Patient Basics: Acute Pancreatitis

Originally published by Harvard Health.

What Is It?

Acute pancreatitis is a sudden inflammation of the pancreas.

The pancreas is the large gland located in the upper part of the abdomen, behind the stomach. It produces digestive enzymes and hormones.

In pancreatitis, enzymes that normally are released into the digestive tract begin to damage the pancreas itself. The gland becomes swollen and inflamed. More enzymes are released into the surrounding tissues and bloodstream.

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.

It is not known exactly why the enzymes start to damage the pancreas. But there are several known trigger of acute pancreatitis.

One of the most common causes of acute pancreatitis is gallstones. Gallstones that escape from the gallbladder can block the pancreatic duct. (The pancreatic duct delivers digestive enzymes from the pancreas to the small intestine.) When the pancreatic duct becomes blocked, enzymes can’t flow properly. They 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. Alcohol use may be over a period of time or in a single binge. Alcohol combined with smoking increases the risk of acute pancreatitis.

Another common cause of acute pancreatitis is a complication of a medical procedure called ERCP. ERCP is performed through an endoscope. This is a flexible tube with a small camera and a light on one end and an eyepiece on the other. ERCP is used to identify stones and tumors and to view ducts in the pancreas, liver and gallbladder.

Other factors that sometimes can cause pancreatitis include:

• Use of any of a wide variety of medications, such as
  • Sulfa drugs
  • Water pills (hydrochlorothiazide, others)
  • Immunosuppressants (azathioprine)
  • Drugs used to treat HIV
• Abdominal surgery
• Severe trauma
• Metabolic conditions, such as high blood levels of calcium or triglycerides
• Some infections, such as mumps or viral hepatitis

In many cases, no cause can be found.

Symptoms

The most common symptom of acute pancreatitis is upper abdominal pain. It can range from tolerable to severe.

The pain usually occurs in the middle of the body, just under the ribs. But it is sometimes felt on either the left or right side. This is a steady, drilling or “boring” pain. It can radiate to the back, flank, chest or lower abdomen.

Pain reaches a maximum intensity quickly, often within 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. 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
• 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
• Certain laboratory tests

Blood tests usually reveal high levels of two pancreatic enzymes.

In some cases, a computed tomography (CT) scan may be done. The scan can identify swelling of the pancreas and accumulation of fluid in the abdomen.

The scan also may show whether you have pancreatic pseudocysts. Pseudocysts are pockets of digestive enzymes. They develop in some cases of severe pancreatitis or after repeated attacks. Serious complications can result if the pseudocysts 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 one week. 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.

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. This is crucial to prevent the condition from coming back or becoming chronic.

Most first episodes of acute pancreatitis that are not related to alcohol use cannot be prevented. However, taking steps to prevent gallstones may help to prevent gallstone-related acute pancreatitis. To help prevent gallstones, maintain a normal weight and avoid rapid weight loss.

If the cause is gallstones, gallbladder surgery will usually be recommended to prevent future attacks. When a medication is the likely cause, it will be stopped if possible.

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. This will make the pain worse.

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

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. These will help to prevent or treat infection in the pancreas or surrounding tissues. Most cases do not need any additional medications.

If you have an attack of pancreatitis caused by gallstones, you may need to have an ERCP. During the test, the doctor may make a tiny cut into the opening of the bile duct to treat current or future blockage. You will likely be advised to have your gallbladder removed. This usually is done days to weeks after the episode of pancreatitis has gone away. Immediate surgery is technically more difficult and can make pancreatitis worse.

In rare cases, surgery may be needed to:

• Drain a pseudocyst
• Treat an abscess
• Stop bleeding

When To Call a Professional

Call your doctor or go to the nearest hospital emergency room if you have:

• Intense abdominal pain that lasts longer than 30 minutes
• Pain accompanied by vomiting or severe nausea

Prognosis

In most cases, acute pancreatitis goes away on its own after a couple of days. There are usually no complications or further problems.

A small percentage of patients develop complications. These may include a pseudocyst or abscess in the pancreas. They 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. A chronic form of the disease may develop.

Additional Info

National Institute of Diabetes & Digestive & Kidney Disorders
Office of Communications and Public Liaison
Building 31, Room 9A04
31 Center Drive, MSC 2560
Bethesda, MD 20892-2560
Phone: 301-496-4000
http://www.niddk.nih.gov/