What is acute pancreatitis?
Acute pancreatitis is an inflammation in the pancreas. The pancreas is an organ behind the stomach and connected to the bowel. It produces enzymes, which are necessary to break down food during digestion and helps regulate the body's glucose levels by producing the hormones insulin and glucagon.
There are several causes of acute pancreatitis. Some of the most common causes are drinking large amounts of alcohol, gallstones and certain medications. Typical symptoms of acute pancreatitis are pain in the upper part of the abdomen and the back, as well as nausea and vomiting. Treatment involves rest, fluids and treating the underlying cause.
Around 275,000 people in the United States are hospitalized with acute pancreatitis each year. It is a serious condition, but most people recover well, once the underlying cause is recognized and treated.
Acute pancreatitis vs chronic pancreatitis
Acute pancreatitis can be treated and will fully resolve in a few days. Chronic pancreatitis does not heal, worsens over time and causes permanent damage to the pancreas. Chronic pancreatitis can be debilitating and lead to death. Repeated episodes of acute pancreatitis may lead to chronic pancreatitis.
Symptoms of acute pancreatitis
- Be severe enough to require strong painkillers
- Appear suddenly, where the cause is gallstones
- Appear one to three days following a drinking binge or stopping drinking, where the cause is alcohol
- Persist for several days
- Be made worse by coughing, deep breathing and moving vigorously
- Sometimes be eased by leaning forward
Other symptoms of acute pancreatitis include:
- Nausea and vomiting
- Loss of appetite
- Elevated heart rate
- Tender abdomen
- Blue/gray skin discoloration around the sides, also known as the Grey Turner sign or ecchymoses of the flanks
- Blue/gray skin discoloration around the navel, also known as the Cullen sign or ecchymoses of the flanks
Causes of acute pancreatitis
60 to 75 percent of acute pancreatitis cases are caused by gallstones or high intake of alcohol. There is no identifiable cause for around 20 percent of acute pancreatitis cases; this is known as idiopathic pancreatitis.
Heavy alcohol use over a prolonged period of time can cause acute pancreatitis. It is unclear how alcohol causes pancreatitis, though there are theories that alcohol may convert into chemicals that damage the pancreas, or that alcohol blocks the pancreatic duct.
The risk of pancreatitis increases with heavy alcohol use, which is considered to be:
- Four to seven drinks a day for men
- Three or more drinks a day for women
If a person with acute pancreatitis drinks less than these amounts, the condition may still progress to chronic pancreatitis. Alcohol should be completely avoided while undergoing treatment for acute pancreatitis.
Cystic fibrosis is a genetic disorder that causes some glands to function abnormally. In people with cystic fibrosis, the pancreas produces secretions that can block the gland. Having cystic fibrosis increases the risk for repeatedly developing acute pancreatitis and also increases the risk of developing chronic pancreatitis.
The following medications may cause acute pancreatitis as an uncommon, but potentially severe side effect:
- Angiotensin-converting enzyme (ACE) inhibitors, used to treat hypertension and heart failure
- Azathioprine, used in kidney transplants and for rheumatoid arthritis
- Furosemide, used to treat hypertension
- 6-mercaptopurine, used to treat acute lymphocytic leukemia
- Pentamidine, used to treat pneumonia
- Sulfonamides, a class of synthetic antibiotics
- Valproate, used to treat seizures and bipolar disorder
Endoscopic retrograde cholangiopancreatography (ERCP)
3 to 5 percent of people who have a procedure called endoscopic retrograde cholangiopancreatography (ERCP) go on to develop acute pancreatitis. ERCP uses an endoscope, which is a flexible tube inserted into the esophagus, stomach and intestine to examine the bile and pancreatic ducts.
Other causes of pancreatitis
- Mononucleosis/Epstein-Barr virus
- Parasitic infection, such as ascariasis, toxoplasmosis or cryptosporidium
- High cholesterol levels
- Pancreatic cancer
Diagnosis of acute pancreatitis
Diagnosis of acute pancreatitis is based on the symptoms and a physical examination. A diagnosis will generally be confirmed if two of the following three symptoms are present:
- Abdominal pain
- Increases of amylase and lipase levels in the blood that are threefold or higher
- Inflamed pancreas, seen on a CT scan or MRI scan
- High levels of digestive enzymes made by the pancreas, called amylase and lipase
- High blood glucose levels
- High levels of blood fats, called lipids
- Signs of infection
- Pancreatic cancer
Computed tomography (CT) scan, to create a picture of the pancreas, gallbladder and bile ducts Magnetic resonance imaging (MRI), another method of creating a picture of the pancreas, gallbladder and bile ducts Ultrasound, which can be used to identify gallstones
Treatment of acute pancreatitis
Acute pancreatitis is a serious condition and can lead to complications such as fluid-filled pseudocysts, damage to the pancreas and heart and lung or kidney failure. However, with appropriate treatment, most people recover well.
People with acute pancreatitis are usually admitted to hospital. Treatment generally includes:
- Fluids administered intravenously
- Drugs to reduce nausea and vomiting
- Feeding by tube or intravenously if the person cannot eat
- Antibiotics, if the person has an infection in the pancreas
Treatment for acute pancreatitis caused by gallstones
If acute pancreatitis is caused by gallstones, this condition also needs to be treated. There are various options to treat gallstones:
Surgical removal of the gallbladder. This is a common procedure and will prevent acute pancreatitis caused by gallstones recurring.
Non-surgical options to eliminate gallstones may be possible where a person is unable to have their gallbladder removed, such as because of old age or other medical conditions. However, without gallbladder removal, acute pancreatitis caused by gallstones is likely to recur in 30 to 50 percent of cases.
- Bile acid pill, to break down small gallstones caused by cholesterol
- Endoscopic retrograde cholangiopancreatography (ERCP), to remove gallstones from the bile duct
- Shock wave lithotripsy, a rarely offered procedure which uses shock waves to break up larger gallstones
Preventing acute pancreatitis
Eating a healthy diet that is rich in fiber, fruits, vegetables and whole grains and avoiding unhealthy fats can reduce the risk of developing gallstones.
Stopping drinking alcohol and stopping smoking can help prevent future episodes of acute pancreatitis and prevent progression to chronic pancreatitis.
Acute pancreatitis FAQs
Q: Are acute pancreatitis and pancreatic cancer linked?
A: If not properly managed, repeated episodes of acute pancreatitis can lead to chronic pancreatitis. Chronic pancreatitis is linked to an increased risk of pancreatic cancer. However, most people with pancreatitis will not develop pancreatic cancer.
Other names for acute pancreatitis
- Acute pancreatic necrosis
UpToDate. “ERCP (endoscopic retrograde cholangiopancreatography).” May 2018. Accessed June 30, 2018. ↩
US National Library of Medicine. “Review of Infectious Etiology of Acute Pancreatitis.” June 2017. Accessed June 30, 2018. ↩
US National Library of Medicine. “Pancreatic cancer causing acute pancreatitis: a comparative study with cancer patients without pancreatitis and pancreatitis patients without cancer.” August 2013. Accessed June 30, 2018. ↩