Acute Pancreatitis

acute pancreatitis

The pancreas is in the upper abdomen and lies behind the stomach and intestines (guts). It makes a fluid that contains enzymes (chemicals) that are needed to digest food. The enzymes are made in the pancreatic cells and are passed into tiny ducts (tubes). These ducts join together like branches of a tree to form the main pancreatic duct. This drains the enzyme-rich fluid into the duodenum (the part of the gut just after the stomach). The enzymes are in an inactive form in the pancreas. They are 'activated' in the duodenum to digest food.

Groups of special cells called 'Islets of Langerhans' are scattered throughout the pancreas. These cells make the hormones insulin and glucagon. The hormones are passed directly into the bloodstream to control the blood sugar level.

What is pancreatitis?

Pancreatitis means inflammation of the pancreas. There are two types:

Acute pancreatitis - when the inflammation develops quickly, over a few days or so. It often goes away completely and leaves no permanent damage. Sometimes it is serious.

Chronic pancreatitis - when the inflammation is persistent. The inflammation tends to be less intense than acute pancreatitis but as it is ongoing it can cause scarring and damage.

What are the causes of acute pancreatitis?
  • Gallstones -In some people a gallstone gets stuck in the bile duct or where the bile duct and pancreatic duct open into the duodenum. This can affect the enzymes in the pancreatic duct (or even block them completely) and trigger a pancreatitis. Alcohol - is the other common cause. How alcohol actually triggers the inflammation in the pancreas is not clear. Symptoms typically begin about 6-12 hours after a heavy drinking session.
  • Uncommon causes - include: virus infections (for example, the mumps virus, HIV); a rare side-effect to some medicines; injury or surgery around the pancreas; parasite infections; high blood fat or calcium levels; abnormal structure of the pancreas.
  • Autoimmune - this is where your own immune system attacks the pancreas.
  • Unknown - no cause is found in about 1 in 10 cases.
What happens in acute pancreatitis?

The digestive enzymes (chemicals) that are made in the pancreas become activated and start to 'digest' parts of the pancreas. This leads to a range of chemical reactions that cause inflammation in the pancreas.

In most cases, the inflammation is mild and settles within a week or so. Symptoms may be bad for a few days but then settle and the pancreas fully recovers. In some cases (about 1 in 5) the inflammation quickly becomes severe. Parts of the pancreas and surrounding tissues may die (necrose). This can lead to shock, respiratory failure, kidney failure and other complications. This is a very serious situation which can be fatal. What are the symptoms of acute pancreatitis?
  1. Abdominal pain - just below the ribs is the usual main symptom.
  2. Vomiting, fever and generally feeling very unwell are common.
  3. Abdomen may become swollen.
  4. You may become dehydrated and have low blood pressure.
What happens if acute pancreatitis is suspected?

You will need to be admitted to hospital if your doctor suspects that you have acute pancreatitis. Blood tests can check the blood level of amylase and/or lipase (enzymes made by the pancreas). A high blood level of these enzymes strongly suggests that pancreatitis is the cause of your symptoms.

An ultrasound scan may be done to look for a gallstone if this is the suspected underlying cause.

What is the treatment for acute pancreatitis?

The treatment depends on how bad your attack of acute pancreatitis is. There is no specific treatment that will take the inflammation away.

  • Strong painkillers by injection.
  • A tube may occasionally also be passed down your nose into your stomach (nasogastric tube) to suck out the fluid from your stomach.
  • A nasogastric tube may also be passed into the stomach to feed you, as you will not be able to eat properly.
  • A 'drip' is needed to give fluid into your body until symptoms settle.
  • A catheter is likely to be inserted so the doctors can monitor accurately the amount of urine you are passing.

Other treatments that may then be needed include the following:

  • Intensive care treatment.
  • A procedure to remove a blocked gallstone if this is found to be the cause.
  • Antibiotics if the pancreas or surrounding tissue become infected.
  • Surgery is sometimes needed to remove infected or damaged tissue.
What is the outlook (prognosis) for acute pancreatitis?

If acute pancreatitis is mild, no complications develop (about 4 in 5 cases). In this case the outlook is very good and full recovery is usual. Severe acute pancreatitis (about 1 in 5 cases) means that one or more complications develop. Despite intensive care treatment, up to a quarter of people with severe acute pancreatitis die.

Will it happen again?

An attack of acute pancreatitis may be a one-off event. However, if there is an underlying cause, then it may recur unless the cause is corrected.

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