Acute pancreatitis

Definition

Acute pancreatitis is swelling (inflammation) of the pancreas. The pancreas is a gland located behind the stomach. It releases the hormones insulin and glucagon as well as substances that help you digest food.

Causes, incidence, and risk factors

What exactly causes pancreatitis is not well known. It is thought that inactive substances (called enzymes) normally released by the pancreas somehow become active. These substances eat (and digest) the tissue of the pancreas. This abnormal process is called autodigestion. It causes swelling, bleeding (hemorrhage), and damage to the blood vessels.

Acute pancreatitis affects men more often than women. Certain diseases, surgeries, and habits make you more likely to develop this condition.

The main causes of acute pancreatitis in adults are:

• Alcohol use
• Gallbladder (biliary) disease
• Gallstones

Other causes include:

• Use of certain medications (especially estrogens, corticosteroids, thiazide diuretics, and azathioprine)
• Some types of bile duct surgery
• Pancreas surgery
• Severe injury to the belly (abdominal) area
• Viral infections, including mumps, coxsackie B, mycoplasma pneumonia, and campylobacter

Acute pancreatitis may also be caused by:

• An abnormal structure of the pancreas
• Complications of cystic fibrosis
• Genetic factors (hereditary pancreatitis)
• High lipid levels in the blood (hypertriglyceridemia)

In children, this disorder may be associated with:

• Abdominal trauma
• Cystic fibrosis
• Hemolytic uremic syndrome
• Kawasaki disease
• Mumps
• Reye syndrome
• Some medications
• Various viral illnesses

Symptoms

The main symptoms is abdominal pain felt in the upper left side or middle of the belly area (abdomen).

The pain:

• Is persistent or chronic
• May be worse lying flat on the back
• May spread (radiate) to the back or below the left shoulder blade
• May be worse after eating or drinking (occurs within minutes following meals), especially foods with a high fat content
• May be worse after drinking alcohol

Other common symptoms may include:

• Anxiety
• Fever
• Mild yellowing of the skin and the whites of the eyes (jaundice)
• Nausea and vomiting
• Sweating

Other symptoms that may occur with this disease include:

• Indigestion
• Clay-colored stools
• Gaseous abdominal fullness
• Hiccups
• Skin rash or lesion
• Swollen abdomen

Signs and tests

The doctor will perform a physical exam. This may show that you have:

• Fever
• Low blood pressure
• Rapid heart rate
• Rapid breathing (respiratory) rate

Laboratory tests will be done. Tests that show release of pancreatic enzymes include:

• Increased blood amylase level
• Increased serum blood lipase level
• Increase urine amylase level

Other blood tests that can help with the diagnosis include:

• Complete blood count (CBC)
• Blood sugar (glucose) level
• Blood calcium level

Imaging tests that can show inflammation of the pancreas include:

• Abdominal CT scan
• Abdominal MRI
• Abdominal ultrasound

Treatment

Treatment may involve:

• Pain medicines
• Fluids given through a vein (IV)
• Withholding food or fluid by mouth to limit the activity of the pancreas

Occasionally a tube will be inserted through the nose or mouth to remove the contents of the stomach (nasogastric suctioning). This may be done if there is persistent vomiting or severe pain, or if a paralytic ileus develops.

Treating the condition that caused the problem can prevent recurrent attacks.

In some cases, radiologic or endoscopic therapy is needed to:

• Drain fluid collections in or around the pancreas
• Remove gallstones
• Relieve blockages of the pancreatic duct

In the most severe cases, surgery is necessary to remove dead, infected pancreatic tissue.

Expectations (prognosis)

Most cases go away in a week. However, some cases develop into a life-threatening illness.

The death rate is high with:

• Hemorrhagic pancreatitis
• Liver, heart, or kidney impairment
• Necrotizing pancreatitis

It is common for the condition to return.

Complications

• Acute respiratory distress syndrome (ARDS)
• Build-up of fluid in the abdomen (ascites)
• Cysts or abscesses in the pancreas
• Heart failure
• Kidney failure
• Low blood pressure

Calling your health care provider

Call your provider if:

• You have intense, constant abdominal pain
• You develop other symptoms of acute pancreatitis

Prevention

You may lower your risk of pancreatitis by taking steps to prevent the medical conditions that can lead to the disease:

• Avoid aspirin when treating a fever in children, especially if they may have a viral illness, to reduce the risk of Reye syndrome.
• Do NOT drink too much alcohol.
• Make sure children receive vaccines to protect them against mumps and other childhood illnesses (see: Immunizations - general overview).
• Use proper safety precautions to avoid injury to the belly (abdominal) area.

If you develop acute pancreatitis as a result of alcohol use, you should avoid all alcohol in the future.

If you develop acute pancreatitis as a result of a medication, your doctor may tell you to avoid the medication in the future.

You should consider genetic counseling if you would like to have children and you have a family or personal history of cystic fibrosis.

References

Banks PA, Freeman ML; Practice Parameters Committee of the American College of Gastroenterology. Practice guidelines in acute pancreatitis. Am J Gastroenterol. 2006;101:2379-2400.

Frossard JL, Steer ML, Pastor CM. Acute pancreatitis. Lancet. 2008;371:143-152.