Acute Pancreatitis
Acute pancreatitis is a sudden inflammation of the pancreas that can range from mild discomfort to a serious medical emergency. While most people recover within a week, understanding the symptoms, causes, and treatment options is essential for anyone experiencing severe abdominal pain.
Table of contents
- What is Acute Pancreatitis?
- Symptoms and Warning Signs
- Causes and Risk Factors
- How Doctors Diagnose Acute Pancreatitis
- Treatment and Hospital Care
- Recovery and Outlook
- Prevention
What is Acute Pancreatitis?
Acute pancreatitis is a condition where the pancreas becomes inflamed and swollen over a short period of time.[1] The pancreas is a small organ located behind the stomach that plays an important role in digestion and blood sugar control. It makes digestive enzymes that help break down food and hormones like insulin that regulate blood sugar levels.[2]
- Pancreas
- Stomach
- Small intestine
In the United States, acute pancreatitis leads to approximately 275,000 hospital admissions each year.[2] The condition occurs when digestive enzymes become activated inside the pancreas instead of in the small intestine, causing the pancreas to begin digesting itself.[3] This premature activation triggers inflammation, which is the body’s immune response that causes swelling and pain.
Acute pancreatitis is different from chronic pancreatitis. Acute pancreatitis is temporary and happens suddenly, while chronic pancreatitis is a long-term condition where the pancreas becomes permanently damaged over many years.[1]
Symptoms and Warning Signs
The most common symptom of acute pancreatitis is severe pain in the upper part of your belly, in the center of your abdomen.[1] This pain often spreads to your back and may feel like it is radiating through to your spine.[2] The pain typically comes on suddenly and can be very intense.
Additional symptoms of acute pancreatitis may include:[1][2]
- Feeling sick or vomiting
- A high temperature of 38°C or more (fever)
- Fast heart rate
- Fast, shallow breathing
- Tenderness when touching the belly
Some people find that the pain feels worse when lying flat, coughing, exercising, or eating more food. The pain may feel slightly better when sitting upright, leaning forward, or curling into a ball.[2]
If you suddenly develop severe abdominal pain, you should see a doctor immediately. If this is not possible, contact emergency medical services for advice.[1] Acute pancreatitis requires prompt medical attention, as it can lead to serious complications if left untreated.[5]
Causes and Risk Factors
Acute pancreatitis is most commonly caused by gallstones or chronic alcohol use.[1] Gallstones are responsible for about 40% of cases, while chronic alcohol use or abuse accounts for approximately 35% of cases.[6] When gallstones slip out of the gallbladder, they can block the bile duct, which prevents pancreatic enzymes from traveling to the small intestine and forces them back into the pancreas, causing inflammation.[4]
Other causes and risk factors include:[5][6]
- Certain medications, such as azathioprine, corticosteroids, and some antibiotics
- Injury to the pancreas from medical procedures like endoscopic retrograde cholangiopancreatography (ERCP), which is a procedure where a tube with a camera is passed through the mouth to examine the digestive system
- Structural abnormalities of the pancreas or bile duct
- Genetic mutations, including hereditary pancreatitis and cystic fibrosis gene mutations
- High levels of triglycerides (fats in the blood) or calcium in the blood
- Traumatic injury to the abdomen
- Viral or bacterial infections
- Pancreatic cancer
In some cases, doctors cannot identify what caused the pancreatitis. This is called idiopathic pancreatitis.[5] Sometimes the cause is not known at all.[1]
How Doctors Diagnose Acute Pancreatitis
Doctors diagnose acute pancreatitis using the Atlanta criteria, which requires that a patient has at least two of three findings:[6]
- Abdominal pain that suggests pancreatitis
- Blood levels of pancreatic enzymes (amylase and/or lipase) that are at least three times higher than normal
- Characteristic findings on imaging tests
Your doctor will ask about your medical history and symptoms, perform a physical examination, and check for pain or tenderness in your belly.[8] Blood tests can show how well your pancreas and related organs are working by measuring enzyme levels.[8]
Imaging tests may include:[8]
- Ultrasound to look for gallstones or inflammation of the pancreas
- Computerized tomography (CT) scan, which uses X-rays and computers to create detailed images showing gallstones and the extent of inflammation
- Magnetic resonance imaging (MRI) to look for irregular tissues in the gallbladder, pancreas, and bile ducts
- Endoscopic ultrasound, where an ultrasound device on a small tube is fed through the mouth and into the digestive system
Contrast-enhanced CT scanning is considered the preferred imaging technique because it helps determine disease severity and predict outcomes.[6] However, CT should not be ordered routinely for patients with mild acute pancreatitis.[6]
It is important to distinguish mild from severe disease because severe pancreatitis can have a mortality rate of up to 30%.[6] Mortality depends on disease severity, ranging from approximately 3% in mild cases to 20% in severe forms with tissue death.[3]
Treatment and Hospital Care
Acute pancreatitis is treated in the hospital, where you will be closely monitored for signs of serious problems and given supportive treatment.[7] Most people with acute pancreatitis need to stay in the hospital for a few days, although those with mild cases may be well enough to leave hospital after this time.[1]
Treatment focuses on helping control the condition and managing symptoms. The main elements of care include:[7][8]
Fluids: Acute pancreatitis can cause dehydration, so fluids are given through a tube into your vein (called intravenous or IV fluids) to prevent dehydration and maintain blood volume.[7]
Oxygen: To make sure your body gets enough oxygen, you may be given oxygen through tubes in your nose. These tubes can be removed after a few days once your condition improves.[7]
Pain relief: Acute pancreatitis often causes severe stomach pain, so you will probably need painkillers. Some of these medications can make you feel very drowsy.[7]
Nutritional support: If you have mild acute pancreatitis and are not feeling or being sick and do not have stomach pain, you can usually eat normally. However, if your condition is more severe, you may be advised not to eat solid foods for a few days or longer, as trying to digest solid food could put too much strain on your pancreas.[7] When prolonged rest from eating is needed, you may be given special liquid food through a tube in your stomach, called enteral feeding. Research shows that enteral nutrition through the digestive tract is better than feeding through a vein (parenteral nutrition), as it is associated with lower rates of complications, including death, organ failure, and infections.[6][9]
Antibiotics: You may need antibiotics if you develop an infection in addition to pancreatitis, such as a chest or urinary infection.[7] In severe cases involving more than 30% tissue death in the pancreas, antibiotic treatment may decrease the risk of pancreatic infection.[6]
People with severe acute pancreatitis can develop complications that require further treatment and may need to be admitted to a high-dependency unit or intensive care unit.[7] Potentially affected organs include the kidneys, heart, and lungs, and complications can be life-threatening.[5]
Treating the Underlying Cause
Once the condition is under control, the underlying cause may need treating.[7]
If gallstones caused your pancreatitis, you may need an ERCP procedure to remove the stones, or your gallbladder may need to be removed through surgery.[7] In patients with gallstone-related pancreatitis, having the gallbladder removed within 48 hours of presentation can shorten the length of hospitalization and does not increase the risk of complications.[6] Ideally, the gallbladder should be removed within two weeks of your attack of pancreatitis unless you are too unwell for surgery.[7]
If alcohol caused your pancreatitis, you must completely avoid alcohol after recovering.[7] Some people with acute pancreatitis have alcohol dependency and need help and support to stop drinking. Treatment for alcohol dependence may include one-to-one counseling, self-help groups, or medication to reduce cravings.[7]
Recovery and Outlook
Most people with acute pancreatitis start to feel better within about a week and have no further problems.[1] Many people are well enough to leave hospital after a few days.[1] With mild acute pancreatitis, people usually start to get better within a week and experience either no further problems or problems that resolve within 48 hours.[7]
Most people with acute pancreatitis will recover completely in a few days with supportive care, including rest, hydration, and pain relief.[2] Recovery from severe acute pancreatitis may take much longer, and there is a risk it could be fatal.[7]
About 20% of acute pancreatitis cases are considered severe.[2] A very severe case of acute pancreatitis can cause serious health complications, some of them life-threatening.[2]
Prevention
By reducing how much alcohol you drink and changing your diet to make gallstones less likely, you can reduce your chances of developing acute pancreatitis.[1]
If you have experienced acute pancreatitis caused by alcohol, you should completely avoid alcohol to prevent future attacks.[7] Seek help from your doctor if you need support to stop drinking.
If gallstones were the cause, having your gallbladder removed can prevent future episodes.[7] Although having your gallbladder removed should not have a major effect on your health, it might make it more difficult to digest certain foods, such as fatty or spicy foods.[7]
Other preventive measures include:[5]
- Quitting smoking or chewing tobacco
- Losing weight if you are overweight
- Managing high triglyceride levels and other metabolic conditions
- Eating a healthy diet low in fat
