What is Acute Pancreatitis?

Acute pancreatitis refers to inflammation of the pancreas, often causing sudden onset, severe upper abdominal pain. The pancreas is an organ that lies behind the stomach in the left upper abdomen. It produces digestive juices (enzymes) and hormones that regulate blood sugar levels.

Most acute pancreatitis attacks resolve uneventfully with supportive medical care. However, a minority of people have a more serious illness requiring intensive medical care. It is important to try to determine and address the underlying cause to prevent recurrence.

What Causes Acute Pancreatitis?

About 70% of acute pancreatitis attacks are caused by gallstones or excessive alcohol consumption. Other causes include high blood fat (triglyceride) levels, high blood calcium levels, a cyst or tumor in the pancreas, drugs, infection, blockage of the bile duct or pancreas duct, an inherited condition, or traumatic injury to the abdomen. Acute pancreatitis occurs in 3-5% of patients that undergo ERCP (endoscopic retrograde cholangiopancreatography), a procedure most often performed for a blocked bile duct. Finally, at least 10% of cases are “idiopathic,” meaning no underlying cause can be identified even after a thorough investigation.

What Are the Symptoms of Acute Pancreatitis?

The most common symptom of acute pancreatitis is sudden pain in the upper abdomen, which occurs in 90% of patients. The pain is typically severe but may be mild or absent in some cases. The pain usually lasts for days and may radiate to the back or chest. The pain is often relieved by leaning forward. Other common symptoms include nausea, vomiting, bloating, and increased heart rate. Some patients may develop pseudocysts, which are benign fluid collections that can become infected. Severe pancreatitis attacks may lead to potentially life-threatening complications, including severe infection, dangerously low blood pressure, and damage of the heart, lung, and kidneys.

What Are the Diagnostic Tests For Acute Pancreatitis?

It can be tricky to diagnose acute pancreatitis because the symptoms may resemble several other conditions. The diagnosis requires a thorough medical history, careful physical examination, and the results of diagnostic tests. The diagnosis requires the presence of at least 2 of the three following criteria:

1. Typical abdominal pain.
2. Blood pancreas enzyme (amylase or lipase) levels at least three times the upper limit of normal.
3. Finding of inflammation of the pancreas on an imaging test.

Imaging tests that may show inflammation of the pancreas include computed tomography (CT) scan or magnetic resonance imaging (MRI) scan.

Once a diagnosis of acute pancreatitis is made, additional tests are often needed to determine the cause. An ultrasound of the abdomen may be ordered to look for gallstones as the cause of acute pancreatitis. Blood tests can assess for high blood fat (triglyceride) levels or an antibody (IgG4) as a possible cause. An endoscopic ultrasound (EUS) may be performed to examine for tiny gallstones (microlithiasis), precancerous cysts, scarring, or inherited conditions. Some people with a family history of pancreatitis or pancreatic cancer may require genetic testing.

How is Pancreatitis Treated?

The goals of treating acute pancreatitis are to relieve inflammation of the pancreas and to correct the underlying cause whenever possible. Treatment usually requires at least a few days of hospitalization for supportive care. This typically entails aggressive hydration with intravenous fluids and medications for nausea and abdominal pain. Usually, it is necessary to avoid eating for the first few days to allow the pancreas to rest. Some patients may require temporary placement of a feeding tube through the nose or intravenous nutrition. Once pain and nausea have improved, a low-fat diet may be resumed.

If there is a gallstone lodged in the bile duct, a procedure called endoscopic retrograde cholangiopancreatography (ERCP) is needed to remove the gallstone. People with gallstone pancreatitis will usually need surgery to remove the gallbladder to lower the risk of further attacks. If the pancreatitis was caused by alcohol, it is crucial to stop alcohol consumption immediately to allow the pancreas to heal. If the pancreatitis was caused by high blood fat (triglyceride) levels, a cholesterol medication is usually needed along with a low-fat diet. If there is a large fluid collection (pseudocyst) that is infected or causing nausea or pain, it may require a procedure for drainage. Patients with serious complications such as severe infection or damage to the lungs, heart, or kidneys may require treatment in an intensive care unit. Upon recovery, patients are advised to avoid smoking and consuming alcoholic beverages to prevent recurrent attacks of acute pancreatitis.

David Palma, MD