Pancreatitis (Acute)

What is Pancreatitis?

Pancreatitis is an inflammation of the pancreas. Pancreatitis occurs when digestive enzymes begin irritating the pancreas. The pancreas is located in the abdomen, behind the stomach, and in front of the spine. The head of the pancreas is wrapped by the first part of the small intestine, the duodenum. It is a flat, long gland that plays an important role in digestion. The pancreas produces fluids that are emptied into the small intestine that help the digestion of food. The duct (tube) that connects the pancreas to the small intestine also connects with a duct from the liver and gallbladder that deliver bile to the GI tract. The pancreas also produces insulin into the bloodstream. Insulin is important in allowing the body to use sugar for energy and to keep blood sugar levels from going too high or too low.

Why does it happen?

The most common causes of acute pancreatitis are alcohol abuse and gallstones

Gallstones. This is the single most common cause. Only 3-7% of patients who have gallstones develop pancreatitis. The exact reason why gallstones can lead to pancreatitis is unknown. It might be due to bile that enters the pancreas, causing irritation, blockage of the duct, obstruction of the outlet of the duct, or swelling after a stone is passed. Removing the gallbladder and removing stones from the ducts can prevent recurrence.
Alcohol. Consumption of alcohol causes about 30% of cases. The exact reason is unknown. This may be due to overstimulation of the pancreas to make digestive juices.
Other Causes:
- High levels of triglycerides in the blood
- Genetic conditions like cystic fibrosis or abnormality of the pancreas
- Medications
- Infections such as mumps
- Trauma to the abdomen
- Blood vessel disease
- Unexplained. 30% of the time no clear cause can be identified

What are the symptoms?

The seriousness of the symptoms can range from just mild discomfort to a very severe condition.

Abdominal pain
Nausea
Vomiting
Restlessness or agitation
Yellowing of the skin

How is it diagnosed?

Laboratory tests:

Pancreatic enzymes (chemicals created by the pancreas
Imaging may be obtained:
- Abdominal x-ray
- Abdominal ultrasound. This typically is performed in everyone with their first attack of pancreatitis to not only look at the pancreas but to identify if gallstones are present in the gallbladder.
- CT scan. This is the most important imaging test for acute pancreatitis to assess for complications and determine severity.
- Magnetic resonance imaging (MRI or MRCP)
- After the diagnosis of acute pancreatitis is determined, the cause should be identified. Sometimes further testing will be required or procedures will be performed such as an ERCP or sphincter of Oddi manometry. Sometimes no cause can be identified.

How is it treated?

Hospitalization is usually required. Treatment is based on how severe the disease is. Treatments work to remove the causative factors and to reduce inflammation. Recovery usually occurs within 5-7 days.

Pancreatitis is treated with drinking fluids only for several days. Supportive care is provided:

Pain control
IV fluids
Monitoring of lungs, heart, kidneys, and liver
Correction of any blood chemical level abnormalities