Acute pancreatitis

Sudden inflammation of the pancreas. The pancreas abruptly becomes inflamed and then gets better. Some people have more than one attack but recover fully after each one.

The cause of acute pancreatitis is most often alcohol abuse or gallstones. Other causes include use of prescribed drugs, trauma or surgery to the abdomen, or abnormalities of the pancreas or intestine. In rare cases, the disease may result from infections, such as mumps. In about 1 case in 6 or 7, the cause is unknown.

Symptoms usually begin with pain in the upper abdomen that may last for a few days, is often severe, and may be constant, just in the abdomen, or it may reach to the back and other areas. The pain may be sudden and intense, or it may begin as a mild pain that is aggravated by eating and slowly grows worse. The abdomen may be swollen and very tender. Other symptoms may include nausea, vomiting, fever, and an increased pulse rate. One often feels and looks very sick.

In about 20% of cases, the disease is severe. The patient may become dehydrated and have their heart, lungs, or kidneys fail. In the most severe cases, bleeding can occur in the pancreas, leading to shock and sometimes death.

During acute attacks of pancreatitis, high levels of amylase and lipase (a digestive enzyme formed in the pancreas) are found in the blood. Changes may also occur in the blood levels of calcium, magnesium, sodium, potassium, and bicarbonate. There may high glucose (sugar) and lipids (fats) in the blood, too. After the pancreas recovers, the blood levels of these substances usually return to normal.

The treatment depends on how bad the attack is. Unless complications occur, acute pancreatitis usually gets better on its own, so only supportive care is needed. The patient may enter the hospital where fluids can be given by vein to restore blood volume and the kidneys and lungs treated to prevent their failure. Other problems, such as cysts in the pancreas, may need treatment, too.

Sometimes a patient cannot control vomiting and needs to have a tube inserted through the nose into the stomach to remove fluid and air. In mild cases, the patient may not have food for 3 or 4 days but is given fluids and pain relievers by vein. An acute attack usually lasts only a few days, unless the ducts are blocked by gallstones. In severe cases, the patient may be fed through the veins for 3 to 6 weeks while the pancreas slowly heals.

Antibiotics may be given if signs of infection surface. Surgery may be needed if complications such as infection, cysts, or bleeding occur. Attacks caused by gallstones may require removal of the gallbladder or surgery of the bile duct. Surgery is sometimes needed to exclude other abdominal problems that can simulate pancreatitis or to treat it. When there is severe injury with death of tissue, an operation may be done to remove the dead tissue.

After all signs of acute pancreatitis are gone, the doctor will usually try to determine the cause to prevent future attacks. In some patients the cause of the attack is clear, but in others further tests need to be done. For more information, see Pancreatitis.