of the late complications of pancreatitis. In conjunction with the acute complications (addressed in a previous post), they indicate what a nasty disease pancreatitis can be. I’ll shut up now.
One of things that really annoyed me when my spouse had pancreatitis was the constant and unrelenting questions about his “drinking” habits. At the time, the spouse hadn’t had an alcoholic drink in several years. But it was like no one believed us. I even had doctors pulling me into the hallway to say “no, really, how much alcohol does he drink in a day? Check the trash for bottles.” No, really, he had had no alcohol for quite a long time prior to the episode. Give it a rest, people, not every case is connected to alcohol! Just because he looks like a redneck doesn’t mean he drinks like one!
Finally, they mumbled something about maybe some sort of viral infection. In retrospect, it might have been elevated triglycerides, but maybe the elevated levels were a result and not a cause? His check-up prior to the pancreatitis did not show such elevated levels.
The real relief is that there hasn’t been a repeat.
Word. My husband just went through a bout of suspected pancreatitis. (They never did give it a definitive diagnosis; when he wasn’t dead 3 days later, they sent him home.)
*Constant *harping on the drinking. No. He’s a true social drinker, less than 2 drinks a week, many weeks none at all.
I get it. Patients lie. This is true. But I think part of the firm belief hospitalists have that pancreatitis is so strongly linked to drinking is because they don’t believe those of us to tell them, truthfully, that no, he hasn’t been drinking a lot. So they chart it as alcohol related, with maybe a note that the patient is a poor historian. :mad:
The worst part of that may be that spending so much time and energy on a wrong cause (alcohol) means they’re excluding from their thoughts other causes, one of which, presumably, is the actual cause. I prefer to know the actual cause because then, just maybe, we can avoid going through all this again.
Exactly.
Same with my friend (who is also an ex). She doesn’t drink, either.