Acute pancreatitis

What is acute pancreatitis?

Acute pancreatitis is a sudden inflammation of the pancreas.

The pancreas is located in the upper part of the abdomen, behind the stomach. It produces digestive enzymes and hormones.

In pancreatitis, enzymes that normally are released into the digestive tract begin to damage the pancreas itself. The organ becomes swollen and inflamed. More enzymes are released into the surrounding tissues and bloodstream.

The most common causes of acute pancreatitis are

• alcohol
• gallstones
• having the medical procedure known as ERCP.

Alcohol-related pancreatitis. Most people who drink alcohol never develop pancreatitis. But certain people will develop pancreatitis after drinking large amounts of alcohol. Alcohol use may be over a period of time or in a single binge. Alcohol combined with smoking increases the risk of acute pancreatitis.

Gallstone pancreatitis. Gallstones that escape from the gallbladder can block the pancreatic duct. (The pancreatic duct delivers digestive enzymes from the pancreas to the small intestine.) When the pancreatic duct becomes blocked, enzymes can't flow properly. They can back up into the pancreas. This causes the pancreas to become inflamed.

ERCP-related pancreatitis. Endoscopic retrograde cholangiopancreatography (ERCP) is a medical procedure used to evaluate the bile and pancreatic ducts and help open any blockages. ERCP is performed through an endoscope. This is a flexible tube with a small camera and a light on one end and an eyepiece on the other. ERCP is used to identify stones and tumors and to view ducts in the pancreas, liver, and gallbladder.

Other factors that sometimes can cause pancreatitis include

• use of any of a wide variety of medications, such as
  • sulfa drugs
  • water pills (hydrochlorothiazide, others)
  • immunosuppressants (azathioprine)
  • drugs used to treat HIV
• abdominal surgery
• severe trauma
• metabolic conditions, such as high blood levels of calcium or triglycerides
• some infections, such as mumps or viral hepatitis.

In many cases, no cause can be found.

Symptoms of acute pancreatitis

The most common symptom of acute pancreatitis is upper abdominal pain. It can range from tolerable to severe.

The pain usually occurs in the middle of the body, just under the ribs. But it is sometimes felt on either the left or right side. This is a steady, drilling, or "boring" pain. It can radiate to the back, flank, chest, or lower abdomen.

Pain reaches a maximum intensity quickly, often within 30 minutes. In alcohol-induced pancreatitis, the pain tends to begin one to three days after a binge.

It may be difficult to find a comfortable position. Bending over or lying on your side may reduce the pain. Eating usually makes the pain worse.

Other symptoms of acute pancreatitis include

• nausea and vomiting
• loss of appetite
• abdominal bloating.

In severe cases, fever, difficulty breathing, weakness, and shock may develop.

Diagnosing acute pancreatitis

Your doctor will diagnose acute pancreatitis based on

• your symptoms
• a physical examination
• certain laboratory tests.

Blood tests usually reveal high levels of two pancreatic enzymes.

In most cases, people suspected of having pancreatitis undergo an abdominal computed tomography (CT) scan. The scan can identify swelling of the pancreas and accumulation of fluid in the abdomen.

The scan also may show whether you have pancreatic pseudocysts. Pseudocysts are pockets of fluid created by escaped digestive enzymes. They develop in some cases of severe pancreatitis or after repeated attacks.

If gallstones are suspected, an ultrasound examination of the gallbladder is usually performed.

Expected duration of acute pancreatitis

Mild to moderate pancreatitis often goes away on its own within one week. But severe cases can last several weeks.

If significant damage is done to the pancreas in a single severe attack or several repeat attacks, chronic pancreatitis can develop.

Preventing acute pancreatitis

Avoiding heavy alcohol use will help to prevent pancreatitis. Anyone who already has had one episode of pancreatitis caused by alcohol should stop drinking entirely. This is crucial to prevent the condition from coming back or becoming chronic.

Most first episodes of acute pancreatitis that are not related to alcohol use cannot be prevented. However, taking steps to prevent gallstones may help to prevent gallstone-related acute pancreatitis. To help prevent gallstones, maintain a normal weight and avoid rapid weight loss.

If the cause is gallstones, gallbladder surgery will usually be recommended to prevent future attacks. When a medication is the likely cause, it will be stopped if possible.

Treating acute pancreatitis

If you suspect you have acute pancreatitis, you need to seek urgent medical care. Most people who develop pancreatitis are admitted to the hospital. They are treated with pain relievers and intravenous fluids.

You will usually be able to start taking clear liquids once the pain is controlled and you are not vomiting. In most cases, nothing can be done to speed healing or shorten an episode. If the episode is prolonged, and a patient cannot eat for longer than a week, nutrition may be given intravenously.

If the damaged pancreas becomes infected with bacteria, antibiotics may be prescribed, but only if the damaged pancreas becomes infected with bacteria.

If you have an attack of pancreatitis caused by gallstones, you may need to have an ERCP. During the test, the doctor may make a tiny cut into the opening of the bile duct to treat current or future blockage. You will likely be advised to have your gallbladder removed, often before leaving the hospital.

Surgery also may be needed to

• drain a pseudocyst
• treat an abscess
• stop bleeding.

When to call a professional

Call your doctor or go to the nearest hospital emergency room if you have

• intense abdominal pain that lasts longer than 30 minutes
• pain accompanied by vomiting or severe nausea.

Prognosis

In most cases, acute pancreatitis goes away on its own after a couple of days. There are usually no complications or further problems.

A small percentage of patients develop complications. These may include a pseudocyst or abscess in the pancreas. They may require monitoring or additional treatment.

Pancreatitis caused by heavy drinking is likely to come back if drinking continues. Over time, permanent damage may be done to the pancreas. A chronic form of the disease may develop.

Additional info

National Institute of Diabetes & Digestive & Kidney Disorders
https://www.niddk.nih.gov/