Acute pancreatitis

Acute pancreatitis is an inflammatory condition of the pancreas that is painful and at times deadly. Despite the great advances in critical care medicine over the past 20 years, the mortality rate of acute pancreatitis has remained at about 10%. Diagnosis of pancreatic problems is often difficult and treatments are therefore delayed because the organ is relatively inaccessible. There are no easy ways to see the pancreas directly without surgery, and available imaging studies are often inadequate. In addition to the acute form, there are hereditary and chronic forms of pancreatitis which can devastate a person over many years. Sufferers often endure pain and malnutrition, and are most likely left with a higher risk of pancreatic cancer.

Causes of acute pancreatitis

Gallstones or alcohol cause more than 8 in 10 cases. Other causes are rare.

  • Gallstones– the most common cause in the UK. A gallstone can pass through the bile duct and out into part of the gut just after the stomach (the duodenum). This usually does not cause a problem. However, in some people a gallstone becomes stuck in the bile duct or where the bile duct and pancreatic duct open into the duodenum. This can affect the chemicals (enzymes) in the pancreatic duct (or even block them completely) and trigger a pancreatitis.
  • Alcohol– the other common cause. How alcohol actually triggers the inflammation in the pancreas is not clear. Symptoms typically begin about 6-12 hours after a heavy drinking session. In some people pancreatitis can develop even after a small amount of alcohol. In these people, a ‘sensitivity’ to alcohol develops in their pancreas.
  • High blood fat levels– hypertriglycerdaemia. This is reported to cause 1 to 4 percent of all cases of AP and up to 56 percent of pancreatitis cases during pregnancy.
  • Uncommon causes– include the following:
    • Viral infections (for example, the mumps virusHIV).
    • A rare side-effect to some medicines.
    • Injury or surgery around the pancreas
    • Infections with parasites (parasites are living things (organisms) that live within (or on) another organism).
    • High blood calcium levels.
    • Abnormal structure of the pancreas.
    • There is also a rare form of pancreatitis which can be inherited from a parent (hereditary).
  • Autoimmune– your own immune system attacks the pancreas. This can be associated with other autoimmune diseases – for example, Sjögren’s syndrome and primary biliary cirrhosis.
  • Unknown– no cause is found in about 1 in 10 cases. However, a number of these cases are probably due to tiny gallstones or ‘gallstone sludge’ which passes through the bile duct but is too small to be seen on scans or other tests.

Symptoms of Acute Pancreatitis

Acute pancreatitis usually begins with gradual or sudden pain in the upper abdomen that sometimes extends to the back. The pain may be mild at first and become worse after eating. The pain is often severe, constant, and commonly lasts for several days in the absence of treatment. A person with acute pancreatitis usually looks and feels very ill and needs immediate medical attention. Most cases require hospitalization for 3 to 5 days for close monitoring, pain control, and intravenous hydration. Other symptoms can include:

  • Swollen and tender abdomen
  • Nausea and vomiting
  • Fever
  • Rapid pulse

Acute pancreatitis treatment

The treatment depends on how bad your attack of acute pancreatitis is. There is no specific treatment that will take the inflammation away. However, in most cases the pancreatitis settles over a few days, although symptoms can get worse before they get better.

  • Strong painkillers by injection are usually needed to ease the pain.
  • A tube may occasionally also be passed down your nose into your stomach (nasogastric tube) to suck out the fluid from your stomach. This can be useful if you are being sick (vomiting) a lot.
  • A nasogastric tube may also be passed into the stomach to feed you, as you will not be able to eat properly.
  • A ‘drip’ is needed to give fluid into your body until symptoms settle.
  • A catheter –  a thin tube going into your bladder to drain urine – is likely to be inserted so the doctors can monitor accurately the amount of urine you are passing.

Less commonly, complications develop and the situation can become very serious. Other treatments that may then be needed include the following:

  • Intensive care treatment. If you have a severe attack of pancreatitis then you will be monitored very closely in the intensive care unit.
  • A procedure to remove a blocked gallstone if this is found to be the cause.
  • Antibiotics if the pancreas or surrounding tissue become infected.
  • Surgery is sometimes needed to remove infected or damaged tissue.