Acute pancreatitis

Definition

Acute pancreatitis is an inflammation (irritation and swelling) of the pancreas. The pancreas is a long gland, located behind the stomach, that secretes digestive enzymes and the hormones insulin and glucagon.

Causes

The chief causes of acute pancreatitis in adults are gallstones, other gallbladder (biliary) disease, and alcohol use. Other causes include:

• Viral infection (mumps, coxsackie B, mycoplasma pneumonia, and campylobacter)
• Traumatic injury
• Pancreatic surgical procedures
• Common bile duct surgical procedures
• Certain medications (especially estrogens, corticosteroids, thiazide diuretics, and azathioprine)

Acute pancreatitis may also be caused by an abnormal structure of the pancreas, genetic factors (hereditary pancreatitis), high lipid levels in the blood (hypertriglyceridemia), and complications of cystic fibrosis.

The mechanism that causes pancreatitis is not well known. It is thought that enzymes normally secreted by the pancreas in an inactive form become activated inside the pancreas and start to digest the pancreatic tissue. This process is called autodigestion and causes swelling, hemorrhage, and damage to the blood vessels.

The disease affects men more often than women. Alcohol abuse is an important risk factor.

In children, this disorder may be associated with:

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

Symptoms

• Abdominal pain that is greatest in the upper abdomen (upper left quadrant or upper middle of the abdomen)
  • Is persistent or chronic
  • May be worse lying flat on the back
  • May 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
• Nausea and vomiting
• Sweating
• Anxiety
• Fever
• Mild jaundice

Additional symptoms that may be associated with this disease:

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

Exams and Tests

General examination may show fever, low blood pressure, rapid heart rate or rapid respiratory rate.

Tests that show release of pancreatic enzymes:

• Elevated serum amylase
• Elevated urine amylase
• Elevated serum lipase

Test that show inflammation of the pancreas:

• Abdominal CT scan
• Abdominal ultrasound
• Abdominal MRI

In other blood tests results:

• CBC shows an elevated WBC coun.
• A glucose test may show elevated levels.
• Serum calcium may be decreased.

Treatment

Treatment is aimed at supportive measures such as fluid replacement by intravenous (IV) infusion, pain relief, and withholding food or fluid by mouth (to limit the activity of the pancreas that makes symptoms worse). Occasionally nasogastric suctioning may be required, if there is persistent vomiting or severe pain, or if a paralytic ileus develops.

Recurrent attacks may be prevented by treating the underlying condition.

In some cases, radiologic or endoscopic therapy is needed to remove gallstones, relieve obstructions of the pancreatic duct, or drain fluid collections in or around the pancreas. In the most severe cases, surgery is necessary to remove dead, infected pancreatic tissue.

Outlook (Prognosis)

While most cases go away in a week, some cases develop into a life-threatening illness. The death rate is high with hemorrhagic pancreatitis or necrotizing pancreatitis, and complications such as liver, heart, or kidney impairment may occur. Recurrences are common.

Possible Complications

• Low blood pressure
• Heart failure
• Kidney failure
• ARDS (acute respiratory distress syndrome)
• Ascites (accumulation of fluid in the abdomen)
• Cysts or abscesses in the pancreas

When to Contact a Medical Professional

Call your provider if intense, constant abdominal pain is present, or if other symptoms suggestive of acute pancreatitis develop.

Prevention

Prevention of acute pancreatitis is associated with prevention of the disorders that cause it:

• Do not abuse alcohol.
• Use proper safety precautions to avoid abdominal trauma.
• Genetic counseling may be advised for prospective parents with a family or personal history of cystic fibrosis.
• To reduce the risk of Reye syndrome, avoid aspirin for treatment of fever in children, especially if they may have a viral illness.
• Immunize children against mumps and other childhood illnesses (see: immunizations - general overview).

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, avoid the medication in the future.

Banks PA, Freeman ML; Practice Parameters Committee of the American College of Gastroenterology. Practice guidelines in acute pancreatitis. Am J Gastroenterol. 2006 Oct;101(10):2379-400.