Acute pancreatitis

Definition
Acute pancreatitis is an inflammation (irritation and swelling) of the pancreas. The pancreas is an elongated, tapered gland, located behind the stomach, that secretes digestive enzymes and the hormones insulin and glucagon.

Causes, incidence, and risk factors

The chief causes of acute pancreatitis in adults are gallstones, other gallbladder (biliary) disease, and alcohol use. Viral infection (Mumps, coxsackie B, mycoplasma pneumonia, and campylobacter), traumatic injury, pancreatic or common bile duct surgical procedures and certain medications (especially estrogens, corticosteroids, thiazide diuretics, and azathioprine) are other causes. Acute pancreatitis may also be caused by abnormal anatomy of the pancreas (pancreas divisum), genetic factors (hereditary pancreatitis), high lipid levels in the blood (hypertriglyceridemia), and complications of Cystic fibrosis.

The mechanism that causes pancreatitis is not well known. It is thought that enzymes normally secreted by the pancreas in an inactive form become activated inside the pancreas and start to digest the pancreatic tissue. This process is called autodigestion and causes swelling, hemorrhage, and damage to the blood vessels.

The disease affects men more often than women. Alcohol Abuse is an important risk factor.

In children, this disorder may be associated with:

     
  • Abdominal trauma  
  • Cystic fibrosis  
  • Hemolytic uremic syndrome  
  • Kawasaki disease  
  • Mumps  
  • Reye syndrome  
  • Various viral illnesses  
  • Some medications

Symptoms

     
  • Abdominal pain that is greatest in the upper abdomen (upper left quadrant or upper middle of the abdomen)       o Is persistent or chronic       o May be worse lying flat on the back       o May radiate to the back or below the left shoulder blade       o May be worse after eating or drinking (occurs within minutes following meals), especially foods with a high fat content       o May be worse after drinking alcohol  
  • nausea and Vomiting  
  • Sweating  
  • Anxiety  
  • Fever  
  • Mild jaundice

Additional symptoms that may be associated with this disease:

     
  • Swollen abdomen  
  • Gaseous abdominal fullness  
  • Abdominal Indigestion  
  • Hiccups  
  • Skin rash or lesion  
  • Clay-colored stools

Signs and tests

General examination may show fever, Low Blood pressure, rapid heart rate or rapid respiratory rate.

Tests that show release of pancreatic enzymes:

     
  • Elevated serum amylase  
  • Elevated urine amylase  
  • Elevated serum lipase

Test that show inflammation of the pancreas:

In other blood tests results:

     
  • CBC shows an elevated WBC count.  
  • A glucose test may show elevated levels.  
  • Serum calcium may be decreased.

Treatment

Treatment is aimed at supportive measures such as fluid replacement by intravenous (IV) infusion, pain relief, and withholding food or fluid by mouth to restrict pancreatic activity that makes symptoms worse. Occasionally nasogastric suctioning may be required if there is persistent Vomiting or severe pain or if a paralytic ileus develops.

Recurrent attacks may be prevented by treating the underlying condition.

In some cases, radiologic or endoscopic therapy is needed to remove gallstones, relieve obstructions or the pancreatic duct, or drain fluid collections in or around the pancreas. In the most severe cases, surgery is necessary to remove necrotic, infected pancreatic tissue.

Expectations (prognosis)

While most cases resolve in a week, some cases develop into life-threatening illness. The death rate is high with hemorrhagic pancreatitis or necrotizing pancreatitis and complications such as liver, heart, or kidney impairment may occur. Recurrences are common.

Complications

Calling your health care provider

Call your provider if intense, constant Abdominal pain is present, or if other symptoms suggestive of acute pancreatitis develop.

Prevention

Prevention of acute pancreatitis is associated with prevention of the causative disorders.

     
  • Do not abuse alcohol.  
  • Use proper safety precautions to avoid abdominal trauma.  
  • Genetic counseling may be advised for prospective parents with a family or personal history of Cystic fibrosis.  
  • To reduce the risk of Reye syndrome, avoid aspirin for treatment of fever in children, especially if they may have a viral illness.  
  • Immunize children against Mumps and other childhood illnesses (see Immunizations - general overview).

If you develop acute pancreatitis as a result of alcohol use, you should avoid all alcohol indefinitely. If you develop acute pancreatitis as a result of a medication, avoid the medication entirely.

Johns Hopkins patient information

Last revised: December 2, 2012
by Arthur A. Poghosian, M.D.

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