Acute pancreatitis is an inflammation of the pancreas. It is painful, develops quickly, and it can, in some cases, be fatal.
Some mild cases resolve without treatment, but severe, acute pancreatitis can trigger potentially fatal complications. The mortality rate ranges from less than 5 percent to over 30 percent, depending on how severe the condition is and if it has reached other organs beyond the pancreas.
Acute pancreatitis is estimated to affect between 4.5 and 35 in every 100,000 individuals per year. However, this figure may not include the many mild cases that resolve without medical evaluation or treatment. Every year, there are 275,000 hospitalizations for acute pancreatitis in the United States.
The pancreas is a long, flat gland located behind the stomach in the upper abdomen. It produces digestive enzymes and hormones, which regulate how the body processes glucose, for instance, insulin.
The most common cause of pancreatitis is gallstones, but a rise in alcohol misuse is linked to an increase in incidence. Alcohol now accounts for around 30 percent of cases.
Acute pancreatitis starts suddenly, but chronic pancreatitis is recurring or persistent. This article will focus on acute pancreatitis.
Fast facts on acute pancreatitis
Here are some key points about acute pancreatitis. More detail is in the main article.
Pancreatitis is split into acute and chronic types.
The pancreas carries out many tasks, including the production of digestive enzymes.
Symptoms include pain in the center of the upper abdomen, vomiting, and diarrhea.
The most common causes of acute pancreatitis are gallstones and alcohol abuse.
Sharp and sudden abdominal pain can be a sign of pancreatitis.
Typically, the patient will experience a sudden onset of pain in the center of the upper abdomen, below the breastbone (sternum).
Rarely, the pain is first felt in the lower abdomen. It will gradually become more intense until it is a constant ache.
The ache may intensify further and become severe. It also spreads into the back in around half of cases. Eating may exacerbate the pain.
Pancreatitis that is caused by gallstones will develop very fast. When it is caused by alcohol, symptoms develop more slowly, over a number of days.
Leaning forward or assuming a fetal position (curling up) may help lessen the pain slightly. Anybody who experiences constant pain should seek medical attention.
The following symptoms may also be present:
loss of appetite
pain with coughing, vigorous movements, and deep breathing
tenderness when the abdomen is touched
fever and a temperature of at least 100.4 °F (38 °C)
jaundice, when the skin and whites of the eyes take on a yellowish tinge
pain cannot be relieved even with strong painkillers
blood pressure may fall or rise, but it will fall when the patient stands, sometimes causing faintness
What’s to know about chronic pancreatitis?
Pancreatitis can be acute or chronic
Treatment for acute pancreatitis will depend on whether it is mild or serious. In mild cases, the risk of complications is small. In serious cases, the risk is significant.
Treatment for mild acute pancreatitis
Treatment aims to maintain bodily function and ease symptoms while the pancreas is repairing itself.
This will include:
Painkillers: Mild acute pancreatitis can be moderately or severely painful.
Nasogastric tubes: A tube may remove excess liquids and air as a treatment for nausea and vomiting.
Bowel rest: The gastrointestinal tract will need to rest for a few days, so the person will not take any food or drink by mouth until their condition improves.
Preventing dehydration: Dehydration often accompanies pancreatitis, and it can worsen the symptoms and complications. Fluid is often provided intravenously for the first 24-48 hours.
The person can usually go home after about 5 to 7 days.
Treatment for severe acute pancreatitis
In severe acute pancreatitis, there is usually some tissue death, or necrosis. This increases the risk of sepsis, a severe bacterial infection that can affect the whole body. Sepsis can lead to multi-organ damage or failure.
Severe acute pancreatitis can also cause hypovolemic shock. Severe blood and fluid loss can leave the heart unable to pump enough blood to the body. Parts of the body can become rapidly oxygen-deprived. This is a life-threatening situation.
Treatment for this kind of pancreatitis includes:
Treatment in the intensive care unit (ICU): Injections with antibiotics aim to stop any infection from developing in the dead tissue.
Intravenous fluids: These help maintain hydration and prevent hypovolemic shock.
Breathing assistance: Ventilation equipment will help the patient breathe.
Feeding tubes: These provide nutrition as appropriate. In this case, early feeding improves outcomes.
Surgery: In some cases, the dead tissue may need to be surgically removed.
The patient will stay in ICU until they are no longer at risk of organ failure, hypovolemic shock, and sepsis.
If gallstones caused the acute pancreatitis, the patient might undergo surgery or an endoscopic retrograde cholangiopancreatography (ERCP) after their condition improves.
After the gallstones are removed, the patient may be advised to follow a special diet to lower blood cholesterol, because excess cholesterol encourages the growth of gallstones.
The American Gastroenterological Association recommends surgery to remove the gallbladder of any patient who develops pancreatitis from gallstones.
Treating alcohol misuse
If doctors determine that alcohol misuse was the underlying cause of the acute pancreatitis, the patient may be offered a treatment program for alcohol misuse.
Gallstones, infections, and alcohol misuse are common causes of acute pancreatitis.