Pancreatitis, Acute

What is acute pancreatitis?

Pancreatitis is a condition that occurs when the pancreas, an organ behind the stomach, becomes swollen and painful.

A healthy pancreas produces digestive enzymes and insulin. The digestive enzymes flow into the small intestine to help break down food. Insulin is released into the blood to control the level of sugar (glucose) in the blood.

Pancreatitis can be acute or chronic. Acute pancreatitis occurs as one sudden episode. After acute pancreatitis the pancreas usually returns to its normal condition. Chronic pancreatitis means ongoing or repeated bouts of pancreatitis in which there is permanent damage to the pancreas.

What is the cause?

The causes of acute pancreatitis are not completely understood. The most common cause is gallstones. Gallstones can block the flow of digestive enzymes into the intestines. When the enzymes stay in the pancreas, they irritate it. The second most common cause is drinking too much alcohol.

Less frequent causes are:

• damage from disease in nearby organs, such as stomach or duodenal ulcers
• bruising during surgery on nearby organs
• injury, such as a hit in the stomach
• side effects from some medicines

Sometimes very high levels of blood fats (triglycerides) cause pancreatitis.

What are the symptoms?

The main symptom is severe pain in the middle of your upper abdomen. The pain:

• often happens 12 to 24 hours after a large meal or heavy drinking
• spreads to your back and chest
• is steady and sharp
• gets worse when you move
• feels better when you sit or lean forward
• usually makes you vomit

Other symptoms are:

• fever
• bloating

In severe cases, you may have signs of shock, including:

• restlessness
• a fast heartbeat
• lightheadedness
• confusion
• a cold sweat

If you have abdominal pain and any of these signs of shock, get emergency care or call 911 right away.

How is it diagnosed?

Your healthcare provider will ask about your medical history, particularly about how much alcohol you drink and whether you have had gallstones. Your provider will ask about your symptoms and examine you.

You may have the following tests:

• blood tests
• urine tests
• X-rays of your abdomen and chest
• ultrasound exam of the pancreas and gallbladder
• CT or MRI scan of the pancreas
• ERCP.

ERCP is a way of looking at your pancreas through a slim flexible tube called an endoscope. The scope is passed through your mouth and stomach to see the area where your pancreas and intestines are connected.

How is it treated?

You will probably stay in the hospital for treatment.

• To rest your pancreas, you cannot eat or drink anything for a few days. You usually will not start drinking or eating again until the abdominal pain stops.
• You will be given fluids through your vein (IV).
• A tube may be put through your nose down into your stomach to remove fluids and help prevent nausea, vomiting, and bloating. This is called nasogastric suction.
• You may have to stop taking some of your regular medicines.
• A narcotic drug or other pain reliever will be prescribed for your abdominal pain. You may have other medicines as well.
• If you have an infection, you will need antibiotics.
• You will need to stay in bed and take it easy.
• When the pain stops, you can start drinking clear liquids. As you get better you will start to eat soft, foods that are easy to digest.
• If you have gallstones, they may be removed while you are in the hospital to prevent another attack of pancreatitis. If you are severely ill, they may not be removed until you are feeling better.

Your healthcare provider may decide you can leave the hospital when you no longer have pain and are able to eat without getting sick. Most people treated with nasogastric suction and IV fluids start feeling better in 1 to 3 days and go home in 5 to 10 days. More severe disease requires treatment in an intensive care unit (ICU) and a hospital stay of several weeks.

How long do the effects last?

Most people recover completely, especially if the disease is diagnosed early enough. This is especially true if the cause can be found and treated, such as gallstones.

Pancreatitis can come back and become an ongoing problem, causing frequent, severe pain. It can permanently damage the pancreas. Severe pancreatitis can be life threatening.

How can I take care of myself?

• Follow the instructions your healthcare provider gives you. This includes how you take any medicines he or she has prescribed and how active you can be.
• Don't take any other medicines, including nonprescription drugs, without asking your healthcare provider.
• Ask your provider if you need a special diet.
• Don’t drink alcohol.

How can I help prevent another attack of acute pancreatitis?

To help prevent another attack of pancreatitis:

• Avoid drinking alcohol if your healthcare provider advises it.
• Follow the diet your provider prescribes.
• Follow your provider's recommendations for keeping your blood fats (lipids) at a normal level.

If injury was the cause of your pancreatitis, follow your provider's recommendations for rest and about ways to be physically active without hurting the pancreas again.

If gallstones caused the pancreatitis and they have not been removed, surgery to remove them may help prevent further attacks.