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Acute Pancreatitis

Definition

The pancreas is a long, flat, pear-shaped organ that sits behind the stomach. It makes enzymes that help to break down food for use by the body. The enzymes pass from the pancreas through a duct to the small intestine.

Acute pancreatitis is an inflammation of the pancreas that occurs suddenly, then passes after treatment.

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Pancreatitis
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Causes

Pancreatitis may be caused by a number of conditions such as:

  • Blockage of the ducts from:
    • Gallstones
    • Cancer growth
    • Diseases of the small intestine
  • Alcohol
  • Surgery or trauma to the pancreas
  • Certain medications, such as those that treat cancer
  • Poor blood flow to the pancreas
  • Complications of endoscopic retrograde cholangiopancreatography—procedure to treat or diagnose problems of the pancreas

The enzymes are normally not active in the pancreas. Inflammation can turn on the enzymes in the pancreas which can damage the inside of the pancreas.

Risk Factors

Factors that may increase the risk of having acute pancreatitis include:

Symptoms

Symptoms may start once or occur many separate times. A flare ups of symptoms is known as an attack.

Symptoms may include:

  • Severe pain in the center of the upper abdomen:
    • Pain may spread into the upper back
    • Pain is often made worse by eating, walking, or lying down on your back
  • Nausea and vomiting
  • Low grade fever
  • Yellowing of the skin and eyes
  • Rarely, shock—a medical emergency in which the organs and tissues don't receive adequate blood or fluids

Untreated acute pancreatitis may progress into chronic pancreatitis. This is a more serious condition that can lead to permanent damage of the pancreas.

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. Your doctor may ask about your alcohol habits and what medications you take. Blood tests will help to make the diagnosis. Certain enzymes are much higher in the blood with acute pancreatitis.

The doctor may also need to take images of the pancreas. The images can show changes to the pancreas, gallstones, or duct blockages. Images may be taken with:

The doctor will use information from all of the tests to make a diagnosis.

Treatment

Treatment will depend on the severity of the attack and what is causing it. For example, if medication is the cause, your doctor may simply change the medication or the dose.

In most cases, acute pancreatitis will pass in a few days with proper care. Most will have no lasting damage. Treatment includes:

Hospitalization

The pancreas will begin to work anytime food and drink is taken. To allow the pancreas to fully rest, you will not be allowed to eat or drink. Fluid and nutrition can be given by IV to support you during this time. Pancreatitis can also cause an imbalance in other enzymes and insulin. The medical team will give you medications to help manage these side effects until the pancreatitis has passed.

Severe pancreatitis may take a few weeks to fully heal. A special liquid may be needed to give you better nutrition during recovery. The fluid is passed through a tube that is inserted into your nose and passed down into your stomach.

If treatment is needed for the cause of your pancreatitis, it will be done while you are in the hospital.

Surgery

Surgery may be needed:

  • For severe cases that do not respond well to rest
  • To treat underlying conditions

Surgical options include:

  • Percutaneous catheter drainage—thin tubes are inserted into the abdomen to drain fluid from the pancreas.
  • Endoscopic retrograde cholangiopancreatography (ECRP)—To remove gallstones or open any collapsed ducts.
  • Cholecystectomy—To remove the gallbladder. Will also reduce your chance of getting acute pancreatitis again.
  • Necrosectomy—Removal of dying or dead pancreatic tissue. .

Prevention

To help reduce your chance of getting acute pancreatitis, take these steps:

  • Limit intake of alcohol to a maximum of 2 drinks per day for men and 1 drink per day for women.
  • If you have hyperlipidemia, restrict your intake of fat and follow your doctor’s treatment plan to lower your lipids.
  • Increase your vegetable consumption.
  • Increase your activity level to help lose excess weight. Aim for 30 minutes per day on most days of the week.
  • Make sure your vaccinations are up to date. This includes mumps, rubella hepatitis B, and varicella.
  • If you smoke, talk to your doctor about ways to quit. Smoking can irritate the pancreas.
  • Avoid fatty meals. High amounts of fat intake put extra stress on the pancreas.

Revision Information

  • National Institute of Diabetes and Digestive and Kidney Diseases

    http://www.niddk.nih.gov

  • National Pancreas Foundation

    http://www.pancreasfoundation.org

  • Canadian Association of Gastroenterology

    http://www.cag-acg.org

  • Health Canada

    http://www.hc-sc.gc.ca

  • Acute pancreatitis. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T127664/Acute-pancreatitis. Updated August 19, 2016. Accessed September 26, 2016.

  • Acute pancreatitis. Tulane University School of Medicine website. Available at: http://tulane.edu/som/pancreas-biliary/diseases/acute-pancreatitis.cfm. Accessed November 13, 2015.

  • Causes of acute pancreatitis. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T904336/Causes-of-acute-pancreatitis. Updated March 31, 2015. Accessed September 26, 2016.

  • Pancreatitis. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.niddk.nih.gov/health-information/health-topics/liver-disease/pancreatitis/Pages/facts.aspx. Updated August 16, 2012. Accessed November 13, 2015.

  • Prevention of acute pancreatitis. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T904337/Prevention-of-acute-pancreatitis. Updated August 28, 2016. Accessed September 26, 2016.

  • 4/7/2014 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T127664/Acute-pancreatitis: Baker ME, Nelson RC, et al. ACR Appropriateness Criteria for acute pancreatitis. American College of Radiology (ACR); 2013. 11 p. Available at: http://www.guideline.gov/content.aspx?id=47649. Accessed April 7, 2014.

  • 8/28/2014 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T127664/Acute-pancreatitis: Johnson CD, Besselink MG, et al. Acute pancreatitis. BMJ. 2014 Aug 12;349:g4859.

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