Acute pancreatitis overview

The pancreas is the large gland located in the upper part of the abdomen, behind the stomach. It produces digestive enzymes and hormones. Acute pancreatitis is a sudden inflammation of this gland.

During acute pancreatitis, enzymes that are normally released into the digestive tract begin to damage the pancreas itself. The gland becomes swollen and inflamed. As a result, digestion slows down and becomes painful. Other body functions can be affected. The pancreas can become permanently damaged and scarred if attacks are severe, prolonged, or frequent.

Several things are known to trigger acute pancreatitis:

• gallstones that escape from the gallbladder can block the outflow of enzymes from the pancreas, causing it to become inflamed.
• heavy alcohol use, either over the long term or in a single binge, can inflame the pancreas. Combining smoking with heavy alcohol use increases the risk of acute pancreatitis.
• use of any of a wide variety of medications, such as sulfa drugs, diuretics ("water pills"), immunosuppressants, and some medications used to treat HIV
• abdominal surgery
• severe trauma
• high blood levels of calcium or triglycerides
• infections such as mumps or viral hepatitis

In many cases, no cause can be found.

Mild to moderate acute pancreatitis often goes away on its own within a week or so. Severe attacks can last several weeks. If a single severe attack or several repeat attacks significantly damage the pancreas, chronic pancreatitis can develop.

Symptoms of acute pancreatitis

The most common symptom of acute pancreatitis is upper abdominal pain that usually — but not always — occurs in the middle of the body, just under the ribs. The pain often comes on suddenly.

Other symptoms of acute pancreatitis include:

• nausea and vomiting
• loss of appetite
• abdominal bloating
• in severe cases, fever, difficulty breathing, weakness, and shock

Diagnosing acute pancreatitis

In addition to your description of your symptoms and a physical exam, blood tests showing high levels of two proteins, serum amylase and serum lipase, can help diagnose acute pancreatitis. Other blood tests that may be helpful include:

• a complete blood count can detect a high level of white blood cells, which can increase dramatically during acute pancreatitis.
• high levels of liver enzymes can signal acute pancreatitis caused by gallstones.
• an elevation in bilirubin can indicate that the bile duct is blocked

In some cases, a CT scan may be done. It can identify swelling of the pancreas and accumulation of fluid in the abdomen.

If your doctor suspects that pancreatitis is being caused by gallstones, he or she may recommend that you have an ultrasound of your gallbladder.

Treating acute pancreatitis

If you think you might have acute pancreatitis, don't eat or drink anything until you see a doctor. Food and drink trigger the release of enzymes from the pancreas, making the pain worse.

Most people with acute pancreatitis are admitted to the hospital. They are treated with pain relievers and intravenous fluids.

You won't be able to eat or drink until your symptoms begin to ease. In most cases, nothing can be done to speed healing or shorten an attack. If it lasts more than a week, nutrition may be given intravenously.

Antibiotics can help prevent or treat infection in the pancreas or surrounding tissues. Beyond that, other medications aren't usually needed.

If you have an attack of pancreatitis caused by gallstones, you may need to have an endoscopic retrograde cholangiopancreatography (ERCP). This procedure can open a blocked bile duct, or crush or remove gallstones. Later on, once the pancreatitis has cleared up, it may be necessary to have your gallbladder removed.