Acute pancreatitis

The pancreas is a gland that lies behind the stomach and next to the small intestine. Pancreatitis is a condition in which the pancreas becomes inflamed and unable to produce enough enzymes to digest food or enough hormones to regulate blood sugar (its two main functions). In mild acute pancreatitis, the symptoms (pain being the most prominent) appear suddenly and last for a short period of time. In moderate and severe acute pancreatitis, there’s a high risk of illness and death, thus requiring further clinical intervention. 

At the Comprehensive Pancreas Cancer and Disease Center, our multidisciplinary experts collaborate to ensure that patients receive the highest quality care. We have an extensive team of specialists with vast experience in pancreas diseases, who can perform leading-edge surgical procedures and leverage all possible innovations to provide the highest level of treatment and care. As a patient-focused Center, we’re continuously involved in clinical research to bring the latest advances in treatment to our patients.

Symptoms often include:

• Gradual or sudden upper abdominal pain that may radiate to the back or chest
• Nausea
• Vomiting
• Rapid pulse rate
• Fever
• Distension and tenderness in the upper abdomen

Acute pancreatitis can be caused by:

• Excessive alcohol ingestion
• Gallstones
• Hypertriglyceridemia (a condition in which triglyceride levels are elevated)
• Medications
• Autoimmune disease
• Trauma to the pancreas
• Metabolic abnormalities
• Idiopathic (unknown) reasons

Acute pancreatitis affects about 250,000 people in the U.S. each year.

Acute pancreatitis is usually diagnosed by:

• Laboratory tests: Such as lipase and amylase levels.
• Transabdominal computed tomography scan (CT scan): A CT scan combines a sequence of X-ray images from different angles of the body and uses computer processing to create more detailed information than X-rays do. Fluid collections or pseudocysts are often seen in moderate or severe acute pancreatitis, and both CT scan and MRI will assist in evaluating these entities.
  • Contrast enhanced scan (CT scan): A CT scan that uses iodine-based contrast material and can identify what is known as a necrotizing pancreatitis, a condition in which some part of the pancreas has died as a consequence of the pancreatic episode.
• Magnetic Resonance Imaging (MRI): A test that uses a magnetic field and radio waves to generate detailed images of the patient’s organs. The test produces images of body parts by injecting dye into the veins that helps show the pancreas, gallbladder, and pancreatic and bile ducts.
• Endoscopic procedures: Such as endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS).
• Other tests as needed: Both diagnostic and therapeutic, depending on the suspected cause of pancreatitis.

Acute pancreatitis usually requires a hospital stay. Treatment focuses on resting the pancreas, so that it can recover from the inflammation. This is accomplished through:

• Fluids: A major component of the early stages of acute pancreatitis is fluid loss, both through vomiting and through a process known as “third spacing” in which fluid is lost into the abdominal cavity and in the intestine. Thus, adequate hydration is critical for treatment. Patients will receive extra fluids through an IV during their hospital stay.
• Pancreas rest/fasting: Patients will stop eating for a period of time to give the pancreas a chance to recover. Once the pain and inflammation has gone down, patients can begin drinking clear liquids and eating some bland foods. In simple acute pancreatitis, dietary intake is not restricted for long. In moderate/sever acute pancreatitis, dietary intake may be restricted for weeks and nutrition will need to be addressed.
• Pain control: Patients will receive pain medication intravenously, which is the most effective method for treating acute pancreatitis pain. They may also receive medication to ease nausea. As the inflammation improves, these medications can be given by mouth instead of IV.

The majority of acute pancreatitis cases are resolved with the hospital treatment methods mentioned above. In about 10 to 15 percent of cases, patients can develop severe disease that results in injury or necrosis (death) of the pancreas tissue, which may require continued observation, endoscopic treatment or surgical intervention.