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Acute pancreatitis

Published by Bupa's health information team, July 2008.

This factsheet is for people with acute pancreatitis, or who would like information about it.

Acute pancreatitis is a condition where your pancreas becomes inflamed. One in five people who have acute pancreatitis have a severe attack and it can be life-threatening.

Once treated, an attack of acute pancreatitis should not damage your health long-term, but it can re-occur. If the inflammation continues it can damage the pancreas and cause chronic pancreatitis.

About acute pancreatitis
Symptoms
Causes
Diagnosis
Treatment
Prevention
Further information
Questions and answers
Related topics
Sources

About acute pancreatitis

Your pancreas is a 15 centimetre (six inches) long organ which is part of your digestive system. It's found just in front of your spine (back bone), behind your stomach, at the level where the two sides of your rib cage join together. It's connected to the duodenum (small bowel) by a duct (tube) called the pancreatic duct.

Your pancreas produces enzymes (digestive juices) which break down food, particularly fatty foods. These digestive juices pass down the pancreatic duct into the duodenum which contains food to be digested. The pancreas also produces insulin, a hormone that helps to keep the level of sugar in your blood constant.

If you have acute pancreatitis, the enzymes produced in the pancreas start to digest and damage the pancreas before reaching the duodenum. In the UK, around 10,000 people get acute pancreatitis each year.

Symptoms

There are a number of symptoms of acute pancreatitis, including:

severe pain around the upper part of your abdomen (tummy) and/or back which is worse when you lie down
feeling sick
vomiting
a high temperature
jaundice - which is when the whites of your eyes and your skin look yellowed
your abdomen (tummy) is larger than usual
the skin on your lower back or your abdomen may be blue-grey

Although not always a sign of acute pancreatitis, if you experience these symptoms, you should seek medical advice.

Complications

The sooner acute pancreatitis is treated, the less likely complications will occur. Complications can include:

damage to the pancreas
benign growths called cysts can grow in the pancreas
an abscess
a fistula - which is when a channel or hole develops in the pancreas
bleeding
blocked blood flow to the pancreas
high blood sugar levels

Causes

In eight out of 10 people with acute pancreatitis the causes are:

gallstones in the bile duct - this is the most common cause
excess alcohol

Other causes include:

certain medicines (eg azathioprine, corticosteroids)
abdominal injuries
a tumour
after an ERCP (see Diagnosis)
infection
increased calcium or lipid (fat) levels in the blood
pancreas divisum - this is when you are born with ducts in the pancreas which don't function properly
genetics - you may inherit a faulty gene from your parents, this is called hereditary pancreatitis
inflammation of the blood vessels in the pancreas or reduced blood flow to the pancreas
pregnancy
renal failure

One in 10 people who have acute pancreatitis don't have a specific cause.

Diagnosis

You may go straight to the hospital or your GP will examine you and ask you about your symptoms. He or she may take a blood test and refer you to a gastroenterologist, a doctor who specialises in conditions of the digestive system, for further tests which may include:

further blood tests which will be sent to a laboratory for testing
a faeces sample test which will be sent to a laboratory for testing
a sample of urine may be taken, this will be sent to a laboratory for testing
an abdominal ultrasound which uses high frequency sound waves to produce an image to look for any changes
a chest X-ray
a biopsy which will be taken from the pancreas with a needle - a biopsy is a small sample of tissue which will be sent to a laboratory for testing
a CT scan (computerised tomography) scan uses X-rays to build up a three-dimensional picture of the body
an ERCP (endoscopic retrograde cholangio-pancreatography) is a test where a narrow, flexible, tube-like telescopic camera called an endoscope is guided using ultrasound, to check your digestive system - this procedure can also occasionally trigger an attack of pancreatitis
an MRI (magnetic resonance imaging) scan uses magnets and radiowaves to produce two- and three-dimensional pictures of the inside of the body

Treatment

Most people will need hospital treatment. Three out of four people who have symptoms find that their symptoms will go within three to five days of treatment, but this varies between individuals. When you recover, your doctor will need to do some tests to determine the cause and try and prevent a further episode.

If you have severe acute pancreatitis you may need to stay in the intensive care unit of the hospital.

Medicines

You may be given strong morphine-like painkillers such as pethidine and tramadol for pain.

Antibiotics, such as cefuroxine, may be given to reduce infection. They are usually taken for up to 14 days. Antibiotics have not been shown to help prevent damage to the pancreas (pancreatic necrosis).

Always ask your doctor or nurse for advice before taking your medicine.

Non-surgical treatments

You will be given an intravenous drip to stop you becoming dehydrated.

To stop the pancreas producing digestive juices which are damaging the pancreas, you will be asked not to eat. A tube may then be passed through your nose to the small bowel, so you get the nutrients you need. Alternatively you may receive nutrients via a drip in your arm (intravenous feeding).

Any food that is not emptying from your stomach may also be drained out through a tube in your nose (nasogastric tube).

Surgery

Most people don't need surgery, but you may need to if you have either of the following.

Pancreatic necrosis - this is when a large part (more than 30 percent) of your pancreas is damaged. These areas will need to be removed. This can be done either by a surgical operation or by inserting tubes through the skin.
Acute pancreatitis caused by gallstones - gallstones are solid lumps or stones that form in the gallbladder or bile duct. You may need to have gallstones or your gallbladder removed during your treatment for acute pancreatitis. This will involve either a surgical operation (open or keyhole) or an ERCP.

Prevention

Acute pancreatitis can be prevented by avoiding the causes. After having acute pancreatitis you should prevent another attack by eating a low-fat diet, avoiding alcohol and certain medicines. By avoiding the causes you will reduce your risk of acute pancreatitis re-occurring and the risk of developing chronic pancreatitis.

Further information

The Pancreatitis Supporters' Network
www.pancreatitis.org.uk
CORE charity
www.digestivedisorders.org.uk