Acute Pancreatitis

Definition

The pancreas sits behind the stomach. It makes fluids that help to break down food in the small intestine. This fluid can become active in the pancreas and cause irritation and inflammation. This is called pancreatitis.

Acute pancreatitis is a sudden start of the inflammation. For most this type will pass in a few days.

The Pancreas

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Causes

There are a number of conditions that may lead to acute pancreatitis including:

• Gallstones —block flow of fluid out of pancreas
• Drinking alcohol
• Certain medicine including corticosteroids, opiods, valporate
• High triglyceride levels
• Complications of endoscopic retrograde cholangiopancreatography (ERCP)

Sometimes the cause is not known.

Risk Factors

Any of the following may increase the risk of acute pancreatitis:

• Alcohol use disorder
• Hyperlipidemia —high blood fat levels, especially high triglyceride levels
• Scorpion or other venomous bite
• Exposure to certain toxins at work or in the environment

Symptoms

Symptoms may include:

• Pain in the center of the upper abdomen that:
  • Lasts for a few days
  • Can be mild or severe
  • May spread into the upper back
• Nausea and vomiting
• Low grade fever
• Swollen belly

Diagnosis

You will be asked about your symptoms and past health. An exam will be done. The doctor will check your belly for swelling and pain. You may be asked about your alcohol use and current medicine.

The doctor may suspect pancreatitis based on your pain. Other tests will help to make the diagnosis. Tests may include:

The doctor may also need to take images of the pancreas. The images can show changes to the pancreas. Some causes like gallstones, or duct blockages may also be seen. Images may be taken with:

• Blood tests—certain fluids are higher in blood when pancreatitis is present
• Image tests can show changes to pancreas. It may be able to show some causes as well, like gallstones. Options include:
• Abdominal ultrasound
• Abdominal CT scan
• Abdominal MRI scan
• Endoscopic retrograde cholangiopancreatography (ERCP)
• Magnetic resonance cholangiopancreatography (MRCP)

Treatment

Acute pancreatitis will often pass in a few days with proper care. Most will have no lasting damage.

Support and Rest

The pancreas needs to rest. Since it is active every time you eat, you may need to adjust your diet. You may be asked to avoid fatty foods or stop eating for a couple days. It may also be hard for you to eat or drink because of nausea and vomiting.

A hospital stay may be recommended to provide the following:

• Fluid given through IV
• Nutrition with a low fat diet or through a tube that is passed through nose into stomach
• Pain medicine

Most will only need to be in the hospital for a few days.

Surgery

Surgery may be needed if you do not respond to rest. It may also be needed to treat the cause.

Surgical options depend on the cause of pancreatitis, but may include:

• Percutaneous catheter drainage—fluid is drained from the pancreas.
• ERCP—to remove gallstones.
• Cholecystectomy —to remove the gallbladder. May be needed if gallstones were the cause.
• Necrosectomy—remove dying or dead tissue from the pancreas.

Pancreatitis can happen again. To decrease your chances of it happening again:

Pancreatitis can happen again. To decrease your chances of it happening again:

• Avoid drinking alcohol.
• Do not smoke. If you do smoke, talk to your doctor about tools to help you quit .

Prevention

Pancreatitis may happen again. To help reduce your chances of acute pancreatitis:

• Limit intake of alcohol. This is 2 drinks a day or less for men and 1 drink a day or less for women.
• If you have high cholesterol, follow your doctor’s treatment plan. This will include:
  • Limit intake of saturated fact
  • Regular physical activity
• If you smoke, talk to your doctor about ways to quit. Smoking can irritate the pancreas.
• Reach and keep a healthy weight. Obesity and overweight can increase stress on pancreas.