All about acute pancreatitis
Some mild cases resolve without treatment, but severe, acute pancreatitis can trigger potentially fatal complications. The mortality rate ranges from less than 5 percent to over 30 percent, depending on how severe the condition is and if it has reached other organs beyond the pancreas.
Acute pancreatitis is estimated to affect between 4.5 and 35 in every 100,000 individuals per year. However, this figure may not include the many mild cases that resolve without medical evaluation or treatment. Every year, there are 275,000 hospitalizations for acute pancreatitis in the United States.
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.
Acute pancreatitis starts suddenly, but chronic pancreatitis is recurring or persistent. This article will focus on acute pancreatitis.
Here are some key points about acute pancreatitis. More detail is in the main article.
- Pancreatitis is split into acute and chronic types.
- The pancreas carries out many tasks, including the production of digestive enzymes.
- Symptoms include pain in the center of the upper abdomen, vomiting, and diarrhea.
- The most common causes of acute pancreatitis are gallstones and alcohol abuse.
Sharp and sudden abdominal pain can be a sign of pancreatitis.
Typically, the patient will experience a sudden onset of pain in the center of the upper abdomen, below the breastbone (sternum).
Rarely, the pain is first felt in the lower abdomen. It will gradually become more intense until it is a constant ache.
The ache may intensify further and become severe. It also spreads into the back in around half of cases. Eating may exacerbate the pain.
Pancreatitis that is caused by gallstones will develop very fast. When it is caused by alcohol, symptoms develop more slowly, over a number of days.
Leaning forward or assuming a fetal position (curling up) may help lessen the pain slightly. Anybody who experiences constant pain should seek medical attention.
The following symptoms may also be present:
- loss of appetite
- rapid pulse
- pain with coughing, vigorous movements, and deep breathing
- tenderness when the abdomen is touched
- fever and a temperature of at least 100.4 °F (38 °C)
- jaundice, when the skin and whites of the eyes take on a yellowish tinge
- pain cannot be relieved even with strong painkillers
- blood pressure may fall or rise, but it will fall when the patient stands, sometimes causing faintness
Treatment for acute pancreatitis will depend on whether it is mild or serious. In mild cases, the risk of complications is small. In serious cases, the risk is significant.
Treatment for mild acute pancreatitis
Treatment aims to maintain bodily function and ease symptoms while the pancreas is repairing itself.
This will include:
- Painkillers: Mild acute pancreatitis can be moderately or severely painful.
- Nasogastric tubes: A tube may remove excess liquids and air as a treatment for nausea and vomiting.
- Bowel rest: The gastrointestinal tract will need to rest for a few days, so the person will not take any food or drink by mouth until their condition improves.
- Preventing dehydration: Dehydration often accompanies pancreatitis, and it can worsen the symptoms and complications. Fluid is often provided intravenously for the first 24-48 hours.
The person can usually go home after about 5 to 7 days.
Treatment for severe acute pancreatitis
In severe acute pancreatitis, there is usually some tissue death, or necrosis. This increases the risk of sepsis, a severe bacterial infection that can affect the whole body. Sepsis can lead to multi-organ damage or failure.
Severe acute pancreatitis can also cause hypovolemic shock. Severe blood and fluid loss can leave the heart unable to pump enough blood to the body. Parts of the body can become rapidly oxygen-deprived. This is a life-threatening situation.
Treatment for this kind of pancreatitis includes:
- Treatment in the intensive care unit (ICU): Injections with antibiotics aim to stop any infection from developing in the dead tissue.
- Intravenous fluids: These help maintain hydration and prevent hypovolemic shock.
- Breathing assistance: Ventilation equipment will help the patient breathe.
- Feeding tubes: These provide nutrition as appropriate. In this case, early feeding improves outcomes.
- Surgery: In some cases, the dead tissue may need to be surgically removed.
The patient will stay in ICU until they are no longer at risk of organ failure, hypovolemic shock, and sepsis.
If gallstones caused the acute pancreatitis, the patient might undergo surgery or an endoscopic retrograde cholangiopancreatography (ERCP) after their condition improves.
After the gallstones are removed, the patient may be advised to follow a special diet to lower blood cholesterol, because excess cholesterol encourages the growth of gallstones.
The American Gastroenterological Association recommends surgery to remove the gallbladder of any patient who develops pancreatitis from gallstones.
Treating alcohol misuse
If doctors determine that alcohol misuse was the underlying cause of the acute pancreatitis, the patient may be offered a treatment program for alcohol misuse.
Gallstones, infections, and alcohol misuse are common causes of acute pancreatitis.
Acute pancreatitis is relatively rare but can be serious.
People who consume alcohol for many years may develop pancreatitis. A higher consumption appears to be linked to a higher chance of chronic pancreatitis.
Trypsin is a digestive enzyme produced in the pancreas in an inactive form.
Alcohol misuse can cause trypsin to become active when it is still inside the pancreas, but scientists are not sure why.
Researchers believe that ethanol molecules affect the pancreas cells, triggering them to activate trypsin prematurely.
Gallstones are small, pebble-like formations that develop in the gallbladder, often if there is too much cholesterol in the bile.
Sometimes, the gallstones can get stuck as they make their way out of the bile ducts and into the intestines.
This blockage will also affect the pancreas and prevent it from releasing its enzymes in the intestines.
If the acute pancreatitis is linked to gallstones, removal of the gallbladder is usually recommended before the patient leaves the hospital.
Bacterial infections that can lead to acute pancreatitis include Salmonellosis, a type of food poisoning caused by the bacterium Salmonella, or Legionnaires' disease, an infection caused by the bacterium Legionella pneumophila found in plumbing, shower heads, and water-storage tanks.
Other possible causes are:
- some autoimmune conditions, such as lupus, or Sjogren's syndrome
- genetic mutations that make some people more susceptible
- injury to the pancreas
- high triglyceride levels in the blood
- high calcium levels in the blood
Over 10 percent of all cases of acute pancreatitis are termed idiopathic, meaning there is no obvious cause.
For most people with acute pancreatitis, there are no dietary restrictions, but the person may be unable to eat for a few days, or they may have to avoid solid foods.
In the hospital, some people may need a feeding tube.
When the person starts eating again, they will probably be advised to follow a healthful, low-fat diet, and to eat small and regular meals.
It is important to drink plenty of fluids but to limit caffeine and avoid alcohol.
The American Dietary Guidelines offer advice on a healthful, low-fat, diet.
Pancreatitis can lead to potentially fatal complications.
- obstruction of a bile or pancreatic duct
- leakage from the pancreatic duct
- pseudocysts, with a risk of rupture, hemorrhage, or infection
- damage to the pancreas
- pleural effusion
- splenic vein thrombosis
Heart, lung, and kidney failure may occur. In severe cases, organ failure can happen around 48 hours after symptoms appear. Without treatment, these can lead to death. It is important to seek treatment as soon as possible if someone shows signs of acute pancreatitis.
The doctor will ask the patient about symptoms and examine their abdomen. If certain areas of the abdomen are sensitive when touched, this could indicate acute pancreatitis.
In acute pancreatitis, the abdominal wall muscles will be rigid. When listening to the abdomen with a stethoscope, there may be very few or no intestinal sounds.
Levels of amylase and lipase may be high in the early stages of pancreatitis.
If blood levels of amylase and lipase are higher than normal, the patient will most likely be sent to the hospital. The pancreas produces elevated levels of both chemicals during acute pancreatitis.
However, blood tests may not be accurate if they are not obtained on the first or second day of illness. This is because lipase and amylase levels are highest within the first few hours and return to normal after a few days.
Amylase returns to normal within 3-7 days, and lipase returns to normal in 8-14 days.
Further testing in hospital
To determine the risk of complications, a doctor will want to ascertain how inflamed the pancreas is; the following tests may be performed:
- ERCP (endoscopic retrograde cholangiopancreatography) scan: An endoscope (a thin, flexible tube with a camera at the end) is inserted into the digestive system. An ERCP can help determine the exact location of a gallstone.
- An ultrasound scan: High-frequency sound waves create an image on a monitor of the pancreas, gallbladder, and their surroundings.
- CECT (contrast-enhanced computed tomography) scan: These are used to take pictures of the same area from many angles; these are then combined to produce a 3-D image. CECT scans can help identify inflammation of the pancreas, fluid collection, and any changes in the density of the gland.
- Chest X-ray: The doctor may order a chest X-ray to check for areas of collapsed lung tissue, or accumulation of fluid in the chest cavity.
Acute pancreatitis usually resolves in a few days with treatment, although some people may need to stay in the hospital for some time, depending on the cause and how severe the symptoms are.