Acute Pancreatitis

Types of pancreatitis

Pancreatitis has two stages — acute and chronic. Acute pancreatitis occurs suddenly after the pancreas is damaged. It may also be hereditary. Chronic pancreatitis is a more persistent condition that occurs when irreversible scarring of the pancreas occurs.

Most cases of acute pancreatitis are mild and involve a short hospital stay for the pancreas to recover. About 20 percent of acute pancreatitis cases are severe. Patients with severe acute pancreatitis have an average hospital stay of two months, followed by a lengthy recovery.

Some patients may have more than one attack of acute pancreatitis, but they typically recover after each one. In the most severe cases of acute pancreatitis, the pancreas and surrounding tissue can die, resulting in shock and sometimes death.

Causes of acute pancreatitis

The most common causes of acute pancreatitis are gallstones and high levels of alcohol consumption. Some less common causes of acute pancreatitis include:

• Hypertriglyceridemia, which can occur when a person has high blood fat levels
• Accidental injury or damage to the pancreas as a result of another condition or procedure
• Side effects of some medications
• Viral infections like mumps or measles
• Hypercalcaemia, a condition where blood calcium levels are too high
• Autoimmune pancreatitis, a condition where the immune system attacks the pancreas

Symptoms of acute pancreatitis

Acute pancreatitis is believed to begin when certain enzymes in the pancreas mistakenly start to digest the organ. Acute pancreatitis usually begins with pain in the upper abdomen, where the pancreas is located. This pain may last from a few hours to a few days.

Other symptoms include:

• Pain that can travel along your back or below your left shoulder blade
• Sudden and intense pain, or mild pain that is aggravated by eating and drinking
• An elevated pulse
• A fever
• Nausea and vomiting
• A swollen and tender abdomen

Diagnosis of acute pancreatitis

To diagnose acute pancreatitis, your doctor will ask about your medical history, perform a physical exam and order blood tests to check for certain enzymes. During attacks of acute pancreatitis, your blood contains at least three times more than the normal amount of digestive enzymes formed in the pancreas. There may also be changes in blood levels of glucose, calcium, magnesium, sodium, potassium and bicarbonate.

Your doctor may also perform an abdominal ultrasound to look for gallstones and a computerized tomography (CT) scan to check for injury to your pancreas. They may also perform a procedure called an endoscopic retrograde cholangiopancreatography (ERCP) to look for an obstruction in your bile duct. In this procedure, we'll insert an endoscope, a flexible tube, down your throat into the stomach and small intestines. We'll also inject a special dye that shows up on X-rays into the drainage tube of your pancreas.

Treatment of acute pancreatitis

Treatment for acute pancreatitis depends on the severity of the attack. The goal of treatment is to reduce the levels of digestive enzymes that caused the pancreas to become inflamed in the first place. Most cases improve with a few days of rest and treatment. Usually, patients are hospitalized to receive intravenous fluids to restore blood volume and hydration as well as medications to control pain. Antibiotics may also be required if there is an infection.

It is likely that your doctor will recommend a low-fat diet because patients with acute pancreatitis have trouble digesting fatty foods.

Surgery for acute pancreatitis

If complications such as infection, cysts or bleeding occur, you may require surgery. If gallstones are the cause of your pancreatic issues, you may need to have your gallbladder removed.

If the cause of the pancreatitis is a bile duct obstruction, we may perform an endoscopic retrograde cholangiopancreatography (ERCP). During this procedure, we use special instruments to remove the obstruction or widen the narrowed segment of the bile duct.

Treatment for acute necrotizing pancreatitis

Patients with severe acute pancreatitis may develop a serious condition called acute necrotizing pancreatitis. With this condition, tissue in the pancreas dies and later becomes infected. Several weeks after an attack of acute necrotizing pancreatitis, an abscess may form on the dead tissue. UCSF has developed surgical techniques for removing the dead tissue that result in reduced severity of illness and fewer deaths from this condition.