Acute pancreatitis

Acute pancreatitis is a sudden, severe inflammation of the pancreas, a gland located behind the stomach. The pancreas plays two key roles: producing hormones like insulin to regulate blood sugar and creating enzymes that help digest food. In acute pancreatitis, these digestive enzymes become active inside the pancreas instead of the small intestine, causing the pancreas to essentially digest and damage itself. 

While most people recover within a week, severe cases can cause life-threatening complications. 

Common causes

  • Gallstones: This is one of the most common causes. A gallstone can move from the gallbladder and get lodged in the common bile duct(CBD). Because this duct shares a drainage opening with the pancreatic duct(and others), this blockage forces digestive fluids to back up into the pancreas, leading to inflammation.

  • Alcohol abuse: Heavy, long-term alcohol use is another leading cause. It is thought that excessive alcohol intake can cause the pancreas to produce toxic byproducts that damage the gland.

  • High triglycerides: Very high levels of triglycerides, a type of fat in the blood, can trigger acute pancreatitis.

  • Certain medications: Some drugs, including certain diuretics and immunosuppressants, have been linked to pancreatitis.

  • Abdominal injury or surgery: Trauma to the abdomen or complications from surgery near the pancreas can sometimes trigger an attack.

  • Infections: Viruses like mumps or bacteria like Campylobacter can sometimes cause inflammation of the pancreas.

  • Unknown (idiopathic) causes: In a significant number of cases, the exact cause of acute pancreatitis cannot be determined. 

Signs and symptoms

The hallmark symptom of acute pancreatitis is severe abdominal pain.

  • Pain: The pain is often sudden and intense, located in the upper abdomen. It may radiate to your back, feel worse after eating, and last for several days.

  • Nausea and vomiting: These are common symptoms that often accompany the pain.

  • Fever and rapid pulse: The inflammation can cause a low-grade fever and an elevated heart rate.

  • Abdominal tenderness: The belly may feel sore and tender to the touch.

  • Swollen abdomen: The abdomen may appear swollen or bloated.

  • Jaundice: A yellowing of the skin and whites of the eyes can occur if the bile duct is blocked. 

Diagnosis

Because symptoms can mimic other conditions, diagnosis typically requires blood tests and imaging.

  1. Blood tests: An enzyme blood test is the main diagnostic tool. Your doctor will check for elevated levels of the pancreatic enzymes amylase and lipase. Levels that are three times higher or more than normal are a strong indicator of pancreatitis.

  2. Imaging scans:

    1. Ultrasound: Can be used to check for gallstones, a common cause of pancreatitis.

    2. CT scan or MRI: Can provide detailed images to show inflammation and swelling in the pancreas and surrounding tissues.

    3. ERCP: This specialized procedure is used if a gallstone is blocking the common bile duct. A flexible tube is passed down the throat to look for and remove the obstruction. 

Treatment

Treatment for acute pancreatitis almost always requires hospitalization for close monitoring and supportive care. 

  • Hospital care:

    • "Pancreatic rest": You will likely be put on a fast to stop the pancreas from producing digestive enzymes and allow it to heal.

    • Pain management: Strong pain medication will be given to manage the severe abdominal pain.

    • Intravenous (IV) fluids: Fluids are delivered through an IV to keep you hydrated and support your body while you are fasting.

  • Nutritional support: If you are unable to eat for a longer period, you may be given nutrients through a feeding tube to ensure proper nutrition.

  • Addressing the underlying cause:

    • Gallstones: If gallstones caused the attack, your gallbladder may be removed to prevent future episodes.

    • Alcohol: If alcohol abuse was the cause, stopping alcohol consumption is critical to avoid recurrence and prevent the condition from becoming chronic.

  • Managing severe cases: For severe pancreatitis, which can involve tissue death or infection, more intensive care is required. This may involve drainage of fluid collections or surgery to remove damaged tissue. 

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