Acute Pancreatitis

What Is It?

Acute pancreatitis is a sudden inflammation of the pancreas, the large gland located behind the stomach and next to the gallbladder. The disease affects approximately 50,000 to 80,000 people in the United States each year, and is a common reason for people to be admitted to the hospital.

The main function of the pancreas is to produce digestive enzymes and hormones, such as insulin and glucagon, which regulate blood sugar levels. In an attack of pancreatitis, enzymes that normally are released into the digestive tract begin to damage the pancreas itself. The gland becomes swollen and inflamed, and even more enzymes are released into the surrounding tissues and bloodstream. Digestion slows down and becomes painful, and other body functions can be affected. The pancreas can become permanently damaged and scarred if attacks are severe, prolonged or frequent.

It is not known exactly why the enzymes start to damage to the organ that produced them, but there are several factors known to trigger attacks of acute pancreatitis. One of the most common causes is gallstones. The pancreatic duct, which delivers digestive enzymes from the pancreas to the small intestine, merges with the common bile duct, which is attached to the gallbladder and liver. If gallstones escape from the gallbladder and travel down the common bile duct, they can become lodged at the place where the pancreatic duct enters the intestine. When the pancreatic duct becomes blocked, enzymes can't flow properly and can back up into the pancreas. This causes the pancreas to become inflamed.

The other leading cause of pancreatitis is heavy alcohol use. Most people who drink alcohol never develop pancreatitis, but certain people will develop pancreatitis after drinking large amounts of alcohol, either over a period of time or in a single binge. It is not known why alcohol is particularly toxic to the pancreas, or why pancreatitis develops in only about 10% of heavy drinkers.

Other factors that sometimes can cause pancreatitis include:

• Use of certain medications, including antibiotics, estrogen and thiazide diuretics
• Abdominal surgery or severe trauma, such as a motor vehicle accident
• Metabolic conditions, such as high blood levels of calcium or triglycerides
• Complications from a procedure called endoscopic retrograde cholangiopancreatography (ERCP), which allows physicians to examine ducts in the pancreas, liver and gallbladder
• Some infections, such as mumps or viral hepatitis

In up to 30% of cases, no cause can be found.

Symptoms

The most common symptom of acute pancreatitis is upper abdominal pain, which can range from tolerable to severe. The pain usually occurs in the middle of the body, just under the ribs, but it sometimes can be felt on either the left or right side. This steady, drilling or "boring" pain can radiate to the back, flank, chest or lower abdomen. Pain reaches a maximum intensity quickly, often within 20 to 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, although 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 and abdominal bloating. In severe cases, fever, difficulty breathing, weakness and shock may develop.

Diagnosis

Your doctor will diagnose acute pancreatitis based on your symptoms, a physical examination and certain laboratory tests. For example, blood tests usually reveal high levels of two pancreatic enzymes, amylase and lipase. In some cases, a computed tomography (CT) scan may be done to look for swelling of the pancreas and accumulation of fluid in the abdomen. The scan also may show whether you have pancreatic pseudocysts, which are pockets of digestive enzymes that develop in some cases of severe pancreatitis or after repeated attacks. Serious complications can result if the cysts burst and spill enzymes onto vulnerable tissues.

If gallstones are suspected, an ultrasound examination of the gallbladder may be performed.

Expected Duration

Mild to moderate pancreatitis often goes away on its own within three to seven days, 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. Approximately 10% of patients with alcohol-related acute pancreatitis develop chronic (long-term) pancreatitis.

Prevention

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 to prevent the condition from coming back or becoming chronic.

Most acute pancreatitis that is not related to alcohol use cannot be prevented. However, taking steps to prevent the development of gallstones, such as maintaining a normal weight and avoiding rapid weight loss, may help to prevent gallstone-related acute pancreatitis.

Treatment

If you suspect you have acute pancreatitis, do not eat or drink anything until you see a doctor. Food and drink trigger the release of enzymes from the pancreas, which will only make the pain worse.

Most people who develop pancreatitis are admitted to the hospital and treated with pain relievers and fluids given intravenously (into a vein). You will not be allowed to eat or drink until your symptoms begin to improve. 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. In some cases, antibiotics may be prescribed to prevent or treat infection in the pancreas or surrounding tissues, but most cases do not need any additional medications.

If you have an attack of pancreatitis caused by gallstones, you probably will be advised to have your gallbladder removed. This usually is done days to weeks after the episode of pancreatitis has gone away because immediate surgery can make pancreatitis worse. In severe, life-threatening episodes of pancreatitis caused by gallstones, a lighted tube may be inserted through the mouth and into the intestine, where instruments are used to relieve blockage of the pancreatic duct. This procedure is known as endoscopic retrograde cholangiopancreatography or ERCP.

In rare cases, surgery may be needed to drain a pseudocyst, treat an abscess or stop bleeding.

When To Call A Professional

If you have intense abdominal pain that lasts longer than 30 minutes, or if you have pain accompanied by vomiting or severe nausea, call your doctor or go to the nearest hospital emergency room.

Prognosis

In most cases, acute pancreatitis goes away on its own after a couple of days with no complications and no further problems. About 10% of patients develop complications, such as a pseudocyst or abscess in the pancreas, that 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, and a chronic form of the disease may develop.

Additional Info

National Institute of Diabetes & Digestive & Kidney Disorders

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Building 31, Room 9A04

31 Center Drive, MSC 2560

Bethesda, MD 20892-2560

Phone: (301) 496-4000

E-Mail: niddk_inquiries@nih.gov

http://www.niddk.nih.gov/