Acute Pancreatitis
Acute pancreatitis means inflammation of the pancreas that develops quickly. The main symptom is tummy (abdominal) pain. It usually settles in a few days but sometimes it becomes severe and very serious. The most common causes of acute pancreatitis are gallstones and drinking a lot of alcohol.
The pancreas is a long, flat gland located behind the stomach in the upper abdomen. It produces digestive enzymes and hormones, which regulate how the body processes glucose, for instance, insulin.
Symptoms of Acute Pancreatitis
- Tummy (abdominal) pain, just below the ribs, is the usual main symptom. It usually builds up quickly (over a few hours) and may last for several days. The pain can become severe and is typically felt spreading through to the back. The pain may be sudden and intense, or it may begin as a mild pain that is aggravated by eating and slowly grows worse. However, it is occasionally possible to have acute pancreatitis without any pain. This is more common if you have diabetes or have kidney problems.
- Being sick (vomiting), a high temperature (fever) and generally feeling very unwell are common.
- Your abdomen may become swollen.
- If the pancreatitis becomes severe and other organs become involved (for example, your heart, lungs or kidneys) then various other symptoms may develop. You may become lacking in fluid in the body (dehydrated) and have low blood pressure.
Complications of Acute Pancreatitis
The main complications of acute pancreatitis are
- Pancreatic pseudocyst – A pancreatic pseudocyst is a collection of fluid containing pancreatic enzymes that forms in and around the pancreas. The pseudocyst goes away spontaneously in some people. In other people, the pseudocyst does not go away and can become infected.
- Necrotizing pancreatitis – may occur in severe acute pancreatitis. In necrotizing pancreatitis, parts of the pancreas may die and body fluid may escape into the abdominal cavity, which decreases blood volume and results in a large drop in blood pressure, possibly causing shock and organ failure. Severe acute pancreatitis can be life threatening.
- Infection of the pancreas – Infection of an inflamed pancreas is a risk, particularly in people who have necrotizing pancreatitis. Sometimes, a doctor suspects an infection when a person’s condition worsens and a fever develops, especially if this happens after the person’s first symptoms started to subside.
- Organ failure – can occur in acute pancreatitis because damage to the pancreas may permit activated enzymes and toxins such as cytokines to enter the bloodstream and cause low blood pressure and damage to other organs such as the lungs and kidneys. This damage can cause some people who have acute pancreatitis to develop failure of other organs, including the kidneys, lungs, or heart, and this failure can lead to death.
Causes of Acute Pancreatitis
The most common causes (more than 70% of cases) of acute pancreatitis are
- Gallstones – Gallstones cause about 40% of cases of acute pancreatitis. Gallstones are collections of solid material in the gallbladder . These stones sometimes pass into and block the duct that the gallbladder shares with the pancreas (called the common bile duct). Normally, the pancreas secretes pancreatic fluid through the pancreatic duct into the first part of the small intestine (duodenum). This pancreatic fluid contains digestive enzymes that help digest food. If a gallstone becomes stuck in the sphincter of Oddi (the opening where the pancreatic duct empties into the duodenum), pancreatic fluid stops flowing. Usually, the blockage is temporary and causes limited damage, which is soon repaired. But if the blockage remains, the enzymes collect in the pancreas and begin to digest the cells of the pancreas, causing severe inflammation.
- Alcohol use – Alcohol use causes about 30% of cases of acute pancreatitis. The risk of developing pancreatitis increases with increasing amounts of alcohol (4 to 7 drinks per day in men and 3 or more drinks per day in women). However, less than 10% of people who frequently consume alcohol develop acute pancreatitis, which suggests additional triggers or other factors are needed for pancreatitis to develop. How alcohol causes pancreatitis is not fully understood. One theory is that alcohol is converted into toxic chemicals in the pancreas that cause damage. Another theory is that alcohol may cause the small ductules in the pancreas that drain into the pancreatic duct to clog, eventually causing acute pancreatitis.
- Drugs such as angiotensin-converting enzyme (ACE) inhibitors, azathioprine, furosemide, 6-mercaptopurine, pentamidine, sulfa drugs, and valproate
- Estrogen use in women with high levels of lipids in the blood
- High levels of calcium in the blood
Diagnosis of Acute Pancreatitis
- Blood tests – No single blood test proves the diagnosis of acute pancreatitis, but certain tests suggest it. Blood levels of two enzymes produced by the pancreas—amylase and lipase—usually increase on the first day of the illness but return to normal in 3 to 7 days. If the person has had other flare-ups (bouts or attacks) of pancreatitis, however, the levels of these enzymes may not increase significantly, because so much of the pancreas may have been destroyed that too few cells are left to release the enzymes.
- X-rays of the abdomen may show dilated loops of intestine or, rarely, one or more gallstones. Chest x-rays may reveal areas of collapsed lung tissue or an accumulation of fluid in the chest cavity.
- An ultrasound of the abdomen may show gallstones in the gallbladder or sometimes in the common bile duct and also may detect swelling of the pancreas. This test is done in all people who have acute pancreatitis to make sure there are no gallstones present that might cause further pancreatitis.
- A computed tomography (CT) scan is particularly useful in detecting inflammation of the pancreas and is used in people with severe acute pancreatitis. For this scan, people are also injected with a contrast agent. The agent is a substance that can be seen on x-rays. Because the images are so clear, a CT scan helps a doctor make a precise diagnosis and identify complications of pancreatitis.
Treatment of Acute Pancreatitis
- Fluids by vein
- Pain relief
- Measures to support nutrition
- Sometimes endoscopy or surgery
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